To review the better care fund (BCF) year-end 2022-2023 report, as per the requirements of the programme.

Hayley Doyle (All Age Commissioning) provided an overview of the Better Care Fund year-end report 2022-23. The principal points included:

1.  There are three ambitions that are not on track to meet the planned performance by the end of the year:
   1. Avoidable admissions to hospital:

                                               i.     The planned performance at year-end was 1,106 against a metric of 605

                                              ii.     A programme of admission avoidance including virtual ward and urgent care programmes are being implemented currently and the development of an approach to integrated long-term conditions management is envisioned to help improve future performance.

                                               i.     This relates to the percentage of people who are discharged from acute hospitals to their normal place of residence.

                                              ii.     The metric was set at 91.6% but was not met with data showing a year-end total of 90%.

                                             iii.     There is a key lack of capacity within Herefordshire’s re-enablement and home care markets and the ability to discharge patients from acute beds to home, in a timely manner, has seen some patients being transferred to community hospital beds or to discharge to assessed beds in the community.

                                            iv.     This has been necessary in order to release acute bed capacity within the hospital, however, work is being done to improve in this position.

                                              v.     There has been further recruitment to vacancies within the home first team and the re-enablement service provided by Hoople and this position has increased at the latter end of 2022/23 with Hoople moving toward full recruitment across those service areas.

                                               i.     This relates to the proportion of older people who are still at home 91 days after discharge from hospital into re-enablement/rehabilitation services.

                                              ii.     The metrics show that Herefordshire failed to meet this target with a figure of 70.8% against a target of 80%.

                                             iii.     The CQC registered re-enablement service was transferred from Herefordshire Council to Hoople in June 2022 and there were some reporting issues due to staff changes at this time. This has impacted some of the data collection but have since been addressed.

                                            iv.     Reporting has improved in the remaining quarters in 2022/23 with the percentage of individuals remaining at home 91 days after leaving the service averaging around 78% for the latter quarters.

                                              v.     The issues in the recording in quarter 1 have impacted upon the overall year percentage. Therefore, there are some nuances around the accuracy of data which have been since corrected. Nevertheless, the re-enablement service are experiencing an increase in the complexity of patients being taken on by the service which has an impact on the results in this area.

                                            vi.     Work continues to be done as a local authority with Hoople to improve this position.

2. Overall, the Better Care Fund pools represent a significant increase in investment in core services and there are a number of areas where by end of year, the system can be successful in reaching planned ambitions and improving outcomes for people who receive services.
3. The Better Care Fund approach is considered to be a success in helping increase community teams to support council re-enablement teams and improve outcomes for people.
4. Teams continue to work together across the system to provide a joint approach to help create an outcome of improved flow in the re-enablement team which helps support better outcomes by maximising re-enablement capacity.
5. Recent workshops across the system have been created to look at the discharge to assess pathway which looks at how the promotion of outcomes for people can be achieved to ensure the best outcomes and maximise flow to support the system as a whole.
6. Recently, a discharge to assess board has been established which will meet later this month.
7. There also exists a strong system approach with the development of the One Herefordshire Forum and partners meeting together to provide governance learning and leadership on a weekly basis.
8. A significant remaining challenge around capacity in the market for a number of service areas exist.
9. For Herefordshire, a particular challenge remains around rural communities where the sourcing of care at home is a particularly difficult issue.
10. The local authority are leading on a piece of work which looks at all aspects to provide and create more capacity within the marketplace to increase the range of domiciliary care offered in rural areas and this includes additional commissioning activity, working with system partners.
11. Currently across the system, the Better Care Fund is being worked on which will cover the period of 2023-25 and is currently being drafted.
12. There will be a national deadline for submission and will be subsequently be presented at the following Health and Wellbeing Board meeting on 25^th September 2023.

The Chair thanked Hayley Doyle and asked members for questions and comments.

Jane Ives (Managing Director of Wye Valley Trust) thanked Hayley Doyle for the overview of the Better Care Fund. The key issue in the system exists around home care capacity and backs up into other services. Although national conditions are being met, the most difference made to people is currently poor in terms of the resources being invested in and for value for money from those resources.

The Chair asked why a decision was taken to transfer from Herefordshire Council to Hoople the re-enablement service.

Hayley Doyle was unable to provide a response as to why this took place but noted that she would aim to provide an answer after the meeting.

The Chair also commented about Talk Community and the issue around rural health where there are a significant number of people who cannot access Talk Community facilities due to poor public transport, in particular. The Chair suggested a potential workshop on rural health and how Herefordshire sees itself as a rural county and how to tackle these issues of both rural health and access to Talk Community facilities.

The Chair noted that there were no amendments to be made the template and therefore the board accepted both the report and template in its present condition.

The recommendation was proposed, seconded, and approved unanimously.

Resolved that:

a)    The Better Care Fund (BCF) 2022-2023 year-end template at appendix 1, as submitted to NHS England, be reviewed and the board determine any further actions necessary to improve future performance.

b)    The board accept the report and template as presented to members in the meeting.