Agenda item

The Chairman advised that the report set out the financial position across health and social care and that it would be important to consider the wider views of the NHS regarding the improvements resulting from The Hillingdon Hospitals NHS Foundation Trust’s CQC report. 

It was noted that the Better Care Fund report being considered at this meeting included a breakdown of Hillingdon's performance in reducing delays to transferring care (DTOC).  Although the target of 4,991 was likely to be achieved, and perhaps be exceeded, a severe winter could impact on this performance.  A business case had been produced to consider long term funding of the bridging care commissioned to support this performance and realise the benefits of early discharge.

New data had been issued from the National Child Measurement Programme showing that the proportion of overweight children in Hillingdon at reception year was lower than the London and England averages.  At year six, however, the proportion was below the London average but higher than the England average.  The prevalence of underweight children in Hillingdon was higher than in London and England.  This data would be used to help inform plans for early intervention, prevention and self-care in the Joint Strategic Needs Assessment. 

The Board was aware that there had been a reduction of £0.63 per £1 in Government funding to local authorities.  Although the Government's proposals for future funding of adult social care in the Green Paper and its links to the NHS long term plan were anticipated to be published "later this year", the Health and Care Secretary had announced "winter pressure" additional adult social care funding to support admission prevention and accelerate discharge.  In addition, a further £650m nationally had been made available to tackle immediate challenges in respect of social care.  In Hillingdon, this equated to approximately £2.8m.  Overall this meant that the Council's grant funding from central Government for 2019/20 would now be a net cash reduction of £4.1m on 2018/19 rather than the previously planned net cash reduction of £6.9m.  Specific to social care, the Corporate Director for Social Care added that the Council had a £2m full year effect pressure over this year which was inflation in the care market beyond what had been planned for. 

The Corporate Director of Social Care explained that he had set out how the local authority proposed to apply the additional funding to support winter pressures within the context of the local care market, as was specified in the determination and that this had been shared with the Chief Operating Officer of Hillingdon Hospital, the Managing Director of Hillingdon CCG and the Deputy Chief Operating Officer of CNWL and a subsequent discussion had been undertaken.

The Corporate Director of  Social Care advised that stabilising care provision in the Borough was the most critical feature across the whole system, ensuring that there was care available at the end of the various pathways in order that those pathways were freed up, thereby avoiding referrals onto higher costs health services.  It also supported there being suitable provision available for people when they left hospital.  In addition, the one off nature of the social care winter funding meant that sustainability was important across the system beyond this period.  The Council's view was, therefore, that the most beneficial use of the winter funding money to the overall system would be to support care provision as the final destination of care. 

The Managing Director of Hillingdon CCG stated that it was difficult to argue with that, but that the system would want assurance of the benefits it would see.  The Council provided assurance that investment in the end destination of the system (direct care) in this way, supported the ability of adult social care to meet the requirements of the grant determination and in the broader narrative, including having social care services on standby to mobilise as and when the acute clinical pathways were sufficiently in place to deliver against planned and agreed integrated discharge arrangements including, for example, the availability of appropriate social care services seven days a week and the increased availability of reablement to support admission avoidance and discharge.

It was noted that Hillingdon Clinical Commissioning Group (HCCG) had asked for support from the Council's public health team to help evaluate the impact of its commissioning programme.   This work, together with wider support for HCCG from public health would be developed as part of the core offer delivery plan and it was proposed that the current Memorandum of Understanding be reviewed for 2019/20 and brought back to the Board in the New Year. 

RESOLVED:  That the Health and Wellbeing Board:

1.    considered the issues raised at 3.2 of the report setting out live and urgent issues in the Hillingdon health and care economy.

2.    noted the performance issues contained at Appendix 1 of the report.