Agenda item

This report provides the Health and Wellbeing Board with an update on Medway’s Better Care Fund plan. The report presents the highlights from 2017/18 and developments for 2018/19.

Discussion

The Interim Head of Adults’ (25+), Partnership Commissioning and Better Care Fund presented an update to the Board on Medway’s Better Care Fund.

The Board’s attention was drawn to the highlights of 2017/18, set out at paragraph 3.1.1 of the report. Particular emphasis was given to the programmes initiated through the Better Care Fund to streamline discharge pathways and improve patient flow out of hospital. This included commissioning a range of intermediate care beds and the introduction of the Home First model. The Board was advised that there were now four discharge pathways, which was a reduction from nine and that the Home First model was successfully discharging 35 patients per week.

It was added that Medway was one of the best areas for reducing Delayed Transfers of Care (DToC), this reduction had been particularly noticeable since February 2017 and in April 2018 the average delayed discharge was 1.4 days. It was recognised that as a result of this achievement, other Local Authorities had approached Medway Council for advice on practice to improve DToC. The Director for Assurance and Delivery, NHS England, commended the outcomes under the Better Care Fund and stated that the DToC figure before Christmas was zero which was unprecedented. However, it was explained that improvement and support needed to continue as the DToC figure had since risen.

The Board’s attention was also drawn to the 2018/19 projects outlined in paragraph 4.2.2 of the report. It was explained that these programmes aimed to prevent admissions to hospital and support patients, where appropriate, to return home from hospital with a package of homecare support at the earliest opportunity.

With regards to learning from good practice, the Board was advised that the Better Care Fund team were part of the Better Care Fund network where good practice from other Local Authorities was shared.  Examples of good practice presented to the Board included the Leeds Better Care Fund programme, here 500 patients were on integrated discharge care plans. It was explained to the Board that the Medway team were investigating ways to move towards greater integration and joint care planning. Gloucestershire, Lincoln and Nottinghamshire also provided good examples of the use of joint health and social assessments and care plans.

A member expressed a number of concerns regarding private care providers. Concerns included a lack of continuity of carers, missing or late arrivals to appointments and insufficient time spent with patients over the course of their care. The Interim Head of Adults’ (25+), Partnership Commissioning and Better Care Fund advised the Board that under current commissioning arrangements the Local Authority spot purchased care from seventeen homecare providers. It was explained that many private clients would access the same providers. However, as part of service recommissioning the Board was advised that providers would be given greater certainly regarding the number of care hours and support that would be commissioned annually. This would enable providers to create more salaried posts for carers as opposed to retaining them on zero hours contracts which encouraged a high staff turnover. It was added that salaried staff would also benefit from training and development. In this context and utilising fewer providers it was hoped that better and consistent relationships would be developed with patients and clients who needed domiciliary care. It was added that the home care providers would be encouraged to offer the same model of care to private clients.

A Member sought clarification on where customer satisfaction information on each of the Better Care Fund programmes could be found. The Board was advised that each individual programme collated customer feedback and satisfaction surveys. The Interim Head of Adults’ (25+), Partnership Commissioning and Better Care Fund undertook to provide a briefing note to the Board on Better Care Fund programme outcomes and customer feedback.

Decision

The Health and Wellbeing Board:

a)    noted the update on the Better Care Fund set out within the report; and

b)    requested a briefing note on the Better Care Fund programme outcomes and customer feedback.