Agenda item

Report ACH20-031

The Board considered a report providing an overview of Quarters 3 and 4 (October 2019 to March 2020) performance for the Better Care Fund (BCF) and Improved Better Care Fund (iBCF) for 2019/20, including expenditure and activity. 

Bromley was responding to the following national metrics for the BCF:

  a. Reduction in non-elective admissions;

  b. Delayed transfers of care (DToCs) (delayed days);

  c. Rate of permanent admissions to residential care per 100,000 populations; and

  d. Proportion of older people (65 and over) who were still at home 91 days after discharge from hospital into reablement / rehabilitation services. 

In Quarter 3, non-elective admissions continued to be reported within the activity plan set out in the CCG’s operating plan, carrying on the trend from the beginning of the year. Quarter 4 had seen a significant fall in non-elective admissions into the acute hospitals which reflected the impact of the COVID-19 pandemic towards the end of the quarter, and saw a commensurate reduction in the attendance at the Emergency Department.

The local Health and Social Care Partners of One Bromley had jointly responded to deliver services as required, to meet the local needs of Bromley patients during the pandemic. Contractually, for 2019/20, the position for King’s had been agreed for the financial year at the fixed contract level. The One Bromley Programme continued to develop programmes in the community to identify and manage patients locally, with changes to the pro-active care pathway and services for frail patients. Planning for winter had commenced, which also reflected any changes in capacity required for seasonal pressures and COVID-19.

In respect of DToC, Bromley’s target for 2019/20 had increased from 10.31 bed days per day to 12.5. This was the overall figure for Bromley which included DToC's due to both NHS and / or Social Care. It was noted that for Quarters 3 and 4, Bromley was exceeding its performance targets.

The LBB Integrated Strategic Commissioner for Early Intervention noted that the target for admissions to residential care for Quarters 3 and 4 had not been met. This was despite the continuing drive to promote independence by supporting people in their own homes, and partly due to more people being admitted to residential placements with enduring and more complex needs.

In relation to reablement, it was noted that there was a 91 day lag for data, and therefore Quarter 4 data was not yet available. This data, available at the end of July 2020, would be provided to the September meeting of the Health and Wellbeing Board. It was noted that the most recent data showed that Bromley was exceeding the target of 90% by delivering 93%. Robust plans were in place to ensure early planning, so that reablement opportunities for local residents could be maximised. The alignment between reablement and Bromley Well Prevention and Early Intervention services had been strengthened, in order to maximise reablement opportunities for residents following a period of crisis in the community or discharge from an acute ward. The Take Home and Settle service, delivered by Bromley Well, had significantly increased the number of residents accessing early intervention services post discharge from hospital and contributed to reducing the number of residents with multiple re-admissions.

The LBB Integrated Strategic Commissioner for Early Intervention highlighted some of the pathways being delivered:

-  Employment and Education – had seen a significant growth in business, particularly in relation to volunteering;

-  Learning Disabilities – referrals remained constant, but fewer people were being discharged from this pathway, which was an area that could be explored further; and

-  Physical Disabilities – received a large number of referrals.

It was highlighted that there had been a significant increase in the number of people accessing the Mental Health pathway, with the service running two to three times above the expected capacity. The Chairman requested that the Mental Health pathway be a focus of the next report provided to the Board. In response to a question, the Chairman stated that there would also be an agenda item dedicated to discussing mental health at the September meeting of the Health and Wellbeing Board.

The LBB Integrated Strategic Commissioner for Early Intervention informed Board Members that there were a range of schemes within the iBCF. Overall these schemes had not seen a reduction in activity, there had just been a movement during Quarter 4 to an online provision. An evaluation of the impact of the online provision was taking place, and following the lifting of lockdown there would be some movement back to a face to face provision.

The LBB Director of Adult Social Care expressed her thanks, which were echoed by the Chairman, to the LBB Integrated Strategic Commissioner for Early Intervention for the extremely detailed report provided. It was noted that this work had been undertaken whilst he was carrying out a key role within the COVID-19 Operation Shielding, Volunteering and Assistance Programme.

RESOLVED that the Better Care Fund and Improved Better Care Fund Performance Update for Q3 and Q4 report be noted.