Agenda item

To receive an update on the Better Care Fund and scrutiny of delivery and performance.

The Head of Strategic Planning and Quality Assurance for Adult Social Care and the Director of Primary and Community Care for Dorset Clinical Commissioning Group presented item 8, ‘The Better Care Fund 2019/20’.

The principles of the Better Care Fund (BCF) were explained to the Committee and it was heard that since 2013, the programme had spanned both the NHS and local government in seeking joined-up health and care services. This was so that people can manage their own health and wellbeing and live independently for as long as possible. Members heard that the BCF requires the NHS and local government to create a single pooled budget, accompanied by the ethos of closer working and a shift of resources into social community services. The Committee were told that the plan, along with descriptions of the schemes and how the money will be spent are required to be agreed and signed off by the BCP Health and Wellbeing Board as well as NHS England.

Members heard that at present several schemes make up the plan and these include:

·       Maintaining Independence

·       Early Supported Discharge

·       Carers

·       Moving on From Hospital Living

·       Integrated Locality Teams

A funding table was then shown to members which broke down the cost of each scheme and how those costs were shared between the Clinical Commissioning Group and BCP Council. From this, the current performance statistics were explained, and the four metrics were discussed. The four areas were: Non-elective spells in hospital (all ages), Admissions to Residential and Nursing Homes (older people 65+), Percentage at Home 91 days after discharge (older people 65+) and Delayed Transfers of Care (18+). Members raised queries on the fact that three of the four metrics were highlighted as underperforming. A question was asked on what was being done to seek improvement in this regard and the Committee were told that, in line with the overarching ethos, the community offer would be developed, and workers will be utilised and mobilised as effectively of possible. This piece of work was highlighted as being in line with Primary Care Networks Stream which would help to make a sustainable difference in ensuring the optimal hospital utilisation.

A question was asked as to whether the performance figures put the funding at risk, to which it was explained that although the metrics were not good reputationally nor for patient outcome, the performance has not previously affected funding at all. The Director of Primary and Community Care for Dorset Clinical Commissioning Group reassured the Committee that the current direction was positive and that there must be commitment to ensure that sustainable community-based work was delivered. The BCF metrics exist within a wider work stream in Dorset focusing on growing our capacity and capability within primary and community services to reduce reliance on hospitals, especially by earlier work within our local population. National pressures, especially in non-elective admissions and delays within hospitals also dictate the starting base of performances. It was further detailed that a major piece of work concerns the investment stream into Primary Care services as well as making best use of existing resources, such as staff skills and the capacity of the joint work force GP Practices, community practices and adult social care processes.

The Director of Primary and Community Care for Dorset Clinical Commissioning Group clarified that the metrics of the BCF do not separate health and social care as these are fixed nationally. The Head of Strategic Planning and Quality Assurance for Adult Social Care added that localised data for November 2019 showed that BCP services saw 35 ‘bed days’, NHS hospital services saw 765 ‘bed days’ and there were 110 joint-services ‘bed days’ across the area. This placed the NHS at 123 out of 151 Local Authority areas, BCP Council at 13 out of 151 Local Authority areas and joint-services at 131 out of 151 Local Authority areas.

A question was received from Councillor Stephen Bartlett during item 8, relating to the former care-provision site, Templeman House. The question focused on whether Templeman House would be a viable facility for temporary accommodation following hospital treatment. The Portfolio Holder for Health and Adults, the Director of Primary and Community Care for Dorset Clinical Commissioning Group and the Director of Adult Social Care Commissioning responded by clarifying that the site was not suitable given its size and its current standard of building regulations. In order to refurbish the building suitably, a third of all beds would be lost. Furthermore, the site is even more unsuitable for those with complex needs, who are generally the patients that require temporary accommodation between hospital treatments and returning home.

A question was asked by a member on the cost of equipment to assist with independent living in homes. The Director of Adult Social Care Commissioning explained that provision of equipment was a universal service and there was no cap on the number of pieces that an individual can have. This area has a pooled budget with Dorset Council and the governance arrangements around purchasing equipment is subject to price-effectiveness and recycling schemes.

Resolved that:-

Members agreed to request that Officers bring a report to Committee in October featuring the BCF’s end of year performance and also the 2020/21 plan, for scrutiny.