Apologies were received from Cllr JG Lester, Diane Jones, MBE (NHS Herefordshire CCG), Simon Hairsnape (NHS Herefordshire CCG)and Jo-Anne Alner (NHS England). 

It was noted that Jo Melling would be attending in future as the NHS England representative. 

To receive any details of members nominated to attend the meeting in place of a member of the committee.

There were no substitutions.

To receive any declarations of interests of interest by members in respect of items on the agenda.

None.

To approve and sign the minutes of the meeting held on 19 July 2016.

RESOLVED

That the minutes of the meeting held on 19 July 2016 be approved and signed by the chairman as a correct record.

To receive questions from members of the public relating to matters within the board’s terms of reference.

(Questions must be submitted by midday three clear working days before the day of the meeting)

None.

To approve the better care fund quarter one return.

The better care fund joint commissioning manager presented a report on the performance of the better care fund against the plan for the first quarter of 2016/17.  The return for quarter one had already been approved under delegated authority by the director for adults and wellbeing, in consultation with the CCG accountable officer, in order to meet the timescale for submission to NHS England.    

The following key points were highlighted:

• non-elective admissions were on track. Rapid access to discharge was redesigned on block contract arrangements through the CCG. There were some ongoing issues in relation to delayed transfers of care (DToC) with no indication of immediate improvement and an uplift of £55k had been made available to support improvements in performance
• performance in relation to the number of placements in residential care homes remained the same and the target was reduced from last year in line with regional trends
• a unified contract for residential nursing had been developed and over 100 care homes had submitted bids following extensive engagement and consultation. The benefit to providers is that the council pays the gross amount for care so providers are not affected financially if an individual does not pay their top-up contribution, which would be collected by the council.  It was not considered that the risk and cost to the council of this arrangement was significant.  For individuals, the impact was that the potential was removed for providers to act unethically in attempting to increase fees charged to service users, although it was noted that this had not been a particular issue locally.  Providers were now being assessed using the quality assessment framework. 
• the section 75 agreements that supported the BCF legal framework had been combined to make a single agreement across children’s and adults’ services with effect from 1 October 2016, as agreed by Cabinet.
• in terms of financial implications, there was a 40% increase in the unit price paid for NHS funded nursing care, putting pressure on the budget for the CCG. This was as a result of national policy change and not a local issue.
• it had been possible to cap the risk share for each BCF partner by reducing the client cohort. The risk is set at 13% of the contribution to that cohort for each partner and reviews of clients were picking up. The situation was to be monitored on a monthly basis.

The chair observed that although performance had not reduced, there were no significant improvements and asked how this could be addressed, and what the health and wellbeing board could do to help.

The director for adults and wellbeing explained that the BCF formed only 10% of the directorate’s budget, and much less of the CCG budget, which was not of sufficient scale to change behaviour.   He suggested that one solution might be to count the protection of adult social care element of the BCF budget in with business rates, such that it was received direct by the council rather than as a transfer from  ...  view the full minutes text for item 86.

To review progress in delivering the third priority of the health and wellbeing strategy, covering older people, to include progress plans and challenges.

The director for adults and wellbeing introduced the update by explaining that there was a change in approach from one that was centred on how conditions were defined to one based on what a person’s needs were. To achieve this, teams were less focused on being condition or cohort specific and were instead more based on geography.  There was therefore no single strategy for older people as they were not a specific cohort.

The BCF joint commissioning manager highlighted the key areas of work and the drivers to the approach in terms of delivery of services to enable people to support themselves: 

• A key work area was the help to live at home project as a redesign of home care services which was to be presented to Cabinet for approval in October and if agreed, would mean dedicated providers for those needing more intensive support
• The approach would seek to address some operational challenges faced by providers by focusing on viable geographic areas
• The council would choose the providers for each area so that the service users would know who their providers were and how care would be provided
• The Golden Valley area would have a slightly different approach, making use of its community hub and using one provider for each pathway rather than a number of providers

A Healthwatch representative commented on the costs and the governance issues associated with volunteering despite the sector not attracting funding.   He asked what could be done to reduce the burden for volunteers in order for them to make a bigger contribution to the community.  In the discussion that followed, it was noted that there were misconceptions by some professionals of the reliability of services provided by volunteers, when in reality many volunteers were very committed to their role. However, volunteer input could be better directed, perhaps through Herefordshire Voluntary Organisations Support Service (HVOSS), to where the need was. There was no formal way for volunteers to find out what was needed in their communities or for it to be easier for them to support their neighbourhood without unnecessary bureaucracy.

On the matter of housing, it was noted that accessibility and schemes for extra care were being considered through the possibility of providing housing stock with room to accommodate a carer, and pursuing social housing provision within planning applications.  Commissioners were looking at this via analysis of need in order to inform planning decisions.  There was no funding to provide housing and it was important to work with registered social landlords about what was required as well as consider fuel poverty issues.

The director for children’s wellbeing noted some good progress on outcomes against the strategy, noting that direction was clearer.

A number of areas were identified by board members that would support better outcomes against this priority area:

• public health services such as active here and diabetes prevention and the contribution of GPs to wider prevention issues and supporting people in the right way
• a whole systems approach to discharge to avoid  ...  view the full minutes text for item 87.