Agenda item

The Better Care Fund—Governance and Work Programme report was drafted by the Strategic Commissioner. The purpose of the report was to provide a Better Care Fund (BCF) update, and also an update on the work of the JICE (Joint Integrated Commissioning Executive) which meets to oversee health and social care integration work. The report was also going to the HWB as Health and Wellbeing Boards have a key role in promoting the integration process.

The update on the report was provided at the meeting by Dr Angela Bhan, Chief Officer at Bromley CCG.

The Board were informed that integration work had been temporarily delayed as the CCG had to wait until the end of March 2015 for the release of funding from NHS England. It was explained to the Board how the total funding of £20.837m would be split in the 2015/16 financial year. The Board noted that BCCG were acting as lead commissioners on a joint project to model out of hospital services for Bromley, and that these services would be working in line with the original BCF plans submitted to NHS England In November 2014.

The Board were updated concerning the progress made in developing Bromley’s BCF integration objectives, and were informed that the JICE had been developing plans at a high level, and had brought in additional fixed term management capacity to support development and integration.

The CCG and JICE were seeking to provide joined up services that would provide VFM, and were looking to fill service gaps. These services would operate according to sound policy and practice.

The Board noted that the Bromley BCF Plan could be broken down into seven schemes:

1.  Step Up/Step Down—increase bed availability—this would provide better support for hospitals

2.  Provide more support for those going into Care Homes—and also to provide improved levels of medical cover and training

3.  Dementia

4.  Self-Management—the aim being  to reduce the number of hospital admissions

5.  More support for Carers—with the aim of reducing the number of residential placements

6.  Resilience—plans were being developed to more fully integrate health and  social care around 7 day working

7.  Establishing an integrated care record—the idea being that one set of records would be kept and regularly updated, and that this data would be shared between health and social care

The importance of the work of the JICE was expanded upon as it would be the JICE that would develop and sign off projects, and the JICE would be responsible for reporting back to the relevant governance structures, including the Health and Wellbeing Board. It was noted the HWB’s task and finish groups would also function in the role of key governance groups.

Dr Bhan reminded the Board that a number of risks had been identified, and that the financial risk of underachievement would fall to the CCG as the lead commissioner of acute service. To reduce the effect of risk, the JICE would establish an ongoing risk and issues log.

Dr Bhan concluded by stating that a high level programme would be developed, and that it was intended that leads would be established for each of the seven schemes outlined previously.

A Member referenced the BCF Plan (number 2) concerning increased medical cover in care homes, and asked how this would be achieved. The response to this question was that a new model was being developed over the next six months and that more input was required from visiting medical officers.  Dr Andrew Parson pointed out that more involvement was required not just from GP’s , but all relevant professionals, and that it was important to try and utilise all relevant capabilities and capacities.

A Member asked for clarification of what was meant by “compromised working relationships between the CCG and the Local Authority” and it was explained that this was a reference to possible conflicts relating to resource and capacity. It was also noted by the board that the proper use of “step up/down” beds required careful advance planning so that a proper flow of bed use could be established.

A Member raised the issue of extra pressures on local health and social care services created by the influx of retirement flats for the elderly, in most of these cases it was estimated that the average age of retirees taking up this accommodation would be 78. Dr Bhan acknowledged that more would need to be done to try and deal with these extra pressures.

A Member raised the matter of the importance of joined up transport services, so that those involved in the physical transportation process were adequately briefed about the clients that they were transporting. 

The Chairman requested that BCF updates be incorporated onto future agendas as a standing item until further notice.

RESOLVED: 

(1) that the Better Care Fund—Governance and Work Programme report be noted

(2) that the HWB acknowledge the key role of the JICE as the key senior officer group tasked with the oversight and delivery of the schemes outlined in the BCF

(3) that the HWB recognise that there were differing governance structures between partner bodies, and that this would necessitate the JICE taking executive decisions in the spirit of the BCF. 

(4) that BCF updates be incorporated onto future agendas as a standing item until further notice.