To update Health and Wellbeing Board members on Herefordshire’s Better Care Fund (BCF) Integration Plan 2024-25 and seek formal Health and Wellbeing Board approval.

The Service Director All Age Commissioning provided an update on the Herefordshire’s Better Care Fund (BCF) Integration Plan 2024/25, the principal points included:

i.             The BCF Integration Plan 2023-25 had been approved by the board in 2023, minute 35 of 25 September 2023 refers.

ii.            The refreshed plan included updates to elements of the metrics and to the spending plans, but there was no requirement for a separate narrative plan submission.

iii.          Due to the need to meet the national timeline, retrospective approval was sought for the BCF Integration Plan 2024/25.

iv.          The plan had been signed off by One Herefordshire Partnership, Herefordshire Council, and Herefordshire and Worcestershire Integrated Care Board.  The West Midlands Assurance Panel had recommended the plan for approval.

v.           The Department of Health and Social Care had flagged the intention for additional metrics around discharge and reablement for 2024/25, but these had not yet been published.

vi.          Funding for the BCF had increased by £2.6m for 2024/25 but funding of £2.3m utilised in 2023/24 was not available in 2024/25.  Consequently, the net increase was not sufficient to meet inflationary increases in recurrent commitments, and reductions in expenditure were necessary to deliver a balanced plan.  An overview was provided of the work being undertaken collaboratively to address the pressures.

vii.         The board was advised that planned changes to demand and capacity were considered realistic but could be challenging to deliver.

viii.       It was noted that the One Herefordshire Integrated Care Executive would continue to monitor performance.

The Chairperson drew attention to the following:

·             The BCF 2024/25 Update Template (agenda page 27) showed each line of income and expenditure as being identical, but the total showed a difference of £1; it was later confirmed that this was a result of rounding within the automated template.

·             It was acknowledged that the narrative plan had not been updated but reference to Talk Community ‘Super hubs’ (agenda page 95) was no longer relevant.

Comments from board members included:

1.           Simon Trickett considered that it had been a proactive and successful year due to the health and social care teams leading it.  The challenges were noted but there was assurance that there was capacity and capability to manage the financial pressures.  It was reported that a Point Prevalence Audit was to be conducted shortly, looking at patients and service users on a given day to understand where they were on their journeys; it was suggested that an update could be provided in due course.

2.           Dr Andy Watts questioned whether there were metrics for feedback from service users in terms of the quality of discharge planning and about what happens in the days immediately following discharge.  The Corporate Director Community Wellbeing said that feedback was captured later in the process, but consideration could be given to a systematic approach.

3.           In response to a question from the Vice-Chairperson about the level of confidence in achieving productivity improvements, the Service Director All Age Commissioning commented on ongoing work to increase capacity, including with Home First and the Ledbury Intermediate Care Unit.

4.           In response to a question from the Chairperson, the Vice-Chairperson said that the challenges with discharge into Powys were not taken into account during Care Quality Commission inspections due to the focus on quality standards.  Simon Trickett commented on the work with Powys to ensure that the costs of care were met appropriately and to improve the consistency of discharge pathways; it was noted best practice was being discussed with neighbouring authorities.

Resolved:      That

a)      The Herefordshire Better Care Fund 2023-25 planning template (Appendix 1) and the ICB Discharge template (Appendix 2), submitted to NHS England, be approved (retrospectively);

b)      The ongoing work to support integrated health and care provision that is funded via the BCF be noted; and

c)      That consideration be given to a metric for feedback from service users.

Action 2024/25:02:   That an update on the Point Prevalence Audit be provided to board members in due course.