To review the better care fund (BCF) 2023/24 quarter two and quarter three reports, as per the requirements of the Better Care Fund (BCF) programme.

The Service Director All Age Commissioning presented the item. The principal points included:

1. The Quarter 2 report focuses on a summary of changes in demand and capacity plans and provides updates against metrics. The Quarter 3 report collects the information against the metrics and ambitions in addition to an update on spend.
2. As a system, a lot of work is being undertaken against all of the BCF schemes. The focus remains on supporting people at home to avoid hospital admissions or the need for longer-term care.
3. Over the last two quarters, significant movement has been seen in relation to homecare market with increased capacity, new entrants and new providers to that homecare framework. The waiting list has reduced to only seven people last week.
4. Increased acuity is being seen with a higher number of hours required for those coming through homecare.
5. Work has been ongoing across the system with ICB colleagues around discharge to assess services.
6. Discharge to Assess ‘sprint’ is a significant programme of work to address challenges overseen in Discharge to Assess services including a complete review of pathways such as working with hospital teams at point of discharge, occupational therapy teams, reablement offer, and pathways through the community access team service.
7. There has been an increased commissioning capacity to work closely with Hoople to make changes and work alongside Hoople and other ICS colleagues in the re-design of the service specification for both Home First and Hillside. That work continues and will be reporting into the Discharge to Assess Board from next week.
8. Issues continue with data recording when capturing an accurate picture for Discharge to Assess data. A data specialist is being appointed who will be hosted by Taurus.
9. Work has been close with Hoople and capacity in the Home First service will begin to increase following a number of changes and consultation with staff teams delivering the reablement service via Home First.
10. The BCF partnership group has been re-established and is meeting regularly and will report directly into the Integrated Care Executive and upwards to One Herefordshire Forum in relation to governance and performance monitoring going forward.

Adrian Griffiths (Business Partner) noted that the five pools which make up the BCF are very close to break-even running up to the end of December 2023. At the end of the summer, it is likely that the year-end report will be ready and this year’s refreshed plan.

The Service Director All Age Commissioning added that in terms of longer-term care for residential and nursing care, work is being done with the market to look at block book arrangements for longer-term residential and nursing care beds. There is capacity in the market to source longer-term care, but challenges remain around the affordability of that care.

The Chair asked at what stage is the decision made to determine what level of care a person requires.

The Vice-Chair responded that Discharge to Assess does not involve that decision-making in the hospital but rather at a later stage during support and those decisions are made to determine what long-term arrangements are required.

The Chair asked when would that assessment be made in relation to people with more complex needs for care.

The Vice-Chair responded that a lot of that work would be done upfront. The complexity largely exists around emergencies and those patients are ones that are more likely to get stuck in the system.

The Vice-Chair asked what, in twelve months’ time, will be different from now and what are the metrics that will be measured.

The Service Director All Age Commissioning responded that the data analyst that will be hosted by Taurus will be leading on those wider metrics. There is currently an initial draft around what the dashboard should look like and that can be brought back.

The Executive Director Strategy and Integration ICB requested that a health inequality lens be applied to the dashboard.

The VCS representative asked whether the VCS is helping to deliver the plan.

The Service Director All Age Commissioning responded that there is not currently a commissioned service through the BCF delivering specifically on the Discharge to Assess services, however, work with Talk Community is done to assess all available options.

The VCS representative noted that other VCS groups such as Age UK do work that would be useful to be captured.

The Corporate Director Community Wellbeing agreed and argued that the template is very narrow and does not give the full picture. There is more work that can be done as to how all of the partners can come together beyond services which are commissioned.

Resolved:

That:

a) The better care fund quarter two and quarter three reports for 2023/24, at appendix 1 and 2, as submitted to NHS England, be reviewed; and

b) The board determine any actions it wishes to recommend to secure improvement in efficiency or performance.

c) A broader set of metrics be measured to assess outcomes and value for money from the BCF as part of the report which comes back to the Health and Wellbeing Board.

d) A health inequality lens be applied to the dashboard.