Agenda item

(To receive a report by Glen Garrod, Executive Director Adult Care and Community Wellbeing, and Gareth Everton, Head of Integration and Transformation, which includes the BCF 'Narrative Plan' for 2019/20 for approval by the Board prior to submission)

Consideration was given to a report which included the Better Care Fund (BCF) 'Narrative Plan' for 2019/20.  It was reported that as with previous plans this must be agreed by the Board prior to submission.  The Plan would also be approved by the Executive Director of Adult Care and Community Wellbeing in consultation with the relevant Executive Councillors on behalf of the County Council.  The plan was in the process of being considered by the Clinical Commissioning Group's (CCG's).  The report also provided an analysis of the latest performance concerning the BCF metrics.

The Executive Director for Adult Care and Community Wellbeing introduced the report and highlighted that whilst the Board received regular updates on the BCF as an information item, this report included the narrative plan that was to be submitted to government for approval to allow the authority to spend the money from April 2019 – 2020.  The time frame for approvals did not always match with the reality of when the funding was to be spent.

It was highlighted that there would be a sizeable loss if the Government did not continue with the BCF in some form.  The narrative plan that was contained within the report was set against the template provided by the government.  A final decision was expected in November 2019 and it was expected that it would be processed and approved without undue delay.  The end of the BCF had been moved back from March 2020 to March 2021 and so would continue for a further year.  This would allow the government time to come up with a longer term solution. 

The narrative plan for Lincolnshire had been subject to NHS, district council and county council involvement.  It reflected the narrative plan that was agreed the previous year as part of a two year programme.  It was noted that the conditions that went with the BCF had not changed for a number of years.  There were three main conditions – to protect social care, to ensure the supply of social care services and to support the NHS with the provision of out of hospital care.

Expectations from government had been reduced and there was now more of a focus on Delayed Transfer of Care (DTOC) which had a high profile on the national agenda.  It was reported that Lincolnshire was in a good place for meeting some of these conditions.  It could be expected that subject to national changes, the funding would be used to further integration from 2020/21 onwards.  Lincolnshire had one of the largest pooled budgets in the country.

The signatories were the four CCG's, the County Council and the Health and Wellbeing Board.  The decision to approve this was critical due to the necessity of the funding which was used to underwrite the base budgets as well as some new investments.  The Plan needed to be submitted by 27 September 2019.  It was currently going through the CCG's decision making processes and Councillor Mrs P A Bradwell OBE, Executive Councillor for Adult Care, Health and Children's Services would sign on behalf of the County Council.

The Board was provided with the opportunity to ask questions to the officers present in relation to the information contained within the report and some of the points raised during discussion included the following:

·         It was commented that a lot of issues were due to a lack of communication and there was a need to work with the hospitals.  It was noted that East Lindsey had dedicated discharge workers.

·         It was highlighted that the County Council placed people out of county as well as in private hospitals which made it difficult to co-ordinate care for leaving hospital.

·         It was queried how many people came into Lincolnshire for care from out of county and the Board was advised that Lincolnshire was a net exporter, and the numbers of those coming in from out of county were relatively low.  It was acknowledged that out of county placements did cause issues, however, this was a challenge across the country.

·         It was noted that when people had elective surgery they could choose to go to a private hospital for NHS care.

·         It was queried what was being done to improve the position, and the Board was advised that discussions were taking place with NHS colleagues about this.  It was noted that there were some patients who were placed in London hospitals.

·         There was a need for a proactive date of discharge, as not all out of county hospitals would provide this.  If there was not a predicted date of discharge, this could cause a delay of 12 - 24 hours for the patient leaving hospital.

·         It was commented that there was not just one thing that would resolve this.  Credit should be given to colleagues for the achievements made so far. 

RESOLVED

            That the Lincolnshire Health and Wellbeing Board approves the BCF Narrative Plan for 2019/20 and notes the update to performance activity.