Agenda item

Better Care Fund bi-annual update

Tracey Ironmonger, Service Director, Integrated Commissioning, Buckinghamshire Council.

Systems Winter Planning

Caroline Capell, Director of Urgent and Emergency Care, Buckinghamshire Integrated Care Partnership (ICP).

Better Care Fund (BCF)

Tracey Ironmonger, Service Director, Integrated Commissioning, BC, advised that the Better Care Fund (BCF) started in April 2013 to strengthen integration and, more recently, to enable recovery post-Covid-19 and help residents maintain their independence.   There was a national requirement to submit the annual BCF plan and this had been carried out on 16 November 2021.  The plan had been shared with the Integrated Commissioning Executive Team, lead officers in BC and the CCG.  It was recognised that it was not the ideal approach as it did not allow engagement but, due to Covid-19, this financial year and last financial year, national planning guidance was released very late. 

The BCF funding totalled just over £42m; a breakdown and information on the initiatives/schemes funded had been provided in the agenda pack.  The latest national guidance focussed on hospital discharge and there were a number of new metrics.  The BCF plan had been produced by a range of stakeholders across the system and demonstrated that the workplan reflected local priorities including the ICP, Better Lives Strategy and the Joint Health and Wellbeing Strategy.  It had been hoped that the planning guidance would look forward for two or three years but this was not the case.  A local review of the BCF had started in order to be able to provide an earlier opportunity for the HWB and other relevant forums to look at the focus of the BCF and the priorities being worked on.

The Chairman stated that it was encouraging to see partner input and suggested that it could be broadened further, for example, to include the Housing Team at BC and possibly hospitals that were out of the county.

The following key points were raised in discussion:

• The Vice Chair, Neil Macdonald, stated he understood the issues faced in respect of timing and the BCF and welcomed the planned review.
• In response to whether there was a market or pathway for the setting of the reablement metric which was well below the figure of 87% currently being obtained; T Ironmonger advised that the outcomes were unusual last year due to Covid-19.  T Ironmonger had looked at the metrics, historic information and benchmarking performance against the South East and other authorities and advised that the targets were more reflective of ‘business as usual’.  T Ironmonger stated she would review the metrics for next year.  N Macdonald recommended that reablement learning should be captured. 
• T Ironmonger confirmed that an evaluation of what had been carried out would be undertaken as part of the local review.  The review would also consider if there was wider opportunity for integration.

Resolved:  The HWB:

·       Formally approved the 2021-22 Better Care Fund (BCF) plan for Buckinghamshire.

·       Noted the update provided on the BCF including the budget for 2021-22, schemes funded and metric trajectories.

·       Delegated authority for development of Buckinghamshire’s BCF plans to lead officers for Buckinghamshire Council Integrated Commissioning and Buckinghamshire Clinical Commissioning Group. This included allocation of BCF expenditure, trajectories for locally set metrics, completion of supporting narrative, and assurance that all planning requirements and national conditions were met.

·       Agreed that the Integrated Commissioning Team continued to service all requirements of the BCF, including reporting via the Integrated Commissioning Executive Team on performance and bi-annual updates to the Health and Wellbeing Board.

Systems Winter Planning

Caroline Capell, Director of Urgent and Emergency Care, Buckinghamshire ICP, explained that there was a shared system-wide plan to support a winter and Covid-19 surge across the health and social care system.  The plan had been integrated due to the ongoing pandemic and would be delivered across all the system partners.  The actions across Buckinghamshire were aligned to the national system requirements which needed to be met.  C Capell advised that there was a weekly system-wide incident management structure meeting to manage the action focussed plan.  This is also reported to the Buckinghamshire, Oxfordshire and Berkshire West (BOB) ICS team on a weekly basis and support was provided by local partners.  Assurance was provided by the Urgent Emergency Care Board.

The Chairman welcomed Mayank Patel, Chief Officer, Buckinghamshire Local Pharmaceutical Committee (LPC).  M Patel advised that he looked after the 89 community pharmacies in Buckinghamshire who had carried out a record number of flu vaccines this winter.  The pharmacies were also providing the Covid-19 vaccines and booster vaccine at 14 sites in the county and there had been recent discussions to provide further sites to cover the gaps. Some local vaccination sites would be closed over the Christmas and new year period but the pharmacies would be open and consideration was being given to the provision of the Covid-19 vaccine during this period. M Patel stated that a campaign would be launched the following week in order to increase the uptake of the flu vaccine.  Lateral flow delivery services were available and a host of new services were being introduced at pharmacies including case finding service for hypertension, discharge medicine service and provision of obesity and weight management.  Pharmacies were easily accessible and the majority had a consultation room.

The following key points were raised in discussion:

• In response to a query on whether there was a strong enough link to manage pressures at Place and the escalation into the ICS; C Capell advised there was an ICS Operations Centre which would be fully operational in two weeks’ time.  The lead director had visited the Trust site last week and relationships were being developed using the principles of mutual aid. 
• C Capell stated that it had been recognised that there had been gaps in communication with the pharmacies and that they were now incorporated within the Urgent Emergency Care delivery group.
• A query was raised as to whether residents with dementia had been incorporated into the Plan.  C Capell explained that there was a frailty line for care homes to link to an acute consultant to look at alternatives to coming into hospital for patients, primary care GP colleagues could also use the 24/7 frailty line.  There was a Frailty Group which met regularly.  An urgent care two hour response been set up to manage patients in their home rather than hospital.
• Dr Raj Bajwa thanked the community pharmacies on behalf of primary care for their work throughout the pandemic and the flu vaccination service and stated that the pharmacies were becoming an increasingly important part of the health landscape.  The Chair echoed this.
• A comment was made that there had been a spike in the number of children with respiratory viruses recently and primary and secondary care had been overwhelmed.  N Macdonald advised that extra provision had been made available in acute care for paediatric beds.

Resolved:  The Health and Wellbeing Board noted the findings of the report.