Better Care Fund – Follow Up
Source: data.gov.uk (2018-10-29)

CYC Internal Audit Reports 2017. These reports are presented to the Audit and Governance Committee for consideration, and are also included with the agenda papers for the [relevant meetings](http://democracy.york.gov.uk/ieListMeetings.aspx?CommitteeId=437). 

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Follow up of agreed actions from the 
previous Better Care Fund (BCF) audit 
 
City of York Council 
 
 
 
 
 
2016/17 
 
Memorandum 
 
 
 
 
 
 
 
 
 
 
 
 
Responsible Officer: Director of Adult Social Care 
Status: Final 
Date Issued: 24/3/2017 
 

 
 
1 
INTRODUCTION 
1.1 
The Better Care Fund (BCF) was established in 2013 with the aim of 
integrating health and social care to improve outcomes for patients and use 
resources more efficiently. It requires Clinical Commissioning Groups (CCG) 
and local authorities to pool budgets and agree spending plans for how they 
will use their BCF allocation. The BCF budget shared between City of York 
Council and Vale of York CCG is around £12.2m for 2016/17. There is an 
additional risk-share of around £1.2m that is split equally between the Council 
and the CCG. 
  
1.2 
The previous audit in 2015/16 reviewed reporting and performance monitoring   
arrangements, as well as risk management. Four actions were raised as a 
result of the audit and these have been followed up as part of this audit. 
 
1.3 
More recently, Mazars have carried out a review into the BCF and made 
several recommendations regarding performance reporting, governance and 
oversight arrangements at strategic and implementation levels, as well as the 
need to liaise with NHS England’s (NHSE) Better Care Support Team and 
Managers. These findings were reported to the Audit and Governance 
Committee in December 2016 and are broadly in line with the findings of the 
2015/16 Veritau audit.  
 
  
Scope and Objectives 
1.4 
The primary objective of this audit was to establish the progress made 
towards resolving the four actions agreed with management as part of the 
2015/16 audit. 
 
1.5 
The secondary objective of this audit was to agree further actions where 
necessary to address outstanding issues. 
 
 
Key Findings 
 
1.6 
It was found that good progress had been made towards achieving the 
actions agreed as part of the previous audit.  These actions can now be 
considered complete. However, there remains progress to be made in some 
areas and a detailed discussion of the findings is set out below.     
 
1.7 
The Council feels that financial pressures and legal directions imposed on the 
CCG have led to the BCF receiving less attention than required from the 
CCG. The challenges facing the CCG have been noted in the Integration and 
Transformation Board (ITB) report presented to the Health and Wellbeing 
Board (HWB) on the 18th January 2017 and have also been recorded in the 
minutes of the ITB.1 The CCG has acknowledged that its contribution was not 
                                            
1 For example, the November 2016 meeting states: ‘Through discussion it was noted that resources 
were stretched in the CCG which w[as] affecting the amount of time devoted to BCF.’  
 

 
 
as effective as it should have been in 2016, but made a public commitment at 
the 18th January HWB meeting to rectify this.2    
 
2 
FINDINGS 
 
Area Reviewed: Reporting lines and monitoring arrangements 
2.1 
The 2015/16 audit found that the overall responsibilities and reporting lines for 
delivery of the BCF programme were under review, but had not been formally 
agreed at the time of the audit. 
 
2.2 
Formal reporting lines and monitoring arrangements have been set out in the 
narrative submission to NHSE and in the Section 75 agreement. 
Responsibility for BCF lies with the HWB, which provides strategic oversight 
and ensures compliance. It is supported in this by the inter-agency ITB, which 
reports to HWB on a quarterly basis. The ITB is in turn supported by the 
Performance and Delivery Group (PDG), which is made up of representatives 
from the Council, CCG, and other bodies.  
 
2.3 
Schedule 2 of the Section 75 agreement sets out the role and governance 
arrangements of the ITB. It is responsible for reviewing and performance 
managing various areas related to the scheme, such as approving individual 
schemes and financial management. The delegated authority of the members 
of the ITB is set out in the Schedule. The ITB initially had an independent 
chair, but it was agreed at the September 2016 meeting that the chair should 
be shared between the partners.  
 
2.4 
There are also Terms of Reference (TOR) for the ITB that were agreed in May 
2016. It was agreed at the December ITB meeting that these need reviewing 
as its role and geographical remit is changing. Some discussion was had at 
the January 2017 ITB workshop and the Director of Adult Social Care has 
agreed to review them. 
 
2.5 
Schedule 4 of the Section 75 agreement sets out the role of the PDG. It states 
that the PDG has been established to support the delivery of the BCF plan 
and report on operational issues and key performance metrics to the ITB on 
an ‘exception’ basis. The inaugural meeting of the PDG in August 2016 set 
out the values and purpose of the group and these have now been turned into 
formal TOR.  
 
2.6 
Discussion with officers found that the chair of the PDG is shared between the 
Council and the CCG. The Senior Strategic Commissioning Lead for the 
Council and the BCF Programme Manager, who chair the PDG, provide 
updates to the ITB on the performance of BCF.3 The responsible officers for 
each programme are accountable to the BCF Programme Manager for the 
                                            
2 See Agenda Item 9, 01:49:04 – 02:14:22, Health and Wellbeing Board, 18th January 2017, 
https://www.youtube.com/user/cityofyorkcouncil. 
3 The BCF Programme Manager is provided by the CCG and the CCG has overall responsibility for 
programme management. 

 
 
performance of each scheme. Currently, the PDG is asking one responsible 
officer to report at each PDG meeting on the performance of their scheme. 
These reporting arrangements have evolved since the BCF plan was 
submitted to NHSE and since the Section 75 agreement was finalised. These 
documents require amending in future versions to reflect these developments.  
 
2.7 
The responsibilities and reporting lines for the delivery of the BCF programme 
have evolved considerably since the previous audit, with more formal 
monitoring and reporting arrangements now in place. Nevertheless, there is 
still progress to be made in clarifying the reporting lines between the individual 
schemes, the PDG and the ITB.  
 
 
Area Reviewed: Agreement on Council-specific risks, including risk 
owners and action plans 
2.8 
The 2015/16 audit found that there was no overall risk register within the 
Council for BCF. 
 
2.9 
There is a risk register for Health, Housing and Adult Social Care that deals 
with nine risks to the directorate, some of which are related to BCF. These 
have all been given risk ratings and risk owners, as well as action plans and 
due dates.  
 
2.10 Furthermore, the Section 75 agreement sets out financial risk-share principles. 
Minutes of the PDG and ITB meetings show that financial risks and risks to 
meeting the national metrics are being discussed.  The financial risks to the 
Council were reported at the January meeting of HWB and Members raised 
concerns about the impact on the Council’s budget.  
 
2.11 A risk log has been included in the narrative submission to NHSE, based on 
risks identified by the Council and CCG.  Elements of the action plans have 
been carried out, such as agreeing a Joint Commissioning Strategy, but 
actions to address the key risks need to be recorded systematically to provide 
the necessary level of assurance. 
 
Area Reviewed: Section 75 agreement 
2.12 The 2015/16 audit found that the Section 75 agreement had not been agreed 
at the time of the audit.  
 
2.13 The latest Section 75 agreement is now in place between the Council and the 
CCG. The agreement was finalised on 12th October 2016 and signed by 
representatives of both parties. The agreement sets out pooled funding 
arrangements and the responsibilities of each Partner regarding over- or 
under-spends. Schedule 3 sets out the financial risk-share principles for BCF. 
 
2.14 As the Section 75 agreement is now in place, the action can be considered 
complete.  
 

 
 
Area Reviewed: Agreement on and monitoring of timescales and actions 
for specific elements of the BCF plan 
2.15 The 2015/16 audit found that targets for the implementation of elements of the 
BCF plan had been missed. Most of these schemes were rolled over into the 
2016/17 plan due to time constraints that prevented new schemes being 
developed. 
 
2.16 All of the BCF schemes should be laid out in ‘plans on a page’ documents. 
These summarise the purpose, intended outcomes, metrics, finances, 
benefits and risks to each individual scheme. The intention was for the 
Council and CCG to share their respective plans at the November 2016 
meeting of the PDG. However, the CCG’s plans were not presented and were 
still not available at the time of this audit.  
 
2.17 The PDG has developed a local performance dashboard, which shows 
performance against national and local metrics on a monthly and quarterly 
basis. Discussion with officers found that the initial intention was for this 
dashboard to show the RAG rating of individual schemes and which required 
an exception report to ITB. This is no longer the case because it was found 
that this format did not focus on the highest risks, nor did it demonstrate 
whether the national targets were being met. There is now a focus on collating 
all the data from partners for analysis and challenge, as well as receiving an 
in-depth report on a single scheme each month. 
 
2.18 Minutes for the PDG and ITB meetings show that the plans are being 
monitored and discussed. Responsible officers are also providing updates at 
the PDG meetings. Furthermore, performance is being reported in the 
quarterly report to HWB by the ITB and back to NHSE in the quarterly 
submission by the PDG. However, discussion with officers found that NHSE 
has not commented on the submissions even when performance against 
national metrics was off-track and deteriorating. 
 
2.19 The most recent report by the ITB to the HWB stated that it was unlikely that 
the BCF schemes would meet their targets for 2016/17, which reflects the 
performance of BCF schemes nationally, and that guidance for preparing a 
BCF plan for 2017/18 had been delayed. Nevertheless, progress has been 
made since the previous audit in agreeing and monitoring timescales and 
actions for elements of the BCF plan. 
 
 
 
 
 
 
 
 
 
 
 

 
 
3 
CONCLUSION 
 
3.1 
The Section 75 agreement has been signed off and reporting and 
performance 
monitoring 
arrangements 
have 
developed 
considerably. 
Nevertheless, changes to the responsibilities and reporting arrangements 
between the responsible officers for individual schemes, the PDG and ITB 
need to be reflected in the Section 75 agreement as arrangements evolve. 
 
3.2 
Performance and risk monitoring has improved since the previous audit. The 
PDG has developed a dashboard that sets out performance against national 
and local metrics and is working on compiling data and agreeing a reporting 
format for the individual schemes.  
 
3.3 
Risks are now documented on several levels: to the individual schemes; to 
the BCF plan as a whole; to the financing of BCF; and to the national metrics 
set by NHSE. Nevertheless, although Council-specific risks have been 
incorporated into the BCF plan and are reported on an exception basis, 
evidence of systematic reviews of the risks should be documented in the 
records of PDG and ITB meetings. 
 
3.4 
Although governance arrangements have evolved significantly since the 
previous audit, there is still progress to be made to ensure that the BCF plan 
has robust governance, performance and risk monitoring arrangements.