Agenda item

This item presents the Better Care Fund 2023/25 proposal for the London Borough of Hammersmith & Fulham and the H&F Integrated Care Board.

Linda Jackson (Strategic Director of Independent Living) and Julius Olu (Assistant Director, Commissioning and Partnerships) presented the paper which set out the proposal for the London Borough of Hammersmith & Fulham and the H&F Integrated Care Board (ICB) that would form part of the submission to NHS England following the meeting.

Linda Jackson noted that the Better Care Fund was the only pooled budget that the Council had locally with the NHS and that was managed at a local level. The fund helped services to be set up to get people out of hospital as quickly as possible. The fund paid for a range of contracts, including reablement, home care, and preventing people going into hospital.

Linda Jackson explained that officers were ready to submit proposals in June, but the ICS asked for further information from all eight Local Authorities which pushed submission back to the 4^th of August. Officers worked closely with Sue Roostan (NHS North West London ICB) to put a memorandum of understanding in place to ensure continuation of services.

The Chair addressed the Board and noted that the Council had been working well for years with the local NHS and the sign-off process for the Better Care Fund was usually relatively smooth. However this year, the last-minute requests from the Integrated Care System (ICS) created a huge challenge for Local Authorities.

Linda Jackson agreed it was a major challenge. The ICB requested further information on outcomes. There had been debate at NHS NW London Board level about wanting consistency of outcomes – but the Better Care Fund should be built around local communities and their needs. She felt there was a lack of understanding about what Social Care does and how localities worked together.

There was the idea that we could get efficiencies out of the fund. This led to officers having to respond to questions around outcomes. The driver was from the Finance team at North West London ICS. Officers agreed to answer the questions and do a review next year. Services could not change this year as contracts had already been agreed. We refused to respond to all of the questions as some felt unnecessary. The process seemed to be a way of removing money from system. She thanked Sue Roostan for helping to resolve the situation.

At a recent Partnership Board, Rob Herd, ICS Chief Executive, gave an apology for the way it had happened. He recognised it had damaged trust and confidence. As a result, Alex Dewsnap, Chief Executive of Harrow Council, was putting together a group to look at what Local Authorities wanted from the terms of reference for the Better Care Fund process in future. Councils and the ICS were looking at how to work better together and had produced a ‘ways of working’ agreement document.

The Chair said the situation had exposed a number of issues with the new landscape of Integrated Care Systems. Despite the serious challenges, he hoped it would lead to a better way forward. He asked to see the terms of reference when they were agreed, and the wider review to ensure it fairly reflected the Council’s views and outcomes.

ACTION: Linda Jackson

Sue Roostan noted there was a meeting the following day to discuss the terms of reference with health and social care representatives and they would be sharing lessons learned. Linda Jackson said there were also lessons for local authorities and they would be putting them forward at the meeting. The Chair felt the ICS was a good idea in principle, but it needed to be flexible to local need. He said the Council was determined to take it seriously, working together as equal partners.

Councillor Rowbottom asked about the accuracy of the delayed transfers of care statistics, noting it was only used by NHS England and Doctors used the term medically fit discharge in hospitals.

Linda Jackson said NHS England kept changing the measure, from delayed transfers of care to medically fit discharge, to medically optimised and no need to reside. Part of the challenge was around the different data collected around discharges. She noted the acute submitted data that didn’t tally with primary care data. The Partnership had come together to combine intelligence to get an accurate picture of the figures. New IT systems being rolled out in acute would bring together social care and primary care data, giving a more accurate picture. A manual trawl of people across North West London done on 18 September showed one person medically fit for discharge waiting for social care intervention. All others had planned discharges. There were 56 overall.

Councillor Rowbottom said a Doctor from Charing Cross reported on 14 September that 15 patients were medically fit for discharge and only a handful were discharged by the end of the day. The Doctor felt the discharge coordination team were not proactive enough. She acknowledged Charing Cross served a large local area, not just Hammersmith & Fulham, but wondered if with Better Care funding, the partners could put a more proactive team in place to improve discharges. Linda Jackson said that had been done through the Better Care Fund, supported by BI data. Sue Roostan said there were system wide calls across the eight boroughs regularly looking at discharge data. The Chair suggested organising a meeting to take a closer look at the data issue and discuss solutions.

ACTION: Linda Jackson

Councillor Perez felt there was a lack of understanding amongst health partners about social care and asked what Councils could do to make them see local authorities as equal partners. Linda Jackson said those issues had been discussed at an informal Health Care Partnership Board meeting and the Board had agreed to work on a presentation to facilitate a better understanding of the role of local authorities.

RESOLVED

1. That the Chair, on behalf of the Health and Wellbeing Board, agreed the planned total expenditure and the proposed schemes for 2023-25.

2. That the Health and Wellbeing Board receive an end of year report outlining the outcomes of each scheme and the difference it has made for residents of H&F.