Meeting documents

Presenters:  Ms J Bowie, Director of Joint Commissioning, Buckinghamshire County Council and Ms D Richards, Director of Commissioning and Delivery, CCGs and Chair of the System A&E Delivery Board.

As agreed at the December meeting, the Better Care Fund leads will present a deep dive system overview of the BCF to stimulate Board discussion about the core challenges and solutions for forward planning.  

Ms J Bowie, Director Joint Commissioning, Buckinghamshire County Council introduced herself and said she would be presenting on behalf of herself and  Ms D Richards, Director of Commissioning and

Delivery, CCGs and Chair of the System A&E Delivery Board, who had sent her apologies.

Ms Bowie ran through the presentation and highlighted the following points:

• The definition and impact of delayed transfers of care (DToC).
• A multi-disciplinary group had to agree that the patient was ready for transfer.
• The causes of a DToC.
• There were approximately six hospital trust sites that Buckinghamshire patients use.
• The pathway for self-funders was different.
• There were core strategies and drivers which required the Better Care Fund (BCF) to look at DToC.
• The Buckinghamshire trend in DToC was improving; validated data for November expected by the end of January.
• Over target from June to November.
• Comparisons with CIPFA peers.
• The number of delayed days.
• The system approach to DToCs. 

• Looking at areas for improvement and to utilise local strengths.
• Improvement in the discharge process.
• The High Impact Change Model contained 8 changes agreed by NHS England, NHS Improvement, DH, LGA and ADASS.
• Understanding what had been learnt nationally and to make better use of knowledge in Buckinghamshire.
• Trying to prevent admissions in the first place.

The following points/questions were raised.

The Chairman asked if the metric was for Buckinghamshire hospitals or Buckinghamshire patients.  Ms Bowie clarified it was for the Buckinghamshire patients. 

The Chairman added that the funding of the (BCF) was linked to the performance of DToC; therefore there was a linkage to healthcare and social care.

Ms Bowie said Buckinghamshire had been meeting its targets for the social care area but not as a system.  However, the trajectory had been going in the right direction. 

The Chairman asked if there was a risk of financial penalty next year if the authority did not meet the targets.  Ms Bowie said the financial penalties were aimed at social care and that the social care targets in Buckinghamshire had been met.  Ms Bowie had not seen any evidence that there would be any penalties against local authorities.

In response to a question as to why the July figure was so high, Ms Bowie explained it was due to the way the data had been collected and analysed.  The season also had an impact on figures; July was the start of the summer holidays which had placed a challenge on the home care providers.

Ms Bowie confirmed that the numbers did include children and acknowledged that often the focus was on the over 85’s but that there were other interesting aspects such as children and mental health patients which would be useful to consider and include in future updates.

Ms Baker asked if an evaluation was carried out from the patients’ perspective.  Mr Macdonald said that there was a user group who focussed on the experience of the discharge process and that the Health and Social Care Select Committee had also carried out a review and that they would be revisiting it next year. 

The Chairman asked whether enough help was provided to self-funders.  Mr Macdonald advised that an independent brokerage had been commissioned to help families make the right decisions.

The Chairman thanked Ms Bowie for the presentation.