Agenda item

A number of recent developments offer the Health and Wellbeing Board the opportunity to deliver the Joint Health and Wellbeing Strategy and develop a whole system approach to better care. One important element of this is the Better Care Fund (formerly known as the Integration Transformation Fund).   Guidance has been provided by Ministers on how this fund can be used to ensure health and social care work closely together.

 

Alongside this, NHS England has asked for CCGs to ‘develop bold and ambitious plans that look forward to the next 5 years’. The national timetable requires that CCG Boards have plans in place, shared with Health and Wellbeing Boards, by 31 March 2014 and that a ‘good first draft’ of the first 2 Years’ Operating Plan element be made available by 14 February 2014.

 

Understanding that a coordinated approach is required, the Board will receive presentations covering the following elements:

 

·         Better Care (Integration Transformation) Fund

·         CCG 5 Year Plan development

·         Children

·         NHS England

·         Finance

 

Feedback from a stakeholder event which took place on 14 January will also be provided.

In June 2013 the Department of Health announced £3.8billion worth of pooled budgets between health and social care for councils and local NHS organisations to jointly plan and deliver better integrated care and support services.  This is known as the Better Care Fund (formerly Integration Transformation Fund).. 

 

To further encourage this change in service delivery the Department of Health announced in December 2013 that a further £200m would be added to the pool for the transfer from health to social care in 2014/15, which is in addition to the transfer of £900m already planned from NHS to adult social care.  The Department of Health has called on all areas to start planning now, with a view to having draft plans in place by February 2014. 

 

Guidance on the preparation of these plans included that Health and Wellbeing Boards should provide the first cut of their completed Better Care Plan template (an integral part of the CCG’s Strategic and Operational Plan) by 14 February 2014, with a revised version to be submitted to NHS England by 4 April 2014.

 

To ensure a coordinated approach to the preparation of the Plan, the Board requested that presentations be made from key partners to start the Board thinking about how the draft Plan could be progressed.

 

The presentations relating to a whole system approach to Better Care can be found attached to these minutes and included the following.

 

An introduction to Better Care by the Leader of the Council and Chairman of the Board, Cllr Jane Scott.  This covered:

 

·         The need for an integrated care and support structure to be in place within the next 5 years.

·         That future care provision should be person centred co-ordinated care delivered locally where possible.

·         Challenges to be addressed included changing demographics within the local area (20% of the population were aged 65 and over and this was expected to increase to 22.5% by 2021); disjointed information sharing with health and social care professionals and a focus on intervention and treatment, rather than prevention.

·         The outcome of the Care Bill proceeding through parliament at present was awaited.

·         Changes that would be required to the current service, involved:

o   Services designed for the people who use them;

o   Joined up and streamlined services

o   Encouragement for people to take responsibility for their own health and wellbeing;

o   Local health services led by local GPs.

·         Next steps included a joint Plan agreed and signed by the Board.

·         25% of the Better Care fund would be subject to achieving performance outcomes, i.e. addressing delayed transfer of care, emergency admissions and admissions to residential and nursing homes.  It was likely that at least one local indicator would be provided by central government but further details on this were still awaited.

 

It was the desire of the Chairman that the resulting draft Plan include all the key requirements of partners with an aim for it to be one of the best Plans in the country.

 

Michael Hudson (Wiltshire Council) and Simon Truelove (CCG) provided a presentation relating to finances, this included:

 

·         The average cost of an acute bed was £240 per day, with an average length of stay of 11 days.

·         The average cost of a care home placement equated to approx £30,000 per annum with an average length of stay estimated to be just under 3 years.

·         The Better Care Fund for Wiltshire was expected to be approx £27m.  Details of the make up of this fund was provided in the presentation and included a 3% top slice from CCG budgets.

·         As indicated earlier in the presentation 25% was expected to be held back and paid based on performance.  This equated to approx £6m.

·         Details of the areas that current resources funded were provided. 

 

Maggie Rae (Wiltshire Council) provided a brief presentation on the Care Bill.  This included:

 

·         The Bill was expected to proceed through parliament in the Spring and required the Council to promote individual wellbeing, providing information and advice to help reduce the care and support needs of adults and carers, promote integration and develop the local care workforce. 

·         The Dilnot Commission, the findings of which were incorporated within the Bill, requires all stakeholders to think about the function of social care in the future noting that more individuals were likely to be eligible for financial support.

·         The Bill proposes major changes to assessment, eligibility and support planning.  Once through parliament the safeguarding of adults would be on the same statutory footing as children’s safeguarding.  The Council would therefore have a statutory duty to carry out certain functions.  A ‘duty of candour’ rested with the Council which required the authority to step in where serious failings were identified.  This extended to all providers, not just those funded by the authority.

·         The Better Care Fund was understood to incorporate funds to deal with any changes made in the Care Bill but there were concerns that the sum allocated may be significantly lower than what was required.

                                                          

Deborah Fielding (CCG) gave a presentation on the CCG 5 year plan which included the following:

 

·         The CCG, Wiltshire Council and NHS England were already working together to develop a strong strategic approach to future care provision.

·         To continue with engagement several workshops were taking place, the first of which had a commission focus. 

·         A further workshop to help define a clearer model including consideration of the Better Care Plan would be taking place on 6 February.

·         Key design principles included:

o   Individuals taking responsibility for their own healthcare;

o   A high quality affordable system; and

o   Care delivered in the most appropriate setting close to home wherever possible.

·         The key components of the 5 year Plan had already been identified with 7 priorities for 2014/15 agreed as:

o   Planned Care Pathways

o   Optimising the existing community teams

o   Long Term Conditions

o   Urgent Care

o   End of Life

o   Rapid Response

o   Early Supported Discharge

·         The 5 year plan was segmented into 3 parts; namely children, adults of working age and the elderly.  This was in line with the lifetime approach identified within the Health and Wellbeing Strategy.

 

Julia Cramp (Wiltshire Council) gave a presentation on childrens’ services which included:

 

·         A continued aspiration for integrated services allowing for the best outcome for children.

·         The diagram provided (which could be found in the attached presentation) showed the ‘triangle’ of population against need and demonstrated how those with more specific care needs incurred the greater cost.

·         The Joint Children’s Trust/WSCB Early Help Strategy, which it was hoped would soon be signed, included the following priorities:

o   Ensuring the best start in life

o   Gaining the right skills to begin school

o   Being ready for adult life

o   Develop a family based approach to early help

o   Develop effective processes to access early help

·         Details of legislative requirements arising in relation to SEN and disability reforms contained within the Children and Families Bill (expected to be implemented by September 2014) were highlighted. These included:

o   Better choice (including implementation of personal budgets)

o   Introduction of an agreed assessment process

o   Mandatory joint commissioning

o   Requirement for local authorities to publish a ‘local offer’ covering education, health and social care

o   CCG to appoint Designated Health Officer to meet statutory responsibilities.

·         The Pathfinder project in Wiltshire ensured that work was already underway in this area.  Discussions would now take place with CCG Directors.

·         The Pathfinder project has helped local partners in reaching better integration ahead of its neighbours.

 

Feedback from the Stakeholder event which took place on 14 January was provided, further details of which are included within the attached presentation and included:   

 

The Key principles identified:

·         Responsive care in the community

·         Not just person centred but people empowered care

·         Integration

·         Effective co-ordination.

 

The resulting Better Care Plan would be fully operational from 2015/16.  However, the CCG had already made a commitment to address integration in the forthcoming year. It was hoped that a focused approach to bringing integration plans together would come via dedicated officer support in the short term.

 

There was an understanding on the difficulties faced by all partners in delivering existing services with a decreasing budget.

 

It would be inevitable that some services would be affected but the emphasis should remain on choosing the right pathway to deliver the right outcome.

 

The vision for future provision included an emphasis on preventative rather than reactive healthcare.  The £27m allocation would help drive that change. 

 

On further discussion relating to the performance related portion of the funding, clarification was made that this would not be withheld should the target not be met but there was no guaranteed of this beyond 2015/16.

 

Noting the key priorities identified at the stakeholder event on 14 January, the Board were asked to divide into smaller groups to discuss the Plan further and to consider what they felt the priorities should include.

 

Feedback included:

·         Prevention was key in tackling drug and alcohol misuse

·         Working with offenders in custody i.e. for those drink related arrests the response needed to be treating the cause (e.g. mental illness and homelessness)

·         Mental health wasn’t just about mental illness - people with other illnesses e.g. diabetes and heart disease could also have mental health issues.

·         Ensure Health Visitors service picked up issues re Child Protection early and made referrals.

·         A contract of engagement and consultation with the public and stakeholders needs to be included in the Better Care and the 5 year strategy that covers at least the 2 years of development.

 

The Board were made aware of the Kent County Council Vision which was highlighted as a good example of how the Plan could be developed.

 

Noting the limited timeframes by which the draft Plan was to be submitted, the Chairman requested the Board to consider whether an extraordinary meeting should be arranged to review the draft before its submission.  The Board were supportive of this approach.

 

A draft Plan and vision would now be developed and provided to members for comment at an extraordinary meeting to be arranged by the Senior Democratic Services Officer of the Board.  Further details of the date and time would follow.

 

Resolved:

 

That an Extraordinary meeting would be arranged in early February to allow Board members an opportunity to provide final comment on the draft Better Care Plan prior to its submission to the Department of Health by 14 February 2014.