To approve the quarterly better care fund submission.

The director of adults and wellbeing presented the submissions which were a quarterly requirement, and the board’s approval was sought to submit the data.  

The headlines were that:

•           the falls response team had a significant impact on A&E, with evidence that people needed support but this did not have to be in hospital and it was a better outcome if hospital admission could be avoided;

•           reablement had improved and was significantly better than previously reported, having significant impact on long term quality and duration of life. It was key that this was significantly better than previously;

•           the NHS number was used as the primary identifier and there was progress on open APIs (application programme interfaces), allowing systems to talk to each other;

The submission was supported by board members, with the following comments:

•           given the need to deliver savings it was disappointing to see the comment contained in the submission’s narrative regarding development of the better care plan;

•           the range of services continued to work well and effectively within the constraints although health funding implications were not fully understood. The CCG was currently overfunded against allocations and was in a financial recovery situation, but this did not mean that organisations were not striving to get best value;

•           a contributing factor was that drivers through the different routes were not yet as fully aligned as they needed to be. Significant progress had been made in 18 months in securing single approach nationally and guidance was not coherent for either the council or the CCG, but as there was now a single integrated national team, there was confidence that guidance will be meaningful for both health and social care sides;

•           there had been discussions nationally with significant work at that level to bring everything together but there were still pressures. It was hoped this submission was a fair representation and that progress would be made in the next report;

•           the board meetings needed to be aligned with the submission dates so that they could be approved in good time.

Further to approving the submission, further information was requested regarding the matter of the CCG being overfunded given the rurality and demographics of the county. It was clarified that with the current funding formula, the CCG is over target although the county’s rurality, age, age mix and deprivation was considered. Health funding was split into 3 groups, those being CCGs, primary care, and specialised services which are commissioned regionally. There was to be a change in the funding formula to be announced on 17 December which should take into account the greater rurality. There was a commitment to move CCGs to their fair share of allocation by April so funding for Herefordshire may reduce although it was unclear if this would be accurate or better/worse. It was anticipated that there would be a move to fair share allocation in the next two years.

It was suggested that a financial report be commissioned to show changes in funding for the next year and into the future.

As regards budget announcements from the Chancellor of the Exchequer this week, it was understood that the national budget was to grow in 2017-18 by £1.5billion but it was not clear where this would come from. The expectation was that the greater proportion of the CCG budget would to the better care fund although there was no firm evidence to this effect. It was further understood that better care fund plans would lead to full integration of health and social care by 2020 although the meaning of this was unclear although this was the way forward in the government’s view.  It was hoped there would be more central guidance later in December.

It was recognised that intervention at an early stage was beneficial provided that admissions were tracked and monitored to ensure they were appropriate and best value was essential whatever the government’s policy.  

RESOLVED

That the Health and Wellbeing Board approve the Better Care Fund (BCF) quarter two report in order to submit to NHS England.