Agenda item

Tandra Forster introduced her report, which aimed to assure the Board as to the progress on West Berkshire’s Better Care Fund (BCF) Programme of work.

The BCF was a Government initiative established to promote integrated working with the NHS and £3.8 billion of investment nationally had been created to fund projects that delivered a more joined up approach to patient/service user pathways. The programme of work was comprised of projects that were being delivered both on a ‘Berkshire’ West’ and West Berkshire basis.

The BCF framework was shaped by three overarching priorities, Elderly Frail, Children and Mental Health. Although work was being completed within each element Elderly Frail was the main focus on the first phase on the programme. There were five projects within the West Berkshire plan, which could be viewed in detail under Appendix A of the report and included:

1.         Hospital at Home;

2.         Joint Care Provider;

3.         Nursing and Care Homes;

4.         Health and Social Care Hub;

5.         Personal Recovery Guide/Key Worker;

Projects were also underpinned by key enablers, which included:

1.            System interoperability:

2.            Seven day working

3.            Workforce

Philip McNamara reported that the aim was to tick as many of the programme principles as possible, which were shown in the report as a matrix summary.

Philip McNamara moved onto the next section of the report on governance arrangements and highlighted that the Health and Wellbeing Board sat at the top of the governance structure for West Berkshire. Tandra Forster stated that it was important to note that they were working as a whole system and therefore there was a whole other governance structure for the west of Berkshire.

Two projects were already at an advanced stage of preparation including Hospital at Home and Nursing and Care Homes. It was explained that Hospital at Home was about working with patients and through agreement identifying which patients were happy to be treated at home. Tandra Forster explained that it was a very complex system and there would need to be the involvement of a huge range of services. A pilot run with a single patient would be carried out to test the system. Hospital at Home had worked well in other countries and aimed to reduce demand on acute services.

Councillor Graham Pask queried how General Practitioners (GPs) would be informed about patients choosing to be treated at home.  Dr Bal Bahia stated that there should be little impact on GP as responsibility of the patient would lie with the lead from the hospital where they were initially treated.

Philip McNamara reported that there were a certain cohort of patients that Hospital at Home would focus on, particularly younger able patients.

Cathy Winfield confirmed that there was a business case, which provided analysis on efficiency. The programme was currently behind schedule and the Clinical Commissioning Group (CCG) as a result was falling behind with possible savings. It was felt that this was inevitable given the complexity of the project. The business case could be tracked through the Quality, Improvement Productivity and Prevention Plan  (QIPP).

Councillor Marcus Franks drew the Board’s attention to section three of the report, which looked at the Programme Principles – Summary Matrix and queried why there was no tick for seven day working under Nursing and Care Homes. Philip McNamara confirmed that the tick had been omitted and he would ensure the matrix was revised accordingly.

Councillor Franks questioned the remit of the West Berkshire Integration Steering Group and if it was wider than the BCF agenda. Cathy Winfield confirmed that the remit of the group was wider integration as well as the BCF. Philip McNamara reported that the group largely worked to unblock issues in the system and therefore was very much an operational group, unlike the Health and Wellbeing Board which gave strategic oversight.

Tandra Forster highlighted that workforce did not form part of the BCF but was part of wider integration work taking place.

The Chairman invited Jeanette Longhust (Berkshire West Integration) to speak on the matter, who voiced how important it was to look beyond into the wider integration remit as some projects enabled the BCF to go ahead.

Adrian Barker had noted that the Government had asked for BCF proposals to be re-submitted. Philip McNamara confirmed that there was a revised process concerning the feedback. West Berkshire’s approach to the BCF had been perceived in a very positive way and therefore it could be used and tailored to inform other systems.

Rachael Wardell stated that this had been picked up as part of the Fast Track process. Being part of the Fast Track initiative had not necessarily benefitted West Berkshire however, it had helped the Government to gain understanding. Rachael Wardell stressed that the rules of the game had changed that there was now a focus on outcomes in order to receive payment by results. There had been enormous good will by partners to adhere to the changing goal posts however, it was not helping West Berkshire in meeting its objectives. 

 Cathy Winfield reported that the only benefit to being in the Fast Track cohort was that plans were signed off early, which gave an ability to influence. Cathy Winfield was concerned about the guideline reduction from the Department of Health, to reduce emergency admissions by 3.5 percent. She was concerned because the level in West Berkshire was already low making this target particularly difficult.

Adrian Barker questioned if money was only received if targets were met. Cathy Winfield reported that the Government were retaining £1 billion which would be performance related. This would only be received if admissions were reduced by 3.5 percent, which was an unrealistic target for West Berkshire where admission rates were already low. If the money was not earned through the payment by results reward scheme the CCG would have to find it from elsewhere, so it was a significant risk.

Resolved that an update report would be brought to each Health and Wellbeing Board meeting.