To note the better care fund 2016/17 quarter three national performance report as per the requirements of the programme.

The better care fund and integration manager presented the report. The following points were noted:

·         the quarter 3 return was submitted to NHS England on 3 March, having been signed off through delegated authority by the Clinical Commissioning Group accountable officer and the Council’s director for adults and wellbeing

·         For residential care, no improvement in performance was reported; admissions had increased and were at a higher level than a year ago; demand for nursing care appeared to have increased and placements were being evaluated individually

·         Non-elective admissions appeared to be meeting the target for reduction in admissions and this had been supported by the introduction of a number of initiatives including the “red bag” scheme which contained information about the individual when transferring between hospital and care home

·         community provision was being explored with the intention of freeing-up and understanding blockages in transfer of care

·         Healthwatch had developed a patient passport, which included medication and care information, which could be linked to the red bag scheme

·         In terms of risk sharing arrangements, there were some clients who were awaiting review, but it was planned for these to be completed by the end of March 2017.  It had taken time to carry out these reviews due to the various care pathways involved

·         There was a review of the intermediate rehabilitation pilot under rapid assessment and active therapeutic interventions in order to support people to regain independence. The pilot was to be extended to the end of June 2017

·         Further BCF policy and planning guidance was awaited and in the meantime, planning by partners continued. It was noted that the national conditions had been reduced from 8 to 4

·         With regard to financial implications there was pressure on the residential nursing element and funded nursing care

In answer to a question regarding an action plan to address bed blocking, it was explained that the better care fund was an enabler, bringing parts of the system together and drawing upon funding from commissioned services to drive changes.  There was quality assurance of every case funded by the local authority and there had been successes in supporting people to stay at home, which made it easier to predict changes in admissions, with the more complex cases staying longer or going into nursing care rather than residential care.  The pace of change was a challenge, but the focus was on promoting ongoing cultural change through strengths-based practice.

It was noted that there was a significant programme of work underpinning the sustainability and transformation plan and One Herefordshire to avoid admissions, and elements funded through the BCF needed to be considered as part of the overall system.  There was further work to be done to ensure the pace of change on reducing bed blocking was having an impact and continuing progress on redressing the trend in urgent care admissions. An additional factor was delayed transfer of care where patients from out of the county were unable to return home. 

It was confirmed that timeframes for transferring people to the most appropriate care were improving, although there were challenges in cases being picked up to transfer from adult social care. That 7-day services were not available was a factor and there were steps being taken within the system to mitigate this impact. An additional factor was the quality of the market and capacity for example in carrying out assessments at weekends, although it would not be enough to address that without having provision in place for the discharge once the assessment was completed.

It was intended for the BCF to address this but there were aspects of budgets and accountability expected that had not been overcome through the BCF. 

The chairman observed that the report showed just one part of the whole system and invited comments on recommendations.  The view was that the BCF was one part of the bigger system which would be considered more widely in the integration update.

It was further noted that there were challenges regarding capacity and recruitment and retention with a 12 per cent vacancy factor and shortages in qualified staff. There has been some redesigning but output needed to improve, particularly around completing assessments.  It was suggested that some further modernisation ideas and plans be shared with the board.

RESOLVED

That the report be accepted.