Apologies were received from Councillor Pauline Crockett, Ingrid Barker and Simon Trickett.

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

Duncan Sutherland substituted for Ingrid Barker and Jo-anne Alner for Simon Trickett.

To receive any declarations of interests of interest in respect of schedule 1, schedule 2 or other interests from members of the board in respect of items on the agenda.

None.

To approve and sign the minutes of the meeting held on 5 March 2019.

RESOLVED:  That the minutes of the meeting held on 5 March 2019 be approved and signed by the chairperson.

To receive any written questions from members of the public.

For details of how to ask a question at a public meeting, please see:

www.herefordshire.gov.uk/getinvolved

The deadline for the receipt of a question from a member of the public is Tuesday 2 July at 5.00 pm.

To submit a question, please email councillorservices@herefordshire.gov.uk

None.

To receive any written questions from councillors.

The deadline for the receipt of a question from a councillor is Tuesday 2 July at 5.00 pm, unless the question relates to an urgent matter.

To submit a question, please email councillorservices@herefordshire.gov.uk

None.

To review the better care fund 2018/19 quarter four national performance and end of year feedback.

The Board was invited to review the better care fund (BCF) 2018/19 quarter four national performance and end of year feedback.

The Head of integration and Partnerships (HIP) presented the report.  She noted that to meet the national deadline the content of the returns had been submitted using delegated powers.  However, the report provided the Board with the opportunity to review the returns and provide feedback.

She reported that the BCF guidance for 2019/20 had not yet been issued.  There would therefore be no quarter one report.  The expectation was that requirements would remain the same and work was underway to draw up the required plan on that basis.  She had been informed that morning that the delay was a consequence of ongoing discussions nationally on the respective inflationary uplift between health and social care.  The sum involved would not be significant in planning terms.  The indication from government was that a decision was imminent, but that had been the indication for some time.  The plan for 2019/20 had to be submitted by the end of September.

The Director for adults and communities commented that the delay and uncertainty did represent a risk but this would be managed.  A similar situation had arisen in preparing the 2018/19 plan. 

It was observed that, although not large in overall budgetary terms, the outcome may have some service implications.  It was proposed that when the outcome was known and guidance received the Board should therefore be informed by correspondence and any implications highlighted, rather than waiting to report to a formal meeting of the Board.

In response to a question about delayed transfer of care the HIP commented that performance for April 2019 was below target, the local authority being slightly over target, the health service slightly below.  It was noted that reporting was to change to provide a total for the system as a whole reflecting that the key point was the patient experience of the system as a whole and improved outcomes for them.  For managerial purposes monitoring of the separate targets would continue, but it was to be hoped that the time the current system led each body to expend challenging the statistics of the other would reduce.

RESOLVED:

That      (a)     the better care fund (BCF) quarter four performance report at appendix one as submitted to NHS England, be received and the latest performance on delayed transfer of care and the move to measuring it in future at a system level be noted;

(b)       on occasions when board meetings do not coincide with national submission dates, the director for adults and communities has delegated authority, following consultation with the accountable officer of the Clinical Commissioning Group (or their delegate), to approve the submission and to present this to the next available board meeting to enable review of performance and make recommendations for improvement;

            (c)        the director for adults and communities be authorised, following consultation with the chairperson of the Health and Wellbeing Board and with the agreement of the accountable  ...  view the full minutes text for item 7.

To provide an updated overview of the Sustainability and Transformation Programme (STP), One Herefordshire and Integration agenda for health and social care. 

The Board was provided with an updated overview of the Sustainability and Transformation Programme (STP), One Herefordshire and Integration agenda for health and social care. 

The Director of Strategy and Transformation (DST) (Herefordshire CCG and One Herefordshire), Joint Programme Director (Herefordshire and Worcestershire Sustainability and Transformation Partnership - STP gave a presentation on the NHS long term plan, integrated care systems and one Herefordshire.  The presentation was included with the agenda papers as an appendix to the report.

NHS Long Term Plan

The DST noted that an implementation framework for the plan had recently been received.  Sustainability and Transformation Partnerships (STPs)/Integrated Care Systems (ICSs) had been asked to create their five-year strategic plans by November 2019 covering the period 2019/20 to 2023/24.

The following principal points were raised:

·        On behalf of Healthwatch it was requested that there should be local engagement in the development of primary care networks to ensure the voice of local people was heard alongside that of health professionals.  This was particularly important in a rural area where there were challenges to access to services.

·        There was a danger that the national policy, of developing primary care networks with GPs working with other providers at locality level, which was written with an urban perspective, could prove complex in an area with a dispersed population.  It was important to ensure that changes did not lead to poorer access to services.  The plan’s emphasis on digitally enabled care and the infrastructure required to support this was noted.

·        The importance of ensuring the needs of Herefordshire continued to be served as part of a larger system was noted.

Integrated Care System/One Herefordshire

The DST noted that discussions continued to take place on how the work of the Children and Young People’s Partnership would be accommodated within the One Herefordshire Plan.  At the moment the two systems were working in tandem.

In discussion the following principal points were made:

·        Potential barriers to joining up the system as intended were discussed.  It was suggested that these might include:  accountability mechanisms, the CCG deficit and lack of a common engagement strategy, and the separate governance arrangements of the partners in the absence of a common legal framework.

·        The Director for adults and wellbeing saw a need to avoid becoming bound up with governance and structures.  He saw most potential in the communities agenda focussing on community development rather than on “health and social care” as the only solution to meeting needs.  He also commented on the need to be ambitious and not allow financial pressures to lead to short sightedness.  Whilst in year savings were being made these were not at the cost of longer term plans.

·        The Director of Public Health commented that the organisations involved currently had different cultures and drivers and working towards joint commitments might offer benefit.  Training had a role to play in this. 

·        Dr Tait agreed that differing performance management structures was an issue of significance and unless these were aligned organisations would be driven by different  ...  view the full minutes text for item 8.

The next scheduled meeting is 14 October 2019.

The Board noted that the next scheduled meeting was on Monday 14 October 2019.  Dates of the proposed workshops would be issued in due course.