The director for adults and wellbeing presented the quarter 4 submission of performance against the better care fund (BCF) plan. The national submission date had been determined by NHS England close to the deadline which meant that it had not been possible for the submission to be approved by the health and wellbeing board. Therefore the submission had been approved by the director for adults and wellbeing and the accountable officer of NHS Herefordshire Clinical Commissioning Group (the CCG) through delegated authority.

The principal theme from this submission was that performance was broadly satisfactory although demographics continued to be a pressure. For example, in residential care and non-elective admissions, the cohorts were growing at a faster rate with an impact on delayed transfers of care (DToC).

In terms of the BCF plan for the year 2017/18, commencing 1 April 2017, the guidance had been received two weeks ago. The guidance had changed from the draft previously circulated and now included a new timetable and targets. These were being considered by the joint commissioning board in order to address use of the improved BCF (iBCF) funding and management of the income streams. 

It was noted that there were some tensions nationally around the suggested targets for DToC and these were being attended to at a local level.   It was a requirement to submit the DToC target by Friday, 21 July, which would require formal approval from the health and wellbeing board chair or vice-chair. The council was also required to submit a return on the iBCF to the Department for Communities and Local Government (DCLG), signed off by the director for adults and wellbeing under delegated authority.  

The BCF plan, with core BCF and iBCF plans, were required to be submitted to NHS England by 11 September following formal approval by the health and wellbeing board on 7 September. 

There was an assurance process awaiting confirmation for completion in December, but which was intended to be a simplified process.  DToC performance would be based on September data and therefore it would not be possible to show how the BCF would affect DToC, although it would be possible to determine how organisations that failed to meet the required performance targets might be fined in the following year.

A board member commented on the impact on communities in relation to fines, where factors were not within their control. The director explained that this was the first new target in 7 years and that the issue of fines did cause tensions in the system, so it was necessary to work together to make the BCF work locally to ensure the right outcomes for the people of Herefordshire.

A board member noted the key successes that were reported and asked if the challenges around nursing home quality and capacity would mean an increase in DToC.  The director responded that domiciliary care and residential nursing care needs could be met through the available funding. There was a decreasing proportion of people affected because the system was good at keeping people at home; however there was some nursing care needed and this was where there was a potential capacity pressure as a result of recruitment and retention challenges.  A board representative also noted that there were workforce plans within the sustainability and transformation plan (STP) to address these issues.

In terms of what the board could do to raise the profile of workforce pressures, it was noted that provider and workforce development was being addressed through iBCF to make good use of resources and meet pressures.

RESOLVED

That:

(a)  the better care fund (BCF) quarter four performance submission be noted; and

(b)  the board meet on 7 September 2017 to approve the better care fund plan for 2017/18 prior to submission to NHS England on 11 September 2017.