Agenda item

This report outlines progress on the Integration and Better Care Fund Plan for 2017-19 submitted on 11 September to NHS England and the Department of Communities and Local Government.

Graham Terry presented the Better Care Fund (BCF) report which provided a high-level Quarter 3 information, delayed by guidance being issued.  This was a precursor to Quarter 4 data available in May/June.  The report was being considered by HWB as it was responsible for signing off the BCF plan and review the progress made since submission.  The Community Independence Service (CIS) continued to be a priority across all three HWB areas with very good performance on delayed transfers of care.  The current contract was due to expire in July 2018, with agreement by senior health and social care leads to roll this forward until end of March 2019, to enable a full quality and financial review of the service has been undertaken. As CIS continued to play a strong role in parallel with other services.

Previously low performance on Delayed Transfers of Care (DToC) had been improved, largely due to focus and dedicated leadership from Lisa Redfern and her team to reduce DToC.  There was now an upwards trajectory achieving above what was expected and this would meet the cumulative target in July, despite winter figures.  The Integrated Care Partnership had been formally signed off with a two-year agreement, operating as committees in common.  This provided agreement for a group of partners focused on integrated care to improve care pathways for LBHF residents.  A seven-day social work team had been established to provide continuity of care throughout the week. Financial implications meant that both partners faced cost pressures, with a section 75 health funded services shortfall of £9.8 million (covered in report to the September 2017 HWB). 

Keith Mallinson expressed concern regarding the introduction of Accountable Care Organisations (ACOs) in the context of Sustainable Transformation Partnerships (STPs) and the fact that LBHF had not agreed to the STP. Graham Terry reported that general concerns about this had been recently discussed at a Kings Fund meeting and no assurances had been offered. Surrey Borders Partnerships NHS Foundation Trust had delivered without an ACO or an integrated partnership.  There had been some evidence of frontline working and the benefit to residents and how this had developed, questioning the arguments in support of an ACO, a view which was in line with the LBHF approach. 

Councillor Ben Coleman confirmed that there were concerns about ACOs, and unsubstantiated claims about the benefits.  Integration was more a term about centralised control. Councillor Coleman said that more robust action might necessary but that they would be happy to continue with local projects such as diabetes if they continued to provide proven health benefits for LBHF residents.

Councillor Coleman commended Lisa Redfern, Graham Terry, and colleagues for their work on DToC, together with CIS. He recognised that failure to deliver the required targets would jeopardise funding.  This was a significant achievement given the low numbers from last year and he acknowledged the hard work undertaken to achieve this. Councillor Coleman suggested that residents should know about good work like this going on in the Borough and congratulated the CIS team.  Councillor Coleman and Lisa Redfern had visited the team at Charing Cross and had been impressed with both the service and the Team’s ideas for improvement.

ACTION: ASC / COMMUNICATIONS TEAM

Vanessa Andreae also thanked Sue Wisden and her team which had also played a significant role in supporting CIS. She acknowledged that there remained further refinement work to CIS but the CCG and registered partners were still outliers, in terms of going into hospital non-elective care which would need to be addressed. There was a pattern linked to respiratory, urine infections, with the data for LBHF indicating higher occurrences but not necessarily more.  There was a clinical backstory as to why residents end up in hospital and a need to consider how to manage things to prevent this.  Councillor Coleman enquired how CIS figures for Hammersmith and Fulham compared to WCC and RBKC. This was not an unfavourable comparison and it was agreed that this was a question of mapping data.  It was agreed that a report would be prepared for the Board to consider comparative shared data on non-elective admissions. 

ACTION: HWB / PH / CCG