Briefing Note / Middlesbrough Health and Wellbeing Board
Date / 21 June 2017
Title / Better Care Fund and Integration Update
Responsible Officer / Kathryn Warnock – South Tees Integration Programme Manager
Purpose of Item / To provideMiddlesbrough Health and Wellbeing Board with a summary of:
  • Better Care Fund progress for 2016/17
  • BCF Planning for 2017/18
  • Improved Better Care Fund

Summary of Recommendations / MiddlesbroughHealth and Wellbeing Board is asked to :
  • Note the Quarter 4 BCF monitoring template that was submitted to NHS England 31 May 2017
  • Note the latest guidance in respect of BCF planning for 2017/18, progress made in developing 2017/18 plans, including feedback from Special H&WBB meeting( 16 May 2017) and joint session with Redcar & Cleveland H&WBB (24 May 2017)
  • Note the agreed use of the improved better care fund for Middlesbrough.

Better Care Fund 2016/17

  1. Middlesbrough and Redcar & Cleveland’s Better Care Fund Planswereformallyapproved in July 2016.
  1. In June 2016, both Middlesbrough Council and Redcar and Cleveland Council entered into section 75 agreements with South Tees Clinical Commissioning Group to govern the Better Care Fund Pooled budget.
  1. Reporting on progress against Middlesbrough and Redcar & Cleveland’s BCF plans is required on a quarterly basis.
  1. Quarter 4monitoring was submitted to NHS England 31 May 2017, this is attached at appendix 1.
  1. The performance dashboard is attached at appendix 2 provides a high level summary on each of the BCF metric
  1. Key BCF schemes are summarised below:

Single Point of Access / •The SPA initial contact centre was designed, implemented and operational from 30th January 2017. A total of 90 members of staff, which includes qualified and clinical staff as well as initial call handlers, moved into the new building.
•An Information Sharing Agreement is in place
•A new telephony system has been designed and is operational. This allows the provision of statistical data on call volumes, wait times, abandoned calls etc which is informing and shaping service improvements and customer experience.
•A ‘settle and assess’ period is nearing completion and findings will help inform the next phase of the project.
Phase 2 will explore the possibility of having integrated teams within the SPA and possibly co-located teams
This would make better use of the joint resources we have available to meet the health and care needs of the population of South Tees and reduce the financial burden on organisations as well as shifting resource to where it is needed.
Support to Care Homes / Commencing April 2017 a range of 12-18 month schemes have been developed with stakeholders from the 5 South Tees Partner Organisations and care home staff to provide support to improve the quality of care for people in care homes
•Care Home Education visiting and Support Service (CHESS)
3 Emergency Health Care Practitioners to provide response within 2 hours for any resident at risk of being admitted to hospital
Education and Training for care home staff on site at the care home
Development of I.T application to support clinical processes
•Proactive Medicine Management Support to ensure early identification
•Nutrition Training, Education and Support
•Falls Education and Telecare (pilot undertaken and currently being evaluated)
•End of Life Specialist Palliative Nurse
•Patient Passport developed and rolled out to all care homes
•Infection Control Nurse
GP Urgent Care Scheme / This urgent care scheme is looking to shift activity from unplanned, urgent care at A&E and the hospital, into primary care.
•The scheme will provide practices with an additional payment contingent on either:
•Maintaining a low level of urgent care activity
•Reducing the level of urgent care activity
•The aim of the scheme is to reduce pressure on the urgent care system through improvements in the quality of primary medical care services
•Practices will identify and develop improvement schemes to reduce unplanned admissions from their patient groups
•The CCG targeted spend per weighted population head is £168.00 per patient on non-electives and A&E attendances as at the 01st October 2016
•The expected savings over a 2 year period are c.£2m
•The practices have started work on the scheme and there are a number of practices that have achieved a reduction in unplanned admission spend

Better Care Fund Submission 2017/18 – 2018/19

  1. The national policy framework for the next round of the BCF was published in March 2017 however it is still unclear when the guidance will bepublished.
  1. However we have been given the following indications:
  • Plans to be jointly agreed
  • The NHS contribution to adult social care is maintained in line with inflation
  • Agreement to invest in NHS commissioned out-of-hospital services, which may include 7 day services and adult social care
  • Managing Transfers of Care (a new condition to ensure people’s care transfers smoothly between services and settings)
  1. Beyond this, areas have flexibility in how the Fund is spent over health, care and housing schemes or services, but need to agree how this spending will improve performance in the metrics.

  1. A special meeting of the Middlesbrough was held on 16 May 2017.

  1. Although the technical guidance and confirmation on the BCF allocations had not yet been published, the Board was presented with the emerging proposals for 2017/19 for their consideration, so that their views could be taken into account before the final proposals are presented to the Board, which would be at a future meeting.
  1. The proposed spending plan for the Improved Better Care Fund was also presented for information, which must be agreed by the Council and South Tees Clinical Commissioning Group.
  1. Representatives from the Local Authority, The Clinical Commissioning Group and the South Tees Integration Board provided details on each of the individual schemes. Members of the board were given an opportunity to discuss the plan in detail and raise comments and questions.
  1. Officers from the local authority and clinical commissioning group will continue to work on the BCF plans and ensure that comments received by Health and Well Being Board members are taken into account as part of the final submission.
  1. The final BCF plan will be presented to a future meeting of the H&WBB once national guidance and the submission timetable has been published.

Joint Health and Wellbeing Board - 24 May 2017

  1. A second joint meeting between Redcar & Cleveland Health and Well Being Board and Middlesbrough Health and Well Being Board took place 24 May 2017.
  1. Local areas are expected to have a strong local leadership with an agreed vision for health and social care integration to 2020 that links clearly to wider health and local government strategies including housing and planning. The two boards worked together to start to explore our local vision for health and social care integration.
  1. The event was well received, officers are currently preparing a report with the output from the session, and this will be discussed with the Chairs of the two boards, and will be presented to a future meeting of the Board.

Improved Better Care Fund

  1. The Improved Better Care Fund requirements are that the proposals must be agreed between the local authority and the Clinical Commissioning Group as to how the additional funds will be spent.
  1. The guidance states that the fund is intended to enable local authorities to quickly provide stability and extra capacity in the local care systems. Local authorities are therefore able to spend the grant, including to commission care, subject to the conditions set out in the grant determination, as soon as plans have been agreed locally. The grant therefore, may only be used for the purposes of:
  • Meeting adult social care needs
  • Reducing pressures on the NHS, including supporting more people to be discharged from hospital when they are ready
  • Ensuring that the local social care provider market is supported
  1. The proposed use of the funds was considered at the special meeting of the Health and Wellbeing Board, 16 May 2017, and agreed by the South Tees Clinical Commissioning Group Executive Group meeting, 31 May 2017.
  1. The table below sets out the plans for the use of iBCF in 2017/18

2017/18
£000
Fund existing pressures in ASC including demographic increases and support sustained delivery of core, critical social care and maintain overall system / 1200
Further uplifts to domiciliary and care home fee rates / 1956
Enhancing reablement provision and investment in new intermediate care solutions / 1172
Total / 4328

Recommendations

  1. Middlesbrough Health and Wellbeing Board is asked to:
  • Note the Quarter 4 BCF monitoring template that was submitted to NHS England 31 May 2017
  • Note the latest guidance in respect of BCF planning for 2017/18, progress made in developing 2017/18 plans, including feedback from Special H&WBB meeting (16 May 2017) and joint session with Middlesbrough H&WBB (24 May 2017)
  • Note the plans for the use of the improved better care fund for 2017/18

Report prepared by:

Kathryn Warnock – South Tees Integration Programme Manager

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