Agenda item

Mr Gary Collier, the Council's Health and Social Care Integration Manager, advised that the report set out the successes and challenges of the 2016/2017 Better Care Fund (BCF) Plan as well as presenting the 2017-2019 BCF Plan which had been submitted and was expected to be approved (or approved with conditions).  Once approved, it was anticipated that the 2017-2019 Plan would be considered by Cabinet in November 2017. 

Successes from 2016/2017 included:

·         Joint working across services - this had reduced the number of hospital admissions at a time when A&E attendance was increasing (activity levels had remained the same as for 2015/2016);

·         H4All Wellbeing Service - positive results had been gained in preventing the escalation of the needs of older people with long term conditions;

·         Hospital discharge - as patient choice was a significant contributory factor to Delayed Transfer of Care (DTOC), a booklet had been produced to help support these patients and their families.  Training had also been provided for staff in relation to DTOC.  Funding had also been secured for a consultant geriatrician and nine Patient Flow Coordinators had been recruited to improve the discharge process; and

·         Carers' hub contract - this was provided by Hillingdon Carers' Partnership and led by Hillingdon Carers.  This project had been successful in attracting new resources to the Borough which was then reinvested to support carers in Hillingdon. 

It was noted that targets for five of the six national metrics had been missed in 2016/2017.  The Committee was advised that this could give a misleading picture, for example, although the emergency admissions target had been missed, the level of activity had remained at the same level as the previous period within the context of increasing numbers of older people living with more complex conditions.  It was also noted that some targets had been imposed on Hillingdon by the NHSE, e.g., emergency admissions and the effectiveness of Reablement.  The Committee was informed that a contributory factor in the rise in DTOCs had been underreporting in 2015/16.  Much work had since been done to provide a consistent understanding of the definition of a DTOC across partner organisations.  Although this had been particularly successful in respect of Hillingdon Hospital, there was still some work in progress on the verification process with other partners.  Turnover of staff was one reason why this continued to be an issue.  

Hillingdon, like many areas, had also faced market issues such as the availability of appropriate care home places.  Mr Collier noted that 2016/2017 had been anticipated as being a challenging year to deliver as the first year of the plan (2015/2016) had included work that had already been agreed.  2016/2017 was therefore more of a positional year that provided a foundation for the 2017-2019 Plan. 

Members queried what action had been taken to improve DTOCs since it was raised in 2014/2015.  Ms Joan Veysey, Deputy Chief Operating Officer at Hillingdon Clinical Commissioning Group (HCCG), advised that the focus had been on ensuring that the hospital was a safe place to be after a patient was medically well whereas consideration was now given to what value was added to a patient being in that setting.  There was an assumption that there were too many hospital beds and that many patients did not need to be in hospital.  As such, work had been undertaken over the last two years to develop out of hospital services to support patients in home settings.  Although the DTOC processes had not been in place at that time, the work had built up the support capacity that would be needed in the community once these processes were in place.  Work on the processes was now underway.

Mr Collier was asked by the Committee to provide benchmarking information where available so that Members could see how Hillingdon performed in 2016/17 in comparison with London and England.

Dr Veno Suri, Assistant Vice Chair of the Hillingdon Local Medical Committee, agreed that there was a need for community services to be in place to prevent DTOCs and that integrated care was one way of moving this forward.  Although the services had not been available 10 years ago, Dr Suri was now able to offer his patients an increasing range of out of hospital services.  He noted that there needed to be a balance between delayed transfers of care and patient choice. 

The integration of health and social care had been reflected in the North West London Sustainability and Transformation Plan (STP) as a mechanism for assisting in delivering a sustainable health and care system.  The Hillingdon aspect of this could be seen in the Health and Wellbeing Strategy (HWS) approved for consultation by the Hillingdon Health and Wellbeing Board in September 2017. 

Regarding the targets for 2017/2018 and 2018/2019, the Committee was informed that, whilst the Board noted the targets set by NHS England for the 2017/2018 BCF Plan, it reserved the right to consider the deliverability of any external targets for 2018/2019 prior to them being agreed. 

Key developments included in the 2017-2019 Plan included a joint market management and development approach which would be a step-change for Hillingdon.  As part of this, the Council and HCCG would be developing an all age joint brokerage service to, amongst other things, arrange homecare packages and short and long term nursing home placements.  This approach also included the commissioning of integrated end of life care at home provision in 2017/2018. 

The report stated that the investment requirements for the integrated hospital discharge scheme had increased from £16.013k in 2017/2018 to £32.062k in 2017/2018.  Although it was recognised that some of this budget would be used to prevent admissions, concern was expressed that funding for DTOC was not necessarily increasing despite the increased importance placed on it.  Mr Collier stated that effort was made to ensure that the schemes included in the BCF Plan were focussed but also advised that a large proportion of the funding was already allocated towards existing contracts that supported the associated schemes.  An intention of integrated working was to look at ways of upstreaming resources to prevent admissions occurring in the first place and/or facilitating discharge before a DTOC occurred.  He noted that the integrated hospital discharge scheme was about prevention of admission as well as supporting discharge.  Services were working differently now, with more collaboration between teams and services to forge a single pathway for service users. 

Members were surprised that the Early Intervention and Prevention Scheme mentioned in the report did not include diabetes.  Ms Veysey noted that, although not mentioned in the report, H4All had extended the wellbeing service to more than 700 diabetic patients. 

Of the £877k allocated to the wellbeing service (H4All) in 2017/2018, the Council had contributed £543k.  Mr Collier advised that this amount constituted the core grant for four of the constituent organisations of H4All.  Mr Kevin Byrne, the Council's Head of Health Integration and Voluntary Sector Partnerships, advised that there was no intention to change the funding arrangements for the four organisations included within H4All that were funded by the Council.  However, there would be recognition of the dependency between this funding and the capacity of these organisations to develop the Wellbeing Service.

Concern was expressed that the initial intention of the BCF was to bring funding together to afford change but that little flexibility had been realised as much of the funding had to be used for fixed costs.  However, Members appreciated the hard work and time involved in putting the BCF Plan in place. 

RESOLVED:  That the presentation be noted.