Agenda item

The purpose of this report is to update the Health and Wellbeing Board (HWBB) on progress to finalise a submission for the Better Care Fund (BCF) in 2016/17 and beyond.

 

The Board received a report which updated them on progress to finalise a submission for the Better Care Fund (BCF) in 2016/17 and beyond.

 

Officers reported that the Council and CCG had not yet agreed a balanced draft spending plan, but had got a projected £2.3 million overspend with limited room for manoeuvre. Progress had also been hampered by the financial situations of both the CCG and the Council. It was felt that the BCF must not divert from the bigger idea of system transformation in health and social care.

 

Reasons for why an agreement had not been reached were as follows;

 

•      The starting point of the 2015/16 plan contained stretched targets that weren't achieved.

•      It would be very difficult to scale back the 2015/16 plan without having a knock on effect on delayed dicharges from acute settings.

•      In trying to resolve some of the issues locally there was a need to look at the wider health and social care system

•      Partners needed to work in a more integrated way to deliver efficiencies and plans and this needed to be brought forward to be able to do this.

 

It was reported that there was a small task and finish group that would be reviewing each BCF project in the 2015/16 plan to assess it in terms of its impact.

 

Board Members continued to state how the BCF was a tool, a set of principles to follow to enable system change and further integration, and was not just about delayed discharges. It would do this in the following seven areas;

 

·        Reduce inappropriate admissions

·        Shift money into early interventions/prevention

·        Speed up discharge from acute settings

·        Support for Carers

·        Reablement/Intermediate Care Funding

·        Care Act Funding

·        Delayed Transfers of Care

 

One Board Member informed the Board that the submission date for the Better Care Fund had been extended from 3 May to 15 May. There was now a commitment to transformation from partners through the Integrated Transformation Board.

 

One Board Member felt that the schemes funded by the 2015/16 BCF were not delivering what was required or wanted. The original idea behind the BCF was how to get the best mechanism across local government, the Board had this through the Integrated Transformation Board. He felt that there needed to be a medium term financial strategy, performance metrics, that all partners needed to share problems and make shifts in the way they operated and it was the role of the Board to hold them to account. In addition, he felt other agencies needed to brought on board when decisions were being made. He also felt that further risk impact analysis needed to be carried out.

 

It was noted that neither the Council nor the CCG were allowed to have deficit budgets as these were illegal. It was reported that NHS England believed that an agreed submission from York could be delivered by the new deadline of 15 May.

 

Discussion took place amongst Board Members.

 

One Board Member commented that although the BCF was intended to be a tool to ‘speed up the integration’ of health and social care, discussions around integration seemed to take place outside of it. It was not yet known which specific schemes were under threat from being cut, given the financial gap that needed to be closed.

 

It was reported that the total cost of the schemes exceeded the budget by £1.4 million two weeks ago, and £2.3 million earlier in the week. However, the original figure had not been assured by NHS England and the CCG was now working to £2.3 million. Therefore the model had been changed to bring things back under budget. The areas where the CCG had particularly high levels of spending in its budget were;

 

·        Reablement

·        Mental Health Care and Out of Hours

·        Delayed Transfers of Care

·        Mental Health and Learning Disabilities

Another Board Member questioned how the public had been engaged with the process, and how was the financial situation communicated in regards to the financial reality? How is transformation going to be carried out without initial investment?

 

Another comment shared was that it sounded as if it was all about cuts, but there was a positive opportunity to do things differently and improve things. However, there was a need to make sure that the public understood that this was an improvement.

 

There was also an opportunity to look at other areas that had been successful with their BCF plans as they were not all going to have the same approach.

 

One Board Member commented that the BCF by itself could become divisive between partners, and needed to be seen as part of a broader transformation. Difficult questions needed to asked in regards to implications of decommissioning services. There needed to be clear reasons given as to why this action was being taken.

 

Further Board Members issued concerns about the risks and benefits of the Better Care Fund proposal.

 

The Chair commented that she felt that the risks had not been considered or shared with the Board, and that the deadline for submission would not be met. However, rushing to complete the work would ruin the work already carried out and could give time for pressures to ease on the CCG budgets. She suggested to the Board that they could recommend that a smaller budget be put forward and that a system of arbitration be used if no agreement was reached. This would be between the Health and Wellbeing Board, the Vale of York Clinical Commissioning Group and the Council. They would be represented by the Chair of the Board (Councillor Runciman) and the Chair of the Vale of York Clinical Commissioning Group.

 

A Board Member agreed with the Chair that the Council and the CCG were unlikely to reach agreement by the deadline but that she felt that she did not have sufficient information or risks about the various schemes included in the BCF and therefore she could not sign off the plan. She felt it was sensible for the Chair of the Health and Wellbeing Board and the Chair of the Vale of York Clinical Commissioning Group to explore arbitration.

 

It was suggested that NHS England and Association of the Directors of Adult Social Services (ADASS) be approached informally to support the arbitration.

 

Resolved: (i) That the report be noted.

 

                 (ii) That the Chair and Chair of Vale of York Clinical Commissioning Group explore arbitration to resolve ongoing discussions.

 

                (ii) That the sign off the submission of the Better Care Fund (should it happen) be delegated to the Chair in consultation with the Chair of the Vale of York Clinical Commissioning Group.

 

Reason:        To progress the Better Care Fund submission.