Issue - meetings

To consider a joint report of the Service Director (Adult Social Care) Stockport Council and the Chief Operating Officer (Stockport Clinical Commissioning Group)

The report outlines the approach taken to compile the latest submission of Stockport’s Better Care Fund Plan (BCF) which is due for submission to NHS England by the 19th September 2014. The latest submission requires further detail and analysis of how the BCF will be used and the impact this will have on headline measures regarding emergency admissions as well as the impact on Adult Social Care.

The draft submission templates will be circulated ‘to follow’.

Stockport Health & Wellbeing Board is recommended to:

(a)  Note and Comment on the draft Better Care Fund Plan;

(b)  Approve the Stockport’s draft Better Care Fund Plan for submission to NHS England.

(c)  Delegate responsibility to the Chair and Vice Chair of the Health & Wellbeing Board to approve any further amendments to the submission prior to the 19th September as identified by the Director of Adult Social Care (SMBC) and Chief Operating Officer (Stockport CCG).

Officer contact: Tim Ryley; 0161 426 5573; Tim.ryley@nhs.net 

Tim Ryley, Director of Strategic Planning and Performance, Stockport Clinical Commissioning Group, attended the meeting to provide an update to the Board on the development of the Better Care Fund Plan. The Plan would be submitted to NHS England on 19 September 2014. The latest iteration of the submission was provided to the Board along with a summary of the key issues and outstanding items (copies of which had been circulated).

The key issues identified in the summary

·         Setting the ambition for reductions in non-elective admissions.

·         Setting the ambition for other metrics.

·         Agreeing the distribution of the fund and impacts.

·         Agreeing risk sharing arrangements.

The following comments were made/ issues raised:-

·         The proposals had been subject to extensive discussion. The current iteration was a more realistic reflection of what was achievable. As a consequence this has meant that the Council has had to adjust its approach in its Medium Term Financial Plan.

·         Behind the figures contained in the submission the planned improvements in services, such as the falls service, would have a significant impact on people’s quality of life. The falls service was an example of relatively small investments having a significant impact on outcomes. Previous work by Age UK in this respect should be used to inform the development of the service.

·         It was useful to consider the BCF in the broader preventative agenda, particularly as the admission into hospital for an older person, particularly for a fall, was often the precursor to a decline in their overall health so admission should be seen as a last resort.

·         NHS England were likely to seek further reassurance about engagement and buy-in from stakeholders in the development of the plan, particularly in relation to the 3.5% admission reduction, as to fail to achieve this target will lead to further cost pressures. It should be borne in mind that there the plan required contingency funds to cover the costs of the Foundation Trust should they fail to meet the target, which would be a significant challenge for them.

·         What would the Board be able to do in the event of the 3.5% target not being met? The wider system needed to ensure that risk was being placed where it was appropriate.

·         Due to the overall financial profile of the local health economy, it was likely that the submission would be approved subject to conditions, due to the risks in the local health economy.

RESOLVED – (1) That approval be given to the draft Better Care Fund Plan for submission to NHS England, subject to the provisions of the additional note circulated at the meeting, and that the Chair and Vice Chair be authorised to approve any further amendments to the submission as identified by the Director of Adult Social Care (Stockport Council) and Chief Operating Officer (Stockport CCG) prior to the 19 September deadline.

(2) That the gratitude of the Board be extended to all those officers involved in the preparation of the Better Care Fund submission.

The Chair reminded the Board of his earlier announcement concerning an additional agenda item. He reported that he had requested the Democratic Services Manager to circulate a copy to all members of the Board a copy the letter he had received from the Department for Communities and Local Government concerning the Better Care Fund and that this had been done earlier in the day. The Board discussed the contents of the letter and :

RESOLVED - That the Chair be authorised to form a group to have general oversight, monitor and approve the response on the Better Care Fund, subject to formal consideration by the CCG Governing body and the Council Executive. The group to comprise the Chair, Vice Chair, Councillor Keith Holloway (Executive Councillor, Adult Care Services) and Councillor Tom McGee (Chair Health Scrutiny Committee) and that the chair be requested to provide appropriate updates to the Board prior to approval of the final BCF submission.

To consider a verbal update on the second submission with particular focus on the work of Health and Social Care professionals and the outcomes to be secured.

The Service Director (Adult Social Care), Stockport Council and the Chief Operating Officer, Stockport Clinical Commissioning Group, provided an update to the Board on Stockport’s Better Care Fund submission to the Department of Health and NHS England.

It was reported that feedback had been recently been received from the NHS England on the first submission of the integration plan, and all the points in the submission had been rated either green or amber. The feedback was consistent with expectations, and further work was already planned to address those elements rated amber as part of the preparation of the final submission.

The submission was highly ambitious, partly because it needed to be because of the overly hospitalised system in Stockport, but this also meant it was high risk. Nevertheless, NHS England believed the plan was deliverable and the commitment of partners was evident from the submission.

It was stated that the work on integration remained work in progress and the existing Marple and Werneth Locality Hub would provide valuable evidence and experience in the evolving system.

Members commented that the plans in Stockport were ambitious without being reckless, and realistic without being risk adverse, although it was recognised that there remained significant work still to do. The challenge remained to ensure that the savings accrued from integration were released for reinvestment.

RESOLVED – (1) That the update be noted and all those involved in the Better Care Fund preparation be thanked for their hard work to date.

(2) That the Service Director (Adult Social Care), Stockport Council and the Chief Operating Officer, Stockport Clinical Commissioning Group be requested to circulate a summary of the key issues from the first Better Care Fund submission.

To consider a report of the Executive Councillors (Adult Care Services) and (Health & Wellbeing)

The Better Care Fund (BCF) was announced in June as part of the 2013 Spending Round. It is a key enabler to driving forward the integration of health and social care which aims to improve outcomes for patients, service users and carers and develop a financially sustainable delivery model.

The draft BCF plan is attached to the report. Discussions are still on-going with the Clinical Commissioning Group to finalise the plan and the investment proposals within it. The BCF framework includes a significant performance related component and it is critical that plans deliver against the performance measures and national conditions. The draft plan has to be submitted by 14 February and a final plan by 4 April which will be subject to ministerial sign off.

The Executive is asked to endorse the direction of travel detailed in the draft BCF plan and delegate responsibility to the Corporate Director for People, the Executive Councillor (Adult Care Services) and the Chair of the Health and Well Being Board to finalise and submit a draft plan on behalf of Stockport Partners.

Officer contact: Terry Dafter/ Simon Finch, 0161 474 4001/ 4019, terry.dafter@stockport.gov.uk / simon.finch@stockport.gov.uk

A joint report of the Executive Councillors (Adult Care Services) and (Health & Wellbeing) was submitted (copies of which had been circulated) inviting the Executive Meeting to consider the draft plan submission for the Better Care Fund (BCF) that had been introduced by Government to further the integration of health and social care. The aim of the Fund was to improve outcomes and to develop a financially sustainable delivery model. The draft plan, if approved, would be submitted to the Department of Health by 14 February and a final plan by 4 April 2014 which would then be subject to ministerial approval. The Clinical Commissioning Group would also be considering the draft Plan at its Board meeting on 12 February 2014.

RESOLVED – That the direction of travel detailed in the draft Better Care Fund Plan be endorsed and the Corporate Director for People, with the Executive Councillor (Adult Care Services) and the Chair of the Health and Well Being Board, be authorised to finalise and submit the Plan on behalf of Stockport Partners.

To consider a joint report of the Service Director (Adult Care Services) and the Chief Operating Officer (Stockport CCG)

The Better Care Fund (previously referred to as the Integration Transformation Fund) was announced in June 2013 as part of the 2013 Spending Round.  It provides an opportunity to transform local services so that people are provided with better integrated care and support. The report sets out the proposals that will go forward as part of the bid from Stockport.

The Scrutiny Committee is invited to comment on the report prior to consideration by the Executive and Clinical Commissioning Group Board.

Officer contact: Terry Dafter on 0161 474 4401 or email: terry.dafter@Stockport.gov.uk

A representative of the Service Director (Adult Social Care) submitted a report (copies of which had been circulated) detailing a joint bid from the Council and the Stockport Clinical Commissioning Group for funding from the Better Care Fund (previously known as the Integration Transformation Fund) which aimed to provide an opportunity to transform local services so that people were provided with better integrated care and support.

The Executive Councillor for Adult Care Services (Councillor Keith Holloway) attended the meeting to answer members’ questions.

The following comments were made/ issues raised:-

·         It was stated that one of the conditions of funding was the protection of social care services and the definition that  would be worked towards in Stockport would be codified in the final application although it was anticipated that it would revolve around the progression of intermediate care services and reablement.

·         The funding would be allocated over two years with targets associated with spending over this period on an outcomes basis.  It was noted that as funding was only released on the basis of the assessment of achieved outcomes, consideration needed to be given to the stringency of the spending expectations.

RESOLVED – That the report be noted.

To consider a joint report of the Service Director (Adult Care Services) (Stockport Council) and the Chief Operating Officer (Stockport CCG)

The Better Care Fund (previously referred to as the Integration Transformation Fund) was announced in June as part of the 2013 Spending Round. It provides an opportunity to transform local services so that people are provided with better integrated care and support. The report sets out the proposals that will go forward as part of the bid from Stockport.

The Scrutiny Committee is invited to comment on the report before it is considered by the Executive and Clinical Commissioning Group Board.

Officer contact: Terry Dafter, Service Director (Adult Social Care), 0161 474 4401, tery.dafter@Stockport.gov.uk

A joint report of the Service Director (Adult Social Care) (Stockport Council) and the Chief Operating Officer (Stockport Clinical Commissioning Group) was submitted (copies of which had been circulated) containing a draft of the joint Council/ CCG bid to the Department of Health for the Better Care Fund (previously known as the Integration Transformation Fund) that would form the basis of local plans to further integrate health and social care services. The Bid would be submitted to the Council’s Executive and CCG Board in early February before sign-off from the Health & Wellbeing Board (which would had been delegated to the Chair and Vice-Chair because of the timescales involved).

The following comments were made/ issues raised:-

·         Members welcomed the commitment in the document to data sharing and emphasised the importance of doing this across the economy. The Stockport One work had provided important lessons on how and what should be shared. Data protocols would need to be developed to support the technical solutions.

·         Members welcomed the efforts being made and thanks were expressed to those involved from both the Council and CCG for their efforts and leadership in seeking to make such a significant change. Members commented on the potential difficulties in overcoming professional and legislative barriers to closer working, as well as meshing together differing working and organisational cultures.

·         Concerns were also expressed about the impact of the proposals on the financial stability of the acute sector. The involvement and support of the Foundation Trust was welcomed.

RESOLVED – That the report be noted and the proposed direction of travel for the Better Care Fund as detailed in the draft plan submission be supported, subject to the following comments:-

·         the importance of data sharing and appropriate data governance arrangements;

·         the need for robust mechanisms to ensure performance requirements were met; and

·         the importance of these propels in contributing to changes to the culture of health and social care, particularly around 7-day working.

To consider Stockport’s draft bid to the Better Care Fund/ Integration Transformation Fund prior to its consideration by the Council’s Executive on 11 February and the CCG Board on 12 February 2014 and to delegate the final sign-off of the submission to the Chair and Vice Chair for completion before the 15 February 2014 deadline.

Officer contact: Terry Dafter, 0161 474 4401, terry.dafter@stockport.gov.uk

A joint report of the Service Director (Adult Social Care) (Stockport Council) and the Chief Operating Officer (Stockport Clinical Commissioning Group) was submitted (copies of which had been circulated) containing a draft of the joint Council/ CCG bid to the Department of Health for the Better Care Fund (previously known as the Integration Transformation Fund) that would form the basis of local plans to further integrate health and social care services. The Bid would be submitted to the Council’s Executive and CCG Board in early February before sign-off from this Board.

A diagram setting out the services within scope of the new integrated system was also provided (copies of which were circulated).

It was reported that since the last meeting of the Board, the Department of Health had requested that in addition to the Bid in February 2014, a further detailed plan be submitted in early April. It was anticipated that as a result of the February bid the Department of Health would flag-up an areas of concern, clarification or further work before the final submission in April.

It was emphasised that work was ongoing to develop the Bid and more importantly the model of service delivery. The challenge of the model would be to change the culture of those working in the new system to work differently. The Marple & Werneth Pathfinder was due to begin shortly. This would provide invaluable evidence of the impact of these new ways of working before the model was rolled out.

The following comments were made/ issues raised:-

·         Further detail should be included in the narrative of the bid to emphasis the level of collaboration and joint working already taking place in Stockport.

·         Members acknowledged the work that had been done to develop the model and the bid and welcomed the joint leadership shown by both organisations.

·         This area of work was very much embedded within the plans of the CCG and was not seen simply as an ‘add-on’. Similarly, it needed to be seen in the context of other work streams at both regional and national level, such as out of hospital standards and 7 day working.

·         Work was ongoing to develop a ‘joined-up’ ICT solution that would allow all partners to share data where needed from their own systems, rather than to seek a new system that would be costly and that currently was not available on the market. Staff regularly highlighted ICT as a concern about service change. This area of work was being overseen by a multi-agency group that was looking at ICT issues across the economy. Stockport had attracted funding from a national group to support the development of a solution, in recognition of the progress already made locally.

·         Producing a ‘case study’ of a patient’s journey through the health and social care system before integration and afterward, from the perspective of the service user, would be a useful means to demonstrate the impact of the proposals.

RESOLVED – (1) That progress with the development of the Better Care Fund bid be noted.

(2) That the Chair and Vice-Chair be authorised to sign-off the first draft Plan submission of the Bid on behalf of the Board following its consideration by the Council Executive and the CCG Board on 11 and 12 February respectively.

(3) That the Service Director (Adult Social Care) (Stockport Council) and Chief Operating Officer (Stockport Clinical Commissioning Group) be requested to submit a copy of the Interim Better Care Fund Plan to the next meeting on 12 March 2013.

(4) That members of the Board be encouraged to contact officers directly if they had any queries or suggestions about the Plan.