Meeting documents

An update from the System Leads to include the Better Care Fund.

Ms L Patten, Chief Officer, Buckinghamshire CCG, provided a presentation on the Better Care Fund on behalf of Ms J Bowie, Service Director, Integrated Commissioning, BCC, and Ms D Richards, Director of Commissioning and Delivery and highlighted the following points:

• The BCF objectives were to shift resources into social care and community services to keep patients out of hospital.
• Funding for Buckinghamshire was circa £30m, with £9m contributing to social care.
• Extra funding of £3.5m (iBCF) and £1.6 million winter funding had been received.
• National guidance was awaited on criteria and metrics that would be applied for this financial year.
• The Integrated Commissioning Executive Team (ICET) oversaw the budget and its effectiveness.
• Operationally, the A&E Delivery Board monitored performance of the Delayed Transfers of Care (DToCs), funded through the BCF. DTOCs were patients in an acute hospital bed but were awaiting transfer to their home or a residential setting. Whilst the performance of DToCs in this paper showed a slight decrease, it was important to remember that the targets were changed mid-way through the plan. Overall, our DTOC figures had improved due to the implementation of the integrated approach.
• DTOC numbers were still higher at Frimley Health NHS Foundation compared to Buckinghamshire Healthcare Trust and work was taking place to obtain a timely discharge for patients.
• Discharge to Assess – patient’s packages of care were assessed in hospital and re-assessed once the patient had returned home and usually resulted in a reduction in the care needed.
• Non-elective admissions (unplanned) continued to grow; work was required to understand the reason and reduce the number. This was being undertaken by the A&E Delivery Board, who acknowledged that patients had been more acutely ill and had more complex medical conditions.
• Various system-wide initiatives had been implemented.
• It was important to note that DTOCs continued to reduce, despite a reduction in overnight beds in Marlow and Thame community hospitals. This was because the community hubs services were supporting more patients through reablement and community based services.

The following points were noted in discussion and in answer to member’s questions:

• Mr D Williams, Director of Strategy and Business Development, Buckinghamshire Healthcare Trust (BHT), acknowledged that, from a hospital perspective, the work of the system had improved but BHT had seen increasing demand on services.  More work was needed to provide support in the community.
• Dr S Roberts, Clinical Director for Mental Health, Buckinghamshire CCG, mentioned that work was being carried out to identify and support patients with dementia as approximately 25% of patients in hospital over 65 years old would be likely to suffer from dementia and research had shown that these patients would require a longer stay in hospital.
• In response to a question from Ms Baker as to whether there were any plans to involve patients in the discussions; Mr Williams advised that patients’ feedback on their experience in A&E had been received and agreed there was an ongoing need to reflect the views of patients.
• A member of the board requested detail on the DTOC figures in terms of actual numbers of patients as it would put the numbers in perspective.  Ms Patten agreed to ensure this would be shown in future. It would not show the range of reasons but Ms Patten stated the most frequent reason for delay was patients awaiting a care package in their home rather than a residential placement. 
• Work had been carried out to accelerate the process when a discharge date was known and momentum needed to be maintained at a senior level.
• A member of the board asked why non-elective admissions occurred and queried whether it was because people had not engaged with the healthcare service.  Ms Patten stated that admissions were counted as either planned or unplanned and it was known that patients with acute conditions who were supported earlier, often avoided admission.  A non-elective admission did not mean that the patient had not engaged with the healthcare system; the focus was on prevention but patients still required emergency admission to hospital at times.
• Dr J Sutton, Clinical Director for Children’s Services, Buckinghamshire CCCG, commented on the spike in children’s admissions this winter which had been due to a large number of children with respiratory illnesses such as bronchiolitis.  A member of the board queried whether the decrease in the take up of vaccinations had contributed to the increase in admissions but it was confirmed that this was not the case.  

RESOLVED:  The Board NOTED the report and AGREED to approve that the ICET would continue to oversee the BCF Plan and accompanying quarterly BCF returns.

EU Brexit Preparedness

Mr Williams referred to the presentation slide, appended to the minutes, and highlighted there were two key issues:

• EU staffing; there was no substantive impact at the moment.
• Supplies; there was no distinctive issue currently - daily/weekly updates locally and nationally were being received.

RESOLVED:  The Board NOTED the update.