Agenda item

Mark Tyson, Commissioning Director Adults’ Care and Support, advised that by Minute No. 6, 5 July 2017, the Board had given delegated authority for a response to be sent on 11 September 2017 and that the report in front of the Board was not seeking any decision but was purely to provide an update.  Work had been undertaken on the Barking, Havering and Redbridge (BHR) Plan in association with commissioning partners and it reflected the shared ambition for progressing integration and service improvement across BHR.  The work had been significantly borough based this year (Year 1) and had focused on aligning plans and governance.  There would be a more integrated Plan across the three boroughs for the following years, with Year 2 seeing substantive integration through joint commissioning. 

The report and its appendices set out in further detail the implication and planning requirements since the 5 July meeting of the Board.  Mark drew specific attention to several issues including:

·  Funding for the next two years

The contributions from the Local Authority, new grant funding, the Disabled Facilities Grant allocations, CCG contributions resulting in a total BCF funding pot of £21,758,000 in 2017/18 and £24,236,000 in 2018/19.

·  Governance
It is expected that a new structure will be formed in 2018/19 to reflect the greater interdependence of the Plans and further reports will be presented on this issue in due course.

·  Delayed Transfers
Guidance from NHS England had placed a greater emphasis on delayed transfers (out of hospital).  The Borough was out-performing the 45-day target and in the past year had achieved a 30-day average, which was one of the best performances across London. 

·  New grant measures, which were allowing more to be done in regard to mental health provision, , as well as allowing the Council to contain the cost of the previous year’s £100/week increase in residential care fees.

·  Equipment Purchase contract(s) that would allow easy item / service provision, which in turn would reduce delays in people being discharged from hospital.

·  Support for carers in delivering care within an individual’s home.

·  Hospice transfer for both respite and end of life care.

·  The effect on Localities and Intermediate Care provision

The Chair raised concerns that the Partnership appeared to be being penalised for doing well and that we should be setting the achievable average target of 45 days and if we do better that can be applauded.  The partnership had worked together in setting-up the systems to achieve that good level of performance and those systems now need to be left to bed-in, but would continue to be monitored to ensure there was no downward performance drift.  The Chair stressed that the Partnership needed to now concentrate on other pressing areas of performance improvement.  Cllr Carpenter commented that we should determine the target and fight for an achievable target.  Concern was also raised that too stretching targets could encourage risky or too early discharge resulting in rapid readmittance.  It was noted that some negotiation might be necessary with NHS England.

Cllr Carpenter advised that all students at Barking and Dagenham College attend a mandatory course on mental health and wellbeing.  This was aimed firstly at encouraging those that were not coping to seek help earlier and secondly in increasing awareness of the effects of mental ill health and even stress.  This type of course could be expanded to other organisations.

Cllr Carpenter pointed out that there have been two reviews on dementia services and asked why the service needed to be reviewed again.  Matthew Cole advised that those reviews had primarily centred on the services for the older, generally octogenarian plus, dementia patient, but it was now necessary to look at dementia services for an earlier age range.  This provision and access to treatment review was being driven by several issues such as the improvement in clinical diagnosis levels, earlier in the condition, which had increased younger patient demand, and the changing healthcare landscape. 

Sharon Morrow advised that new guidance was also expected imminently and that would probably result in a fresh look at the ways we can effectively deliver the improvement plan, including through commissioning, in the changing healthcare landscape. 

Melody Williams advised that the NELFT Memory Services had received Memory Service National Accreditation Programme (MSNAP) accreditation from the Royal College of Psychiatrists’ Combined Committee, which nationally recognised NELFT good practice. 

Mark commented that further work would be needed to develop the coalition and also the direct payment provisions.

It was noted that plans were underway for World Mental Health Day and Mark would check that this links-up with the work and events at the College.

The Chair concluded the discussion by commenting that the Programme had been developed by the local health community and that the partnership working driven by the Board had benefited the residents.  The Chair stressed that whilst the three boroughs could come together, it must be recognised that the communities are distinctly different and flexibility has to be maintained to meet local needs.

The Board:

(i)   Noted the contents of the report and the Plan summary;

(ii)  Noted that work was ongoing in the development of funding mechanisms amongst the partners and the impact on direct payment;

(iii)  Supported the continuance of the 45 days target for transfer to social care, subject to negotiations with NHS England; and

(iv)   Noted that update reports would be presented in due course.