The director for adults and wellbeing introduced the better care fund plan which was in the second year of iteration. National deadlines for submissions to NHS England were not aligned with health and wellbeing board meetings and it was noted that the next submission date was originally 25 April but subsequently changed to 3 May. The submission presented was for the previous interim submission period in order to give sense of position, and therefore delegated authority was requested for approval of the final plan.

It was noted the director for adults and wellbeing wished to declare a conflicting interest as the regional chair for the BCF process. 

He explained that there were some challenges raised by the process; however, assurance was given that timescales were observed and there was a robust plan to meet national requirements for the deadline on 3 May.

The joint commissioning better care fund manager added that no BCF plans in the region had been approved, including Herefordshire, as they were not regarded as sufficiently robust. However, it was noted that there was confidence that the plan would be approved this time, although there were challenges within the health economy around risk sharing. The work was being supported by KPMG who continued to provide support to address this. 

An action plan was also being developed to address issues regarding delayed transfers of care.

The chief executive, Herefordshire Council, noted the importance of a sound process for working effectively in the wider system. The BCF reflected a robust relationship with the clinical commissioning group; however, there were fundamental challenges across the care system in the county that needed addressing.  The health and wellbeing board was key in driving this work and avoiding a process-driven approach.

In agreement, the chair of Healthwatch Herefordshire noted that the focus needed to be on local issues and ensuring the sign-off is straightforward. Noting that there was work yet to be done, he proposed that authority be delegated to approve the plan in order to enable the focus on delivery.

The director for adults and wellbeing reminded the board that the assurance process would be determined at a regional level rather than nationally. However, it was noted that a detailed list of key lines of enquiry had been provided which did not appear to demonstrate a change in approach.

Discussion took place with regard to the value of writing to NHS England to highlight local progress with the BCF plan whilst noting concerns regarding the process.

The chair, Healthwatch Herefordshire, noted the importance of evidencing public engagement and the role of Healthwatch Herefordshire in that regard.

The joint commissioning better care fund manager provided an overview of the financial picture, highlighting that there was an increase in the contribution to adult social care and implementation of the care act.  There was an inflationary uplift plus an increase to the community health and social care budget to £11.5 million. There was also a contribution from the Wye Valley NHS Trust community contract.  The remainder of the fund was made up of the disabled facilities grant, and with the largest spend being on the care home market.

The director of operations, NHS Herefordshire CCG, noted there were minimal changes from last year and that although the final details for the service model were being developed, the plan was developed to a level that would reflect any changes to show improvements in services for people moving to more appropriate care.  

She added that in relation to risk sharing, it was important to regard the BCF as an enabler and attention was given to ensuring it did not present a burden. 

It was proposed that the recommendations be revised to reflect delegated authority for approval of the final submission, and this was supported by board members.

RESOLVED

That the health and wellbeing board:

(a)          consider the draft Better Care Fund (BCF) plan submission for 2016/17, especially the progress on the national conditions and the proposed pooled budget, and make comments; and

(b)          agree that approval of the final submission, due on 3 May, be delegated to the chair of the health and wellbeing board, as advised by  director for adults and wellbeing,  Herefordshire Council, and chief officer, Herefordshire CCG.