Agenda item

Glynis Rogers, Divisional Director Community Safety and Public Protection and Sharon Morrow, Chief Operating Officer Barking and Dagenham CCG, jointly presented the report and reminded the Board of the background to the Better Care Fund (BCF) that had been announced by the Government in June 2013 and how it provided an opportunity for the Council and CCG to use existing funds to work together to transform local services and accelerate the progress towards integration. 

The plan for the BCF, which focused on the 11 individual schemes, had been approved by the Board and was submitted to NHS England and LGA on the 4 April and positive feedback had been received.  Since then new guidance had been issued, which had required further work to be undertaken to produce a revised BCF plan for submission by 19 September 2014.  However, a major component of the resubmission was the need to agree a target for reducing ‘avoidable emergency admissions to hospital’ against a national target of 3.5% of all admissions.  In this target area Barking and Dagenham had provided good performance over recent years. The further requirements from the NHS were in regard to national assurance process and nationally.  The £1m performance related funding was attached to 3.5% performance and a £2.% performance would result in a £400,000 less funding.  Providers were required to sign off the revised plan including the target on admissions. 

The Chair commented that she had seen the Better Care Fund as being a great opportunity for different and innovative ways of working, but then the rules had changed and decisions were now being restricted by constantly changing guidance and had been undermined by the focus on hospital admissions.  Martin Sheldon added that new guidance was being issued on a weekly basis and comments were constantly being fed back to NHS England, however, he felt if BCF ceased the projects that had been identified were sufficiently robust and would continue regardless of central guidance changes.

The Chair opened the issues for discussion and comments included:

Steven Burgess asked if a 2% target may not be considered stretching enough based upon the background of the BHRUT being one of the worst performing trusts in London at present.  Discussion followed on the negative effect of setting a target that currently was not achievable and also on setting a target that was not stretching enough.

Dr John and Martin Sheldon both raised the effect of targets on A&E and admissions, which first and foremost had to be based on clinical decisions.  Mark Tyson advised that support had been indicated from Consultants.

Councillor Carpenter asked for clarification in regards to support for family carers and engagement with local carers and in particular children who were carers.  Sharon Morrow gave assurance that it did include young carers. 

Councillor Carpenter raised concern about the time that it can take to arrange for appropriate equipment and adaptations so that people could be quickly supported to allow them to remain in their own homes and was advised that work was ongoing to streamline the referrals and that a project plan and scoping paper had been scheduled for the Integrated Care Sub-Group.

Having discussed in some detail the need for an achievable but stretching target, the Board:

(i)  Noted the progress on developing governance and management arrangements and endorsed the direction of travel for those;

(ii)  Noted the progress made in the delivery of the individual scheme plans, provided within Appendix 1 of the report;

(iii)  Agreed the approach for the target reduction in emergency admissions for the Barking and Dagenham BCF, and that the Board would wish this to be in the order of 2%; and,

(iv)  Delegated to the Corporate Director of Adult and Community Services on behalf of the Council to finalise any outstanding matters from the Board’s discussions and to further test our approach against national assurance with the Accountable Officer on behalf of Barking and Dagenham CCG, with the Chair of the HWBB, prior to formal submission to NHS England.