Agenda item

Mr Keith Spencer, Co-Chair of the Health and Wellbeing Board and Managing Director of Hillingdon Health and Care Partners, advised that the Better Care Fund (BCF) template had been submitted on 29 August 2024 under delegated authority.  Discussions were ongoing in relation to how funds should be deployed.  It was noted that Pathway 3 funding related to admittance to long term care and had been an area of focus. 

Given the timings of the national deadlines for reporting on BCF spend and activity, it was agreed that delegated authority to sign off the templates be given to the Corporate Director of Adult Social Care and Health in consultation with the Co-Chairs of the Health and Wellbeing Board, the ICB Borough Director and the Chair of Healthwatch Hillingdon. 

Although A&E attendances had stabilised, the conversion to admittance had increased significantly towards the end of last year and the beginning of this year.  Brunel had agreed to undertake some research to establish whether this increase in admittances had been as a result of individuals being sicker.  It was noted that the wrong solution was sometimes applied to a problem and action needed to be taken to establish whether or not this was the case in this instance. 

It was suggested that more could be done by partners in relation to cervical cancer screening as this had seen some slippage.  Furthermore, reference had been made in the report to slippage in the completion of Education, Health and Care Plans against the national target, yet no explanation had been given as to why the target was not being met. 

There had been some slippage in relation to the estimated diagnosis rate for people aged 65 and over with dementia.  The report stated that the main reason for not meeting the target during this period was due to temporary gaps in permanent staffing in the Memory Service.  However, concern was expressed that, during these temporary staffing gaps, locum support had been provided.  The Board asked what action had been taken to address this issue. 

Ms Vanessa Odlin, Managing Director for Hillingdon and Mental Health Services, Goodall Division at Central and North West London NHS Foundation Trust (CNWL), advised that, as far as she was aware, there had been no major staffing gaps in that service area.  Temporary staff were deployed whenever there were shortages so she would need to investigate to establish what this referred to and report back to the Board.  She would also check the demand for, and capacity of, the service. 

It was noted that Healthwatch Hillingdon had seen an increase in the number of patients that were unhappy with A&E and the Urgent Treatment Centre (UTC).  The CQC had recently undertaken an unannounced visit to the UTC and the resultant report was awaited.  It was queried whether the increase in admittances from A&E had any correlation with those patients that were known to be waiting for a medical or surgical intervention. 

Mr Spencer advised that the admissions from A&E had risen from 30-40% to around 60%, most of whom were patients that had been waiting for medical interventions.  It was recognised that it was important to understand the activity of these patients that were being admitted from A&E as Adult Social Care had also been seeing an increase in activity.  As information gathered by the old hospital IT system had been unable to look at activity or compare data, Brunel had been working on getting these comparisons from the data that was available.  It was suggested that Brunel liaise with Adult Social Care to include this in its research. 

Information from the Clinical Decision Unit had showed that flow had improved and length of stay and discharge were good at Hillingdon Hospital.  However, there were some contradictory issues whereby the length of stay had been reducing but acuity had been lower at the weekend than during the week.

It was queried how much information the Board wanted to receive in future.  Did the Board want to continue to receive the high-level messages arising from activity as well as reporting by exception where its intervention was required to address blockages?  It was agreed that changes would be made to the format of the report and how the data was reported so that the focus would be on those issues that were deemed to be most important.  A dashboard format would be brought to the next Board meeting on 26 November 2024 to get feedback. 

RESOLVED:  That:

1.    the 2024/25 Quarter 1 BCF reporting template be approved;

2.    delegated authority to approve Better Care Fund reporting templates be given to the Corporate Director of Adult Social Care and Health in consultation with the Co-Chairs, the ICB Borough Director and the Chair of Healthwatch Hillingdon;

3.    arrangements for the monitoring of, and reporting on, activity and spend against the agreed BCF plan as outlined in the report (paragraph 9) be reaffirmed;

4.    a dashboard format of the report be reported to the Board’s next meeting on 26 November 2024; and

5.    the content of the report be noted.