As part of the statutory function of the board the purpose is to review the better care fund quarter two and three performance reports and recommend any future improvements.

The chairperson invited the head of partnerships and integration to introduce the report, the principal points included:

a.         It was a statutory function to review the better care fund (BCF) performance reports.

b.         To meet the national submission deadlines, the contents of the quarter 2 and quarter 3 performance reports had been approved under delegated authority by the director for adults and communities in consultation with the accountable officer of NHS Herefordshire Clinical Commissioning Group, and had been submitted to NHS England.  The board was invited to review the completed data.

c.         Attention was drawn to the following sections of the quarter three report:

·                     The metrics position: non-elective admissions was not on track to meet target, residential admissions was on track to meet target, reablement was not on track to meet target but there had been improvements, and delayed transfers of care was on track to meet target and significant improvements had been made;

·                     The high impact change model and the updates provided on the eight key areas; and

·                     The integration highlight which outlined the integrated model of care for adults requiring palliative and end of life care.

d.         It was reported that the Herefordshire BCF and integration plan 2019/20 had received approval and guidance was awaited for 2020/21.

The managing director of Wye Valley NHS Trust said that the board should not be unduly concerned about metric on reablement, being the ‘proportion of older people (65 and over) who were still at home 91 days after discharge from hospital into reablement/rehabilitation services’, as trying to meet that target in a selective way could be detrimental to the system flow.  The head of partnerships and integration commented on the significant investment in this area and the improvements being seen; it was predicted that this metric would be met by the end of the year.

In response to questions from the Leader of the Council on the schemes that comprise the section 75 agreement and the net forecast overspend of £1.939m, principally due to overspends in pool two (£0.669m) and pool five (£1.728m):

§    The head of partnerships and integration advised that overspend in pool two (additional voluntary contributions to BCF) related to residential and nursing care spend.

§    The director for children and families advised that overspend in pool five (children’s services) related to complex needs placements.  It was reported that there was an agreement in place which allocated underspend or overspend between the CCG (1/7^th), Herefordshire schools’ forum dedicated schools’ grant (3/7^ths), and the council (3/7^ths); it was noted that the partners had been notified.  He added that there had been underspend in previous years and work was being undertaken to look at the patterns of placements which were few in number but high in cost.

§    The managing director of the CCG confirmed that overspend would need to be managed within existing resources.

The chairperson requested that a breakdown of the schemes that comprise the section 75 agreement be circulated to board members; attached as appendix 1 to these minutes.

Resolved: That

(a)      the better care fund quarter two and quarter three performance reports for 2019/20, as submitted to NHS England, be noted; and

(b)     there were no further actions that the board wished to recommend to secure improvement in efficiency or performance at this time.