Agenda item

In early July 2014, the Department of Health (DH) announced the Government’s decision to place different requirements on the use of £1bn of the £3.8bn Better Care Fund (BCF). This was followed in the last week of July with the publication of new guidance on the use of the BCF and revised templates for the submission of plans along with the timetable for submission and assurance of plans, with a deadline for submission of plans signed-off by the Health and Wellbeing Board of 19th September 2014.

Changes to the use of the BCF do not, for Bath and North East Somerset, require amendments to the Better Care Plan 2014/15-2018/19 agreed by HWB on 26th March 2014 or to the use of the BCF.

The revised guidance and templates do require clarification of the vision for integrated care and support, case for change and plan of action along with the locally agreed target for reduction in total emergency admissions (to hospital).

This report sets out: i) summary of key changes to the guidance on use of the BCF; ii) the associated timetable; iii) better care plan summary revisions (Appendix 1); and iv) summary of schemes to be funded from the BCF with revisions highlighted (Appendix 2).

The report seeks delegated authority to the Chair of the HWB and CCG’s Interim Accountable Officer to sign-off submission of plans to meet the deadline of 19th September.

The Chairman invited Jane Shayler (Deputy Director for Adult Care, Health and Housing Strategy and Commissioning) to introduce the item.

The Chairman thanked officers for the work they put into this document. 

The Chairman also said that the Better Care Plan 2014/15-2018/19 built upon the previous joint working between the Council and the Clinical Commissioning Group

The Chairman also welcomed Janet Rowse (Sirona Chief Executive), James Scott (The RUH Bath Chief Executive) and Philip Rhodes (AWP Community Services Manager from BaNES Locality) to this meeting and asked for their views.

Janet Rowse commented that the Plan had been a phenomenal piece of work though it would be easy to get lost in some of the detail and technical terms.  The Plan had been excellent in terms of the delivery and in explaining on how everyone should work together.  Janet Rowse concluded that, in her view, focus should be on delivery of services to an individual.

James Scott commented that, given that the RUH has been providing acute services to wider population, B&NES would be in much better starting position considering the history of integration between health and social care partners in this area.  The Board of the RUH had supported this document in principle, though the biggest risk would be in the rise in demand and the hospital had relatively fixed capacity.  James Scott took the Board through some of the issues that the RUH had been facing in terms of the increases in A&E attendances and emergency admissions above its contracted values for 2014/15, all of which could create a potential risk to the CCG and the RUH and the BCF Plan.

Ian Orpen commented that the CCG recognised the points made by James Scott in terms of the pressure and risks that the RUH could have.  However, whilst there were notable increases above the CCG’s plan when activity  levels were compared against last year’s out-turn the growth was much lower.

Tracey Cox commented that the CCG had been in discussion with the RUH on these issues, especially on pressures and risks.  Tracey Cox agreed with James Scott that this year’s contractual arrangements were proving quite challenging.  There would be a number of additional initiatives set as a part of the Operational Capacity and Resilience Plan (ORCP) for this winter that should improve the position.  The CCG would need to provide further assurance to the RUH that there were other initiatives to support admission avoidance and to reduce the demand.  `

The Chairman asked if the framework of the BCF Plan had gone far enough in terms of what the requirements were.

Janet Rowse responded that she has not been aware of any framework for risk sharing.  The performance around the BCF had been associated with the small number of metrics.  All providers haven’t had the opportunity to discuss what the metrics were and what implications these might have for different providers.

James Scott said that it would be in everyone’s interest to maximise the resources from the NHS England.  All providers would want to support the general direction of travel.  This was a system wide issue, not just for one provider. 

The Chairman said this was a start of the long journey together and asked providers if they had any request from the Health and Wellbeing Board.

Janet Rowse said that providers would appreciate clarity of what the Board’s role is.

Jane Shayler highlighted that page 18 of Appendix 1 clearly sets that the contingency funding for the management of financial risk, including the specific risk associated with non-achievement of the target reduction in emergency admissions, had been included in both CCG and Council financial plans, based on assumptions consistent with those in the Better Care Plan.

Julia Davison said that, from the NHS England perspective, this has been seen as joint approach which would reduce burden on health services.  The funding would be going to the CCG who would, together with the Health and Wellbeing Board, decide what to do with that funding.

Bruce Laurence welcomed the Plan and commented that the Board should promote joint evaluation of the scheme.  The Board should also understand what the drivers were.  Bruce Laurence concluded that the main key would be liaison between the Better Care Fund and the CCG’s 5 year strategy and also with the Health and Wellbeing Strategy.

Bruce Laurence asked about governance arrangements.

James Scott informed the Board on the establishment of System Resilience Group (SRG) as an obvious forum to monitor the effectiveness of the BCF.  This was a forum where all the partners across the health and social care system  came together to undertake the regular planning of urgent care service delivery.  The role of SRGs had recently been extended to include elective care as well. This still recognised the independence of Clinical Commissioning Group and local authority decision making bodies.

Jane Shayler commented that the Board would receive a detailed submission with proposed management on governance arrangements.  This document would be amended to include the SRG.

The Board and service providers from Sirona, the RUH and AWP also debated how patients’ experience would be embedded in the plan, what would be next steps (use of resources as one of issues), the role of the Board in terms of the engagement of patients and public, focus on ‘end of life’ care and also challenges that the RUH would be facing considering that their catchment area was with three Clinical Commissioning Groups.

The Chairman concluded the debate by saying that everyone involved should be realistic what resources were available and how the Health and Wellbeing Board should hear from the public on provision of services.

It was RESOLVED to:

1)  Agree the summary of schemes to be funded from the Better Care Fund as revised from that approved by March 2014 HWB;

2)  Delegate to the Chair of the Health and Wellbeing Board and the CCG’s Acting Accountable Officer of sign-off of BaNES BCF submission in the required revised format on 19th September 2014.