Agenda item

This report provides the information in relation to the Better Care Fund (BCF) Plan and its implications for Medway further to revised guidance issued by the Local Government Association (LGA) and NHS England on 25 July 2014.  The Board is being asked to support the Plan in its draft state recognising it will need to be revised prior to final submission on 19 September 2014.

Discussion:

The Assistant Director, Commissioning and Strategy gave a powerpoint presentation as an introduction to the Better Care Fund Plan and emphasised that the Plan had been judged by NHS England and the Local Government Association as good and she did not consider there would be major changes to the narrative.  She referred to a regional workshop held the previous day, which had been attended by officers of the Council and said that there would be changes up to the actual date of submission.

The Board were told that there were five new questions to answer in relation to the Better Care Fund Plan, as well as revisions to the four existing questions.  The new questions related to the following:

• Case for change
• Plan of action
• Risks and contingency
• Alignment
• Implications for acute providers

It was stated that the £1bn linked to pay for performance would be released proportionate to performance against the 3.5% target of reduction in non-elective activity (hospital admissions).

Details were given of the next steps, which were that the plan would be resubmitted on 19 September 2014, the assurance process should end on

13 October 2014 and the next seven months would be used to further the plan recognising that not everything goes ‘live’ by 1 April 2015.  During that period there would be continued engagement with professionals, existing users and potential users throughout the process.  A number of task and finish groups will be established on specific themes.

The Chairman stated that he had received a message from Dr Beach, the Healthwatch Medway representative, supporting the recommendations contained in the report.  Members of the Board generally were very supportive of the Better Care Fund Plan aims and the Acting Chief Executive of Medway NHS Foundation Trust stated that from an acute trust perspective the Plan presented a win/win situation.  He did state, however, there was a degree of scepticism about whether the aims could be achieved bearing in mind the increase in activity at the hospital.  As the target related to hospital admissions, rather than hospital attendance, he felt more optimistic. He felt it would be important to concentrate efforts on prevention and the improved management of long term conditions and social isolation.

The Director of Public Health queried the lack of detail about the impact of each scheme and asked whether the modelling would give the assurances about this.  The Assistant Director, Commissioning and Strategy explained that this would be apparent before April 2015.  The Chief Clinical Officer, NHS Medway CCG confirmed this and stated that the Plan needed to interrelate  with other work which the Council and CCG were undertaking and it would be difficult to decide which component would deliver which outcome.  The Chief Operating Officer,  NHS Medway CCG stated that the community redesign would also be an important factor in achieving the target.

The Deputy Director, Children and Adults referred to a nervousness in the system about the impact on and implications for acute providers but stated that the Medway Better Care Fund Plan was good and that the intention was to empower people and would take some time to achieve.  The Portfolio Holder for Adult Services also spoke positively about the Plan, which he felt was a golden opportunity to improve services for the common good.  

The Chairman then referred to a minor amendment to the final recommendation in the report on page 12 of the agenda, which is reflected in the decision below.

Decision: 

The Health and Wellbeing Board supported the following:

(a)   the proposed governance journey for the delivery of the revised BCF plan;

(b)   the plan (attached as appendix 4 to the report) as it now stands, accepting that the plan is an iterative process that will continue to be developed as more information and guidance from the LGA/NHS England becomes available;

(c)   and notes that the Cabinet has given delegated authority to the Director of Children and Adults Services, in consultation with the Portfolio Holder for Adults Services, to finalise and submit the revised plan after it had been considered and endorsed by the Health and Wellbeing Board and to make any further minor amendments that may be required to the revised plan following submission.  The Governing Body of NHS Medway CCG has given delegated authority to the Chief Clinical Officer to do the same.