Agenda item - Better Care Fund Plan Update

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

            Introduction

6.1       The Board considered a report of the Executive Director, Adult Services and the Chief Operating Officer, CCG which provided an update on progress of the Brighton and Hove Better Care Plan, the two locations for Phase One of the Better Care Plan and the implementation of an integrated model of care for Brighton and Hove’s homeless population.     The report was presented by Denise D’Souza, Executive Director Adult Services and by Geraldine Hoban, Chief Operating Officer, CCG. 

6.2       Denise D’Souza reported that the Better Care Plan was previously approved by the Board on 14 February.  The final revised version had been resubmitted to NHS England on 4 April and was now before members.  More detail had been provided in the report as set out in paragraph 3.4.  Phase 1 of the frailty model of care was set out in paragraph 3.7.  Two GP surgeries had been identified to be involved in Phase 1 frailty.   Workshops were being set up for all providers working in the areas indentified.  Further information would be provided to NHS England on the Better Care Plan by July 2014.    

6.3       Geraldine Hoban reported that a key aspect of Better Care provision was identifying vulnerable people in the city with the view to providing more co-ordinated, integrated care.  The third sector could play a key role in helping vulnerable people in the city.  There was much potential for attracting national funding for pilots.  

            Questions and Discussion

6.4       Dr Xavier Nalletamby stated that from a GP’s perspective he considered the Better Care Fund Plan to be a very important and challenging piece of work.  GPs were looking at innovative and creative ways of working with others.  For example, GPs were talking with pharmacies to see if they could prescribe for some conditions.  There had been many bids for the frailty pilots.  There was a feeling that a new way of working was required to help people and that the current ways of working were not sustainable. 

6.5       Dr Nalletamby stressed that there was no growth in NHS funding, and no growth was effectively a cut.  The workforce had not increased yet costs were higher.  The workload for GPs (patient contact) had risen by 25% in five years (5% a year).  Expectations had risen and more could be done for people; however, there was not always the capacity to do things in the old ways of working.   

6.6       Frances McCabe considered that the Better Care Plan was a really good initiative with service users at the centre of the proposals.  Ms McCabe questioned how the frailty model as set out in paragraph 3.6 would fit in with the proposals.  Ms McCabe referred to paragraph 5.3 of the report relating to community engagement & consultation and stated that she hoped Healthwatch could be involved in the process. 

6.7       Dr Jonny Coxon referred to the Challenge Fund, set up to improve GP access.  He stated that the different funds took up much GP time.  The Challenge Fund was directed at some of the same patients as the Better Care Fund. 

6.8       Frances McCabe stressed that it was important for patients and the pubic that the funding streams were properly co-ordinated or there would be a danger of having aspects of funding that were not accountable. 

6.9       Tom Scanlon welcomed the report and felt that focusing on vulnerable people was excellent.  He asked for more information about homelessness. 

6.10    Geraldine Hoban explained that the homeless strand commenced with the first pioneer site for homelessness work.  The intention was to have joined up integrated care and have a primary care led model.   Ms Hoban informed members that there was already a primary care led model of care being developed at Morley Street Surgery, Brighton.  The integrated teams would deal with substance misuse, assist discharge from hospital, and have alcohol and drug services.   Progress on this work would be reported to the Better Care Board and to the Health and Wellbeing Board.

6.11    The Chief Executive referred to pop up hubs which connected members of the street community with workers from mental health services, substance misuse services, housing officers as well as neighbourhood policing teams.  She suggested that pop up hubs should become part of the arrangements.

6.12    Dr Christa Beesley concurred.  She reported that Eastbourne had pop up hub services, and they could be useful in the City.  Dr Beesley suggested that the pop up hubs should be combined with street triage services.

6.13    The Chair asked if there would be intensity frailty work in the same way that the fire service worked with such vulnerable frail groups.  Geraldine Hoban replied that officers were looking at health data relating to intensity frailty.  For example, all persons aged 70 plus receive health check ups.  An Information Technology Group was looking at sharing records. 

6.14    Tom Scanlon informed the Board that that Public Health had lists of vulnerable people, as did the fire service.  

6.15    Dr Christa Beesley remarked that the definition of frailty in Brighton and Hove was social vulnerability.  The homeless needed to be included in this group.

6.16    RESOLVED – (1) That the final Better Care Fund Plan for Brighton and Hove and the amendments made following the original submission be noted.

(2)       That the progress made with Phase One and with the Homeless Programme be noted.