Agenda item

Following the presentation given at the previous Health and Wellbeing Board (HWB) meeting the Director had prepared a report which outlined a proposal for the joint use of the Better Care Fund (BCF), previously referred to by the Department of Health as the Integration Transformation Fund (ITF).  The intention of the fund was to support an increase in the scale and pace of integration between health and social care and provide a mechanism for promoting joint planning for the sustainability of local health and care economies against a background of significant savings targets right across the system. 

In addition to the overarching integration agenda a number of national conditions and measures are attached to the fund designed to move resources across the system towards prevention and short term care interventions and away from high cost care packages in residential or acute settings.

Locally the Chairman of the Board and Directors from both the Local Authority and Bromley’s Clinical Commissioning Group were proposing to use the Fund to:

• Fund services that came under the banner of ‘short term interventions and preventative services’ in the community in order to mitigate the pressures on long term care packages and admissions into secondary care that were putting considerable financial strain on the Health and Care system as a whole;
• Include services that helped both Health and Care deliver against some of their respective legislative duties as set out in the Health and Care Act 2012 and the Care Bill (currently going through parliament and likely to become an Act in 2014);
• ‘Clean up’ historical joint funding arrangements moving existing joint funded community services into a pooled budget of which the BCF would make up a core component.

Access to the BCF was dependent on agreement of a local 2-year plan for 2014/15 (the planning year) and 2015/16 (first full year).  The plans had been first agreed jointly by the Local Authority and Bromley’s Clinical Commissioning Group and authorised by their respective Executives.

A template has been produced nationally for local areas to complete their submissions to NHS England. This template had been completed locally and attached to the report for the Board’s consideration.

The final sign off required before the Local Plan could be submitted to NHS England needed to be provided by the Board. One of the critical responsibilities for HWBs, as set out in the Health and Care Act 2012, was to encourage joint working and integration in their locality wherever there were clear benefits to the local population. The BCF provided a vehicle that could be used to sustain and accelerate this agenda as well as support the creation of a pooled budget.

The timetable for submission was very tight and Bromley’s submission had to be with NHS England by 14^th February. The final deadline was 4^th April 2014 which gave officers time to finalise the indicative budgets.

The Board requested an outline setting out how the funding could be used.  One of the areas of change would be moving funding from the acute sector to Community Health as the proposed measures should mean that there would be more care in the community leading to less demand on hospital beds.

The Board requested that as the next submission after February, was not until April, it would like to receive the document again prior to final submission.  This would be brought to the March meeting.

One Member of the Board raised concerns as to how the fund would be managed if the Local Authority and the Health Authority had differing ideas.  She also raised concerns about IT andsought reassurance that there would not be a need to purchase new IT systems at a time of budget constraint, and she was also concerned about unrealistic targets for dementia.

The Director explained that this was an evolving process and the Bromley and the CCG would be making appropriate changes although the role of NHS England in the process was still not clear.  He Agreed that IT was a problem as the current “Care First” system was nearing the end its life, however, although other boroughs had spent in the region of £2- £3m on new IT system he had no intention of doing so. 

In relation to dementia patients he explained that his aim was to ensure that dementia sufferers did not end their lives in hospital.  Consideration was being given to all nursing homes, residential homes and dementia work in the borough to ensure the most appropriate residential care for sufferers,

Dr Bhan explained that one of the aims was to promote joint working to improve the delivery of services to Bromley residents to increase their ability to remain in their own homes.  She recognised that all the relevant services needed to be linked and this would be one of the CCG’s areas to focus on.

The Vice-Chairman reported that authorities could become “Dementia Friendly” authorities and encouraged Bromley to do so.

The Board was assured that the CCG had signed up to all the principles of the BCF but work was still ongoing to work through the detail.

RESOLVED that:

1. The Local Plan is authorised and approval is granted for the Plan to be submitted to NHS England allowing Bromley to meet the national deadline for submission of 14^th February 2014.

2. It be noted that this is the first submission to NHS England and that the planning year does allow both organisations to engage with partners, providers and service users on how the integration agenda should be delivered locally.

3. It be agreed that the Local Plan is championed in the community and is communicated positively to colleagues, providers and service users.