Agenda item - Better Care Fund Plan

Report of the Executive Director of Adult Services, BHCC & Chief Operating Officer, CCG  (copy attached).

43.1    The Board considered a report of the Executive Director, Adult Services and the Chief Operating Officer, CCG which provided details of the Brighton and Hove Better Care Fund Plan.  It is a national requirement of the Better Care Fund that plans are approved by the relevant Health and Wellbeing Board.  

43.2    The report was presented by Denise D’Souza, Executive Director Adult Services and by Geraldine Hoban, Chief Operating Officer, CCG, who also provided members with a PowerPoint presentation.  The presentation set out the background to the Better Care Fund and gave details of national conditions, funding and performance measures.  The presentation stressed the changing needs of the city and explained the focus on frailty. The presentation explained the vision for better care in Brighton and Hove and set out principles, the approach and the plan for implementing the changes. 

43.3    Denise D’Souza explained that in the course of the last few weeks conversations had taken place across the City to ensure that the submission had been agreed by partners.  Geraldine Hoban explained the vision for better care and stressed that this involved using money in a more creative way.  The driver was more pro-active, integrated care, looking at the whole person.

43.4    Councillor Bowden referred to the ‘Better Information Means Better Care’ leaflets that had been distributed to households by the NHS, concerning data sharing.  He had been told by senior officers in the Health and Social Care Information Centre that commissioners were already receiving some data.  Councillor Bowden asked if this information was correct, and if so, whether the data informed the Better Care Fund Plan?

43.5    Geraldine Hoban replied that there was no shortage of data.  The problem was that the data was not sharable.  There was a need to create a platform whereby data could be shared with the patient’s permission. 

43.6    Councillor Bowden referred to the emis system used by GPs practices. Emis was not able to share information with other systems.

43.7    Councillor Norman stated that the Better Care Fund Plan was the most in depth plan he had seen since he had been a councillor.  He looked forward to seeing the plan endorsed.  Councillor Norman referred to the principle ‘access to professional support will be available 24/7’.  He stressed that this would be a hard task to get right but it was a great ambition which he supported.  He thanked Denise D’Souza and Geraldine Hoban for their presentation.

43.8    Councillor Norman asked which part of the City would be used to test out the integrated model. 

43.9    Denise D’Souza explained that the pilot area was yet to be determined.   Housing accommodation would be a key issue and an area of the City was required where these types of issues could be tested.  Geraldine Hoban explained that conversations were taking place with GP practices as to where they wanted pilots to be carried out.

43.10  Jane Viner welcomed the proposed Care Co-ordinator approach.  She considered that it would be good if care plans could be owned by individuals.  Plans needed to anticipate the future needs of the person.

43.11  Councillor Meadows noted that it was a fairly ambitious plan.  She felt that the approach was what was already happening in adult social care i.e. extra care housing.  That scheme had a co-ordinator.  Councillor Meadows asked what would happen if the 10.1m savings were not achieved.  Councillor Meadows referred to the report which had recently been submitted to the Policy and Resources Committee which had looked at the future of BHCC provided Adult Social Care services and had suggested putting in place an arms length management company. She asked how this would affect the Better Care Fund Plan.

43.12  Denise D’Souza explained that with regard to Extra Care Housing, there were people on site who co-ordinated the social care aspect but not the whole care element.  The Better Care Plan proposal was a wider approach.  In terms of Adult Social Care provider services, Ms D’Souza explained that there was a piece of work ongoing looking at options for the minority of council-commissioned social care services still provided by the council.  However this was not completed yet.  A range of services had been integrated with health already.  The Care Bill would impact on decisions taken in the future.  Officers were looking at all services to see how they fitted into the integrated approach.

43.13  The Chair stated that there was a requirement for greater integration with health services regardless of who delivered services.   Denise D’Souza stressed that she wanted to see homecare providers and residential homes engaged in this process.

43.14  Councillor Meadows asked if there was a Plan B. 

43.15  Sarah Creamer stated that the plan needed to be submitted to NHS England by 14 February.  NHS England would need to decide if it had confidence in the plans and would consider the delivery of key performance indicators.  There would be no new money in the system. There would be a need to invest in an innovative way. 

43.16  Geraldine Hoban referred to the question of Plan B.  She explained that there was some flexibility to mitigate not delivering all services.  There would be 2 to 3 years to deal with these issues.  It was known that there were inefficiencies in the service.  There were a significant number of people who did not need to be admitted to hospital and there were efficiencies to be made in the system.    

43.17  Councillor Shanks considered that the Better Care Fund Plan was the way forward.  Councillor Shanks noted that frailty had been chosen as a focus for better care.  She approved of holistic approaches and hoped the Board could build on this model.

43.18  Denise D’Souza stressed the need to look at more integrated models.  This model had been based on the ‘Troubled Families’ work carried out in children’s services. 

43.19  Geraldine Hoban made the point that taking money out of the acute sector did not mean making hospitals do more for less.  It was about caring for people in a better way so that they did not need to spend such a long time in hospital – thereby reducing the demand on hospital services, and enabling some economies to be made.  Commissioners were working closely with the hospital trust to ensure that there was a joined-up approach.   

43.20  Councillor Bowden commented that this approach used to be called Care in the Community, which aimed to get people looked after in their home settings.  The Chair replied that the current plans would apply to larger areas. 

43.21  The Chair stated that the Chairs of the hospital trusts had held discussions on this matter.  There had been some anxiety but recognition that there was a need to work together.  Amanda Fadero, Chief Executive of NHS Sussex felt that the plan was good from her perspective.

43.22  Sarah Creamer stated that she was very impressed with the work to date.  She was confident about the direction of travel.

43.23  RESOLVED – (1) That the first cut of the Better Care Fund planning Template as set out in Appendix 1 and 2 of this report, be approved.

(2)       That the Executive Director Adult Services & Chief Operating Officer CCG be instructed to submit Appendix 1 and 2 to NHS England by 14^th February in accordance with the Better Care Fund requirements.

(3)       That the Board delegates to the Executive Director Adult Services & Chief Operating Officer CCG, following consultation with the Better Care Programme Board andChair of the Health & Wellbeing Board, authority to make such amendments to the draft proposals for the administration of the Better Care Fund as they consider appropriate and to agree the final version to be submitted by 4^th April 2014.

(4)       That a report with a copy of the final submission be brought back to the next meeting of the Health & Wellbeing Board meeting on 11 June 2014.