To approve the proposed content of the better care and integration plan 2017-19 for Herefordshire and to note the assurance and final sign off arrangements for national submission.

The director for adults and wellbeing introduced this item and reminded board members that the better care fund (BCF) plan was a developing situation.

The better care fund manager talked through the proposed plan as set out in the appendices and highlighted that the guidance for production of the plan for the two years 2017/18 and 2018/19 had not been received until July so it had been difficult to get papers prepared within timescale. During the presentation the following key points were made:

·           In terms of background context of the BCF, it was explained that the system was utilising existing money as single pooled budget with no additional funding available, and over the last two years closer working had led to the development of a unified contract with the care home market.

·           The plan was for the two years 2017/18 and 2018/19 and how to achieve integration between health and social care by 2020 whilst maintaining protection of adult social care (PASC).  It was not intended to include a risk sharing agreement at this time.

·           There were national requirements for approving the BCF plan within a timeline: Following submission to NHS England on 11 September, the proposed plan would undergo regional moderation. Those plans which were identified through moderation as requiring modification would be required to be resubmitted by 31 October. As a precaution, an additional meeting of the board could be scheduled in case it were necessary to reconsider the plan. A review of performance of metrics would be included in the November meeting.

·           The BCF plan was aligned to One Herefordshire and set out how it would be supported. There was a shared strategic vision between the Clinical Commissioning Group and the Council and a constructive relationship supported a shared direction and understanding of successful outcomes for the population of Herefordshire.

·           The four national conditions were: jointly agreed plans; maintenance of social care; investment on NHS commissioned out of hospital services; and management of transfers of care. Locally, this included key lines of enquiry reflected in the plan, such as how to utilise the disabled facilities grant (DFG), how the inflationary uplift would be used for transformational change, and agreed investment in hospital services with contribution from Wye Valley NHS Trust.  For managing transfers of care, there was a detailed plan involving providers, with a focus on some innovative projects.

·           National metrics included: reduction in non-elective admissions to hospital; reduction in permanent placements into residential and nursing homes; increasing access to reablement services; reducing delayed transfers of care.

·           Looking at these metrics in more detail, diagnostics were being carried out to better understand a recent unseasonal spike in non-elective admissions and ensuring people accessed the right care in the right place.  For reducing placements, from a number of schemes and initiatives, the focus was on the third recommendation, which was based on average admission rates over the past 3 years and accounting for local demographics, as a more reliable metric. To support reablement, a new model, known  ...  view the full minutes text for item 142