Agenda item

The BCF Local Plan 2016/17 was presented as a joint paper on behalf of Chief Officers from LBB and BCCG. Dr Bhan thanked Richard Hills for his hard work in drafting the Plan. The Board heard that BCF funding would continue for the 2016/17 financial year, and that the minimum amount required for Bromley as set out by NHS England was £21, 611,000. This had been created mainly from CCG baselines, and so was not new money. The aim was that LBB and BCCG would provide a whole system integration plan for 2017. It was imperative that the joint integration work be properly funded. The BCF Local Plan report was required to be approved by the Health and Wellbeing Board.

 

The Board were informed that after the final plan was signed off by the HWB, the plan would be submitted to NHS England by 3^rd May 2016. The Board were briefed on the national conditions that the Bromley Plan would be required to meet. Local areas would subsequently be required to demonstrate how the local plans would be pooled together to meet these requirements. The local plan would have to demonstrate how services would be integrated to benefit residents. 

 

The Board were briefed concerning a local example of pooled BCF commissioning which was Bromley‘s new Dementia Hub that was scheduled to launch in July. The Dementia Hub had been developed to address needs that had been identified by the JSNA. In this regard, the key metric for 2016/17 was to provide adequate support for post diagnosed dementia.

 

Section 6.3 of the report highlighted the expenditure assumptions for 2016/17. An update to these assumptions had been emailed to members of the Board during the week before the meeting. The Board were advised that the legislative basis for the Better Care Fund derived from an amended version of the NHS Act 2006—amended by the Care Act 2014. This allowed NHS England to include specific requirements for the establishment and use of an integration fund.

 

The Board were briefed concerning the conditions that would have to be met in Bromley to access the BCF Funding:

 

·  A requirement that the Better Care Fund be transferred into one or more pooled funds, established under section 75 of the NHS Act 2006

·  A requirement that the HWB agree how local monies should be spent, with the plans signed off by both LBB and Bromley CCG

·  A requirement that the plans be approved by NHS England in consultation with the Department for Heath, and the Department for Communities and Local Government.

·  A requirement that a proportion of the areas allocation will be subject to  new conditions which may include a wide range of services, including social care

 

The Board heard that a need for change had been identified in six key areas:

 

1.  A need to improve joined up working

2.  A need to improve access to care

3.  A need to improve care coordination

4.  A need to improve the use of resources

5.  A need to deliver proactive care

6.  A need to improve care capacity and capability

 

Section 7.4 of the BCF Local Plan document identified 10 key areas of focus for the BCF Integration Programme:

 

1- Risk Stratification—it was important to identify patients that were lower down on the risk pyramid, to try and stop them from moving up

 

2- Care Plans—it was vital that all partners input into care plans, and that these plans be easily accessible  

 

3- Single Point of Access—it was imperative that patients were aware of a single access point for services

 

4- Shared Patient Records—accessible by all

 

5- Named Point of Contact—it was key that both patients and professionals benefit from a named point of contact

 

6- Accountability—issues around legal and medical accountability needed to be clarified

 

7- Simple Referrals—the referral process should be simple, with all health care professionals empowered  to make referrals, and not just GP’s

 

8- Care Co-ordinator Role—it was essential that this role would be able to work across organisational boundaries

 

9- Integrated Teams—these were regarded by GP’s as being of significant value

 

10- Clear Role Definitions—this would be required for every role in the new system

 

Cllr Evans expressed concern regarding the issue of “simple referrals”. He agreed with the principle of improving gateways to care, but was worried that in this case the gateways may be too easily opened. Dr Bhan reassured Cllr Evans that this would not be the case. Although the plan was to make referrals simpler, the gateway path would still be robust.

 

Cllr Evans asked for clarification as to what was meant by “social prescribing”. Dr Bhan answered that this was a reference to providing an intervention to provide a service that was not necessarily a clinical service or drug. It could include the provision of support for a luncheon club, and would be likely to involve the voluntary sector. Such interventions would also hopefully have positive mental health outcomes. 

 

The BCF Plan was seen as the initial stage in moving towards a provider led system where providers would work together to achieve outcomes and were incentivised to do so, this was in line with the general direction of travel that had been outlined in the NHS 5 year Forward View. Also in line with the Forward View was the drawing in of the third sector as a core provider. It was hoped that with support, the third sector would be able to bid directly for delivery elements of the new model where non-clinical solutions were required.

 

The Board were briefed on the 8 National Conditions that had been laid down by NHS England to receive BCF Funding, these were:

 

1-Health and Social Care Plans were to be jointly agreed between LBB and the CCG

 

2- Social Care Services were to be maintained

 

3- Agreement for the delivery of 7 day services across Health and Social Care

 

4- Better data sharing between Health and Social Care, based on the NHS Number 

 

5- Ensuring a joint approach to assessment and care planning, and that there would be an accountable professional

 

6- Agreement on the consequential impact of the changes on the providers that were predicted to be substantially affected by the plans

 

7- Agreement to invest in NHS commissioned out of hospital services

 

8- Agreement on a local target for Delayed Transfer of Care (DTOC) and the development of a joint action plan  

 

Cllr Evans wondered if the agreement for 7 day services across health and social care was realistic. Dr Bhan responded that 7 day packages were expected, and in many cases already existed. Care packages could be set up on the weekend. Stephen John informed the Board that there was Social Worker availability in hospitals on the weekend.

 

Cllr Evans asked what issues currently existed around information sharing. Dr Bhan responded that she was conscious of the issues that existed around information sharing, and that it was important to avoid duplication. The Chairman enquired if the stage had now been reached where data could be properly shared and integrated. Stephen John informed the Board that Information Sharing Agreements had been signed off. The sharing of IT systems was a problematic issue, as organisations used different systems; work was ongoing to simplify this.

 

Cllr William Huntington Thresher asked if information and data linked to end of life care was available to the emergency services. Dr Andrew Parson stated that work to coordinate this was in progress. The Board was in general agreement that the integration process should make this easier. Harvey Guntrip asked how the issue of data sharing was linked to private carers. Dr Bhan responded that GPs took care of this. Dr Parson stated that a document signed by health professionals would be available to out of hours services. 

 

Cllr Evans referred to section 10.3 of the report where it was stated that Bromley had an “unrealistically” low level of admissions to residential/care homes. He queried what was meant by the term “unrealistic” in this context. It was agreed that the term “unrealistic” was misleading in this context, and would be omitted from the final draft of the document.

 

Ian Dallaway referred to section 12.1 of the report that referenced the BCF planning template. There was some confusion as to where this template was located. It was clarified that the template was a reference to the table located on page 34 of the report—section 6.3—BCF expenditure assumptions. Mr Dallaway directed the attention of the Board to section 9.37 (Condition 8) of the report where there was a reference to the Delayed Transfer of Care Plan (DTOC) and enquired when this plan would be finalised. Dr Bhan confirmed that the DTOC plans had not been finalised at this stage. This was an issue that would be required to be brought back to the Board for an update.

 

A Member alluded to section 10.2 of the report, which noted a rise in emergency admissions at the local acute hospital. Dr Bhan explained that when an individual was admitted to one of the units with chest pains, he/she would be assessed, and then re-assessed 4 hours later. Whilst waiting for the second assessment, the patient would be placed in a holding ward. The second assessments were being counted as “re-admissions”, and this had increased the overall admission figures. 

 

In conclusion, the Board were reminded of the announcement that was made at the Comprehensive Spending Review in 2015. The announcement made it clear that BCF was the just the first phase on the road to health and care integration:

 

“The Better Care Fund has set the foundation, but the Government wants to further, faster deliver joined up care. The Spending Review sets out an ambitious plan so that by 2020 health and social care are integrated across the country,. Every part of the country must have a plan for this in 2017, implemented in 2020. Areas will be able to graduate from the existing Better Care Fund programme management once they can demonstrate that they have moved beyond its requirements, meeting the Government’s key criteria for devolution.” 

 

The Board noted that the Plan was an ongoing challenge with respect to aligning the priorities of both organisations, but that significant progress had been made in the development of an integration plan for 2017. 

 

RESOLVED that the BCF Local Plan for 2016/17 be noted, and agreement and consent be given by the Board for the plan to be submitted to NHS England.