Agenda item

Purpose: To introduce to the Select Committee the background to Health and Social Integration.

Tandra Forster introduced the report to the Committee and provided Members with a presentation to explain the Health and Social Care Integration plans underway.

Members heard that the Health and Social Care Act 2012 set the scene regarding the need for better integrated health and care services. It detailed the need of Local Authorities to join up local services and this was reinforced further in the Care Act 2014; the Care Act also expanded the role to include matters such as housing.

The purpose of integrating services was to meet the need of an aging demographic (nationally). It was recognised that people were living longer but not necessarily healthier lives. However, West Berkshire statistics suggested that the population was typically healthier than the national average.

The Committee received an illustration of the Council Budget versus the spend on the increasing number of people who required support. Tandra Forster stated that, based on this projection, by 2022-2023 the Council’s spend would only be able to pay for social services and no others.

The Committee heard that it was difficult to recruit younger workers to a profession which was physically tiring and offered limited pay. Care work was typically staffed by older people which also bought challenges regarding their own welfare and physical health.

Tandra Forster advised the Committee that the services were often tending to a small number of people but that they had significant needs which required a lot of resources. There were currently 1576 people receiving care out of a local population of 150,000 (approx).

Tandra Forster explained that Pioneer Bidding provided an opportunity to request funds to support and assist local systems of ‘early implementers’. The Berkshire West joint health and social care groups agree funding and oversaw the development, testing and implementation of innovative approaches to integration. The ten organisations consisted of: South Reading CCG; North & West Reading CCG; Wokingham CCG; Newbury & District CCG; Royal Berkshire NHS Foundation Trust; Berkshire Healthcare Foundation Trust; Reading Borough Council; Wokingham Borough Council; West Berkshire Council and South Central Ambulance Service. The main priorities identified by the group were:

·         Frail Elderly

·         Mental Health

·         Children

Tandra Forster advised that it was not clear why they had failed to secure funding through the Pioneer Bidding system but they considered that the activity was useful as it created the information required for the Better Care Fund. Members heard that the Berkshire West 10 covered an area with a complex organisational structure in terms of health and social care groups. Some groups covered multiple areas outside of Berkshire West and this added to the complexity around who provided services. In response to questions asked by the Group, Tandra Forster advised that reports were produced to identify the learning from schemes funded by the Pioneer Bids.

The Better Care Fund was a national initiative aimed to accelerate integration. The Berkshire West budget was £10,669m, generated by a contribution from the local Clinical Commissioning Groups. Funding was provided on the basis that schemes met the key national conditions – protecting social care services, 7 day services, reducing non-elective admissions and reducing delayed transfers of care. It was stated that the Better Care Fund was seen as a way to fund social care services and to help manage demand.

Social Workers were now in place at hospitals 7 days a week but it continued to be a challenge to move the health structure to a 7 day week. The process was moving in the right direction but still had more work to undertake. Furthermore, it was evident that health partners were struggling to recruit in key areas and this exacerbated the situation.

The Commission discussed the ongoing challenges faced by the health and social care services in terms of demand and complexity of needs. Rachael Wardell acknowledged that there would always be a high level of demand for services as life expectancy increased (although people did not necessarily live healthier) and advised that it was important to analyse trends to consider whether social care arrangements were sufficient.

In response to questions asked by the Committee, Tandra Forster advised that she had sufficient support in place to help in the process of presenting businesses cases to secure funding and she was comfortable that there was an escalation route in place - if necessary.

Tandra Forster explained that the NHS 5 year plan focused on 8 key areas and provided the blue print for the service going forward.

Councillor Carol Jackson–Doerge suggested that it would be useful if the Committee could see more detailed information regarding the demographic of people receiving social care services from West Berkshire Council. Tandra Forster agreed that the information would be provided and that this would be shared with the Committee.

The Committee discussed the ongoing challenges faced with recruitment in the care work sector. Rachael Wardell stated that West Berkshire was slightly below the national average in terms of the percentage of people working in social care services. Locally, employment was most common within ICT or telecommunications companies which offered different working conditions and better pay. Therefore, attracting people to work within the care sector was difficult. Members noted that the situation was exacerbated by the issues associated with access to housing. Councillor Jackson- Doerge asked whether the Council had considered reserving affordable housing for key workers. David Lowe stated that the current housing policy had been shaped by Members and that the policy would need to be amended if Members wanted to address the need for key worker housing.

Councillor Marigold Jacques asked whether Newbury College had been asked to consider avenues into care work. Rachael Wardell stated that there were examples of successful ‘value based recruitment’ and the Council was also looking at apprenticeship routes into social care.

David Lowe stated that it was clear that there were many good ideas being generated in an attempt to improve the integration of services but that, due to the limited amount of funding available, progress was restricted. It was suggested that the Committee could invite the Chairman of the Berkshire West 10 to receive an overview of the funding process and consider West Berkshire’s access to funding.

In conjunction with this, it would be considered useful if the Committee consider the Better Care Fund Plan (in anticipation that West Berkshire would receive a further 2 year’s funding). The plan would be signed off at the end of the 2016/17 financial year.

Members agreed that more scrutiny should be carried out on this subject.

Resolved that:

1.    Tandra Forster would provide statistics regarding the demographic of people receiving social care services from West Berkshire Council.

2.    Strategic Support to scope further work on health/social care integration, including examination of the Better Care Fund’s operation.