To review the better care fund (BCF) 2019/20 quarter four national performance and end of year feedback, as per the requirements of the programme.

The assistant director all ages commissioning presented the report, drew attention to the Better Care Fund (BCF) template for quarter 4 2019/20 as appended to the report, and made the following principal points:

i.           (agenda page 23) Attention was drawn to the key purposes of the BCF reporting.

ii.         (agenda page 27) It was noted that all parts of the template had been completed.  It was commented that, with continued collaboration (especially during the Covid-19 pandemic), the system was more closely integrated than it had been before.

iii.        (agenda page 31) It was noted that the national conditions had been completed.  The assistant director talk community programme was thanked for her previous work on the BCF.

iv.        (agenda page 32) The target for reducing the rate of non-elective admissions had not been met and partners continued to work together to support individuals at home and to avoid admissions, including through the Home First and Hospital at Home schemes.  The target for reducing the rate of permanent admissions into residential care (16.9%) had not been met but a significant reduction of 10.8% had been achieved.  The target for the proportion of older people who were still at home 91 days after discharge from hospital into reablement/rehabilitation services had not met target but performance continued to improve.  The target for delayed transfers of care (DToC) had been achieved, with Herefordshire recording some of the lowest DToC days for a number of years.

v.         (agenda page 37) Actual expenditure was shown as £56,016,560 compared to planned expenditure of £56,078,091, with overspend in some areas being offset by underspend in others.  It was reported that care home placements continued to be an issue due to bed capacity; it was anticipated that some of the pressure would be alleviated through a capital scheme to build a care facility.

vi.        (agenda page 38) Attention was drawn to the agreed statements in the year end feedback and the associated comments were summarised.

The assistant director for adult social care operations said that, even with the considerable pressures during the last year, significant progress had been made, such as the rapid setting up of an integrated hub to manage the discharge pathway.  Updates were also provided on the current position with recruitment for the Home First service and with transfers of care.

Mr Stead welcomed the report and the progress that had been made, adding that Healthwatch Herefordshire had been impressed with the liaison between health and social care during recent months.  In response to a question, the assistant director all ages commissioning said that there was every intention to maintain the trajectory and build upon the close working relationships that had been established.  The assistant director social care operations commented on the learning that had been captured and how this was informing discharge to assess and other processes.

On behalf of the board, the vice-chairperson thanked the director for adults and wellbeing and his assistant directors for all their efforts.  In response to a question, the assistant director social care operations said that the key messages for partners were around continuation, appropriate funding and system cooperation.

The assistant director talk community programme noted the development and growth of the programme during the last year, said that there was an opportunity to align this with the work of the board in terms of the prevention agenda and addressing health inequalities, and praised communities for the way in which they had come together to support the most vulnerable people.

The chair commented on the need to challenge the system and on the importance of working together.  The vice-chairperson welcomed the strong focus on prevention and inequalities, adding that a reset to previous values and behaviours could make the journey of continuation more difficult.

In response to a question from Mr Stead, the assistant director all ages commissioning said that excess mortality during the course of the pandemic was being taken into account in terms of future planning.  He explained that the Market Position Statement 2020-25, once approved by cabinet, would be made available online and would be kept up to date with new developments and planning requirements.  He added that the direction of travel was now around prevention and avoidance, rather than reaction.

The chair thanked officers for their hard work and for the report, noting that the section on resource implications (agenda pages 19/20) was particularly helpful.

Resolved:      That the board has reviewed the better care fund 2019/20 quarter 4 national performance and end of year feedback.