Transcript

Paul Morley - Welcome to the Special Meeting on the Health and Wellbeing Board particularly to look at the Better Care Fund and so welcome everyone and thanks very much for attending. Any apologies? No. Any disclosures of pecuniary or non-pecuniary interests? No. Okay, so we'll move on to the Better Care Fund Plan, sorry, 24 to 25 and over to you. Thank you, Rachel. Thank you, Councillor Bell. So the report summarises the Better Care Fund Plan for 24-25. So you will be aware that we submitted and had assured last year the Better Care Fund Plan for 23-25. So we've already submitted and had approved a two-year plan. So what we're required to do as part of the national policy requirements is to submit using the template provided any changes to the original plan that we submitted for effectively for this year. So the report summarises that and then I'll briefly go through the appendix which is actually the submission which has the changes in. So there was an addendum to the policy framework published on the 28th of March as it says in paragraph 1.3 in the report which detailed the updates required primarily to the finances that are in the Better Care Fund Plan, the metrics and the capacity in demand plans. So they're the kind of key three areas of focus. The deadline to submit our plan with the updates was the 10th of June and so as part of the planning process you can effectively get health and wellbeing board approval following submission. So we did submit the plan by the deadline and this is now to obviously approve it and if there are any changes from today we will resubmit those which is absolutely fine. So the national conditions as it says on page 6 of the pack, paragraph 1.6, have remained the same and we continue to meet the national conditions particularly with regard to funding. So paragraph 2 of the report which is page 7 and the table details the updated finances. So in the submission in our plan last year we submitted a plan of £374 million of NHS and local authority funding. The updates in our revised plan which is in the submission now, the finances equate to £400 million and that relates to an updated Disabled Facilities Grant which you'll be aware goes to the district and borough councils and then updates to the base budgets for adult social care which are in the council's core budgets. That's the two key primary changes. So there's no material changes other than effectively uplifts to previous budgets. Paragraph 5 of the report on page 9 just summarises then effectively which partners and meetings and boards etc that have received a copy of the draft plan and have contributed any changes to it. So you can see it's been through governance both at the local authority and the ICB but as I said there are no material changes to the plan we submitted last year. And the paragraph 5.2 then just details the assurance process as per usual as you'll be aware of it'll go through national assurance from regional moderation, some cross regional collaboration, we may get some feedback and then hopefully we'll get confirmation that our plan is assured by the end of July at the latest. So that's the report and then in terms of it's easier probably to talk about the planning template by looking at the excel document if any of you have got access to that but otherwise I'll just talk through it. So in the pack you've got a tab on the guidance, we're not able to print I'm afraid the submission very well. So there's a guidance tab which basically tells us what we need to do. Then there's a cover tab which basically just confirms who will receive confirmation. You may have noticed in the pack that there are two red bars within the pack. That's just because there are problems with the planning template not because we've missed any information. So I'm now on page, so the red I'm talking about is on page 16 of your pack, 16 at the bottom. So there's nothing for you to worry about, we have filled it in properly but the planning template's got a few little gremlins in it. So the next page which is page 17 just effectively summarises all of the finances and any changes. It's a bit difficult to read on page 17 and 18. So now we're moving to the page numbers at the top right. So if you look at page 9 of 26 this is effectively the demand and capacity tab and there's a couple of things for the board to be aware of. So it's a bit difficult to read but effectively the blue at the top of the page first of all indicates if we've got any surplus or deficit in terms of our capacity and demand. This is for discharge pathways. Now our submission does indicate that we have a deficit, so we have a shortfall in terms of hospital discharge for pathway 1, so that's for people going home. And the reason for that is because we are still, the council and the ICB are still liaising with regard to funding for the community recovery service. So there is a shortfall in funding for the community recovery service. So what we've included... No this is numbers of patients. So you've got a minus number at the top, the top row. I know but it's just the way it works because you're dealing with you know to make three acute, but yeah it's just the you know the number people are just what we've got. So when you take off the 90, the 90 of the top number you can see we have a deficit in each month of the year and that's because we have a funding shortfall for the community recovery service for pathway 1. So that conversation is still happening with the ICB. So there is sufficient capacity in the service in terms of in the provider market and in the therapy workforce, but we haven't got the funding. The service has been recommissioned for a further year because it was a pilot last year, but we do have a funding shortfall because last year there was additional funding from NHSE because it was a national front runner pilot. And although additional funding has gone in, the demand for the service is far higher than expected. So we do have a funding shortfall and that is in the plan okay. So we might get a query back as part of the assurance process to say what is the plan about it. At the moment the conversation is about how to meet that funding shortfall. What's the impact if we don't meet the shortfall? I mean where do these people, what happens to these people that would be on pathway 1 if the funding's run out? Potentially they'll stay in hospital for longer. Right, okay. Yeah, that's the, if they go down an alternative route then they still need to be funded either by the local authority or the NHS. And at the moment there is a funding shortfall. Whether it's for CRS which is our preferred pathway and this is the pathway that we would expect these people to go down. So at the moment they'll be paid for anyway, somewhere. Or they stay in hospital. Well, they'll be paid for. Yes, they will, yes. Okay, so that's the first thing you need to be aware of because it will probably come up as part of the assurance process. The second thing for you to be aware of is if you look at the third row down of the blue box at the top, so I'm still on page 9 of 26, so that's for pathway 2 which is people going to a temporary bedded facility. That could be for therapy, it could be for assessment by social care, it could be assessment by the integrated care board. So it could be a number of different type of beds. In theory our plan suggests that we might have over capacity in that area. Now we don't think that's reality but that's what the numbers look like. So what we want to do is monitor that and see actually because we have moved to a new bedded model for this year. I think we call that we've moved to a block model, so we've block commissioned some step down beds which is cheaper and gives us more capacity. But as a consequence it looks like we might have a little bit of over capacity. But we will monitor that and if we can release any then we will. And that might then obviously help with pathway 1, but obviously these are different cohorts of patients. Potentially yes, which isn't ideal, no it's also in hospital. But we don't think that is a material extra capacity. Because if you think about temporary beds you will always have a bit of extra capacity because the bed will be empty at some point. When one person leaves it needs to be cleaned and another patient then goes in. So you'll always have some over capacity. But this is indicating there's more than we think, but I say we don't think that is accurate. But that's the best we've been able to produce at this moment in time. No it isn't. It does give us flexibility so we don't have to spot purchase as much, which is obviously a lot more expensive. So if we scroll down to the next page, so page 10 and 11, that indicates the forecast demand which has come from the NHS plans. So the ICB have prepared this information using the acute demand plans and then we've done a little bit of reworking to fit the pathways. Warwickshire patients only, yes. So for the first time in our BCF plan we've also got, it's quite difficult to see, but if you look onto page 10 at the top you've got the fifth row down you've got other. So for the first time we've also included in our plan Warwickshire patients in other hospitals outside of Coventry and Warwickshire because obviously that demand is still on the ICB, the NHS and social care, even though they're not in the three main acute. So that gives a real, a more complete picture. So that's what we're expecting. It's similar to last year but with obviously an uplift as you'd expect for the higher activity levels. Can I just ask how accurate last year's proved to be? Last year's wasn't too far off actually, so it wasn't too far off. We had slightly more demand, well we had more demand for pathway 3 than was in the plan but that's because the information in the plan wasn't that robust when we submitted the plan. So it's a more accurate picture now but roughly the proportion of pathway 1 and pathway 2 was very similar and pathway 3 was higher but still very low. I was thinking more about the hospital numbers. The hospital numbers are very similar to last year. But were they accurate last year? Yeah, so so. Just because I know that they're all on level 4 or whatever it's called. It is difficult from the hospital perspective to sometimes break down the Coventry patients, Warwickshire patients and other out of area patients. So we get total information and then we do get more granular information that goes into our local dashboards. What the acute submit to NHS England is total numbers irrespective of where the patients come from. So there is a bit of proportionate work than the ICB do. I'm going to scroll down then to page 13 of 26. The numbers at the top right corner. So this is around the community side. So what we've just been talking about is discharge and this is now the community. So these numbers are significantly higher than last year. So we've got much more capacity for community i.e. support in the community to prevent admission. So this, because of the way we've changed some of the discharge pathway 1, now that has released some capacity for more admission avoidance and support for people in the community. So these numbers are significantly higher than last year which is good. So what we're hoping is that this will help support either maintaining or bringing down the number of people admitted into the acute settings in the first place. This is obviously focusing on over 65s. So the re-ablement and rehab at home is effectively the council, primarily the local authorities re-ablement service. Not all of it but primarily some of it. Some of it is around some of the capacity that's been released for SWIFT and then the rest is in the SWIFT's Urgent Community Response Service. So some of it is what we would know as CERT for under re-ablement and rehab. So it's an amalgamation of SWIFT's out of hospital activity and the local authority. Any questions? Because they balance out effectively. So at the moment we don't have a different number for demand or capacity. So effectively because we're being more proactive now and pulling people into proactive services then effectively it should balance out. So the next page which is page 14 is the finances. And as I mentioned, so the blue is pre-populated from the plan we submitted last year. The yellow columns indicate any changes. So there's been a slight increase to the ICB contribution to the discharge funding, okay, which obviously is helping fund primarily the Community Recovery Service. And then the bulk of the money as you can see, so the $216 million is around adult social care aligned budgets. So that's the base budgets and that's just literally the fact that they've had inflationary uplift, okay. And then the ICB contribution is the same. So that's where the changes have come from. And then page 15 and 16 and 17, this is the detailed summary of how we're spending the money or how we plan to spend the money that is in the Better Care Fund plan. So some of it, if you look at the main table, the first row has got domiciliary care, for example, base budget. So each of the rows indicate whether it's coming out of the improved Better Care Fund, which is the money that comes to the local authority, the base Better Care Fund, which is effectively money that comes through to the ICB and then is either used by the ICB or the local authority, or then it's in aligned budgets. There's also the disabled facilities grant mentioned on one of the rows. So this is quite detailed, but it basically just details any changes to either outputs, which is the column one, two, three, four, five, six, seven, eight, eight from the left. So any changes in forecast capacity or outputs, and then the columns to the right are any changes to the budget. And we just have to indicate whether any changes to the budget. And I think you'll be aware from the meeting in January, the ICB budget, the improved Better Care Fund wasn't increased for 24/25. So some of the budgets were changed. And so that reflects most of those changes. That's what the majority of the changes are, or whether there's just any inflation uplift. Yes. Yeah. We do that through the joint commissioning board, the finance subgroup, which is the colleagues from the council and the ICB, the finance colleagues pull it together based on the budgets, and then the joint commissioning board, which is chaired by Zoe Mayhew now as the BCF lead. They then go through this and agree this and the ICB and the local authority together. So quite a lot of the obviously base budgets have been increased in terms of inflation to enable the services continue to run, but some of the schemes funded through the improved Better Care Fund have been slightly reduced. And the scheme leads on managing that then through either holding a vacancy or potentially commissioning one less bed or, for example, but the schemes are all still running, which is the main thing. Yeah. Sorry, Rachel, can I just check? So there are a number of those are contributions to staffing. Are they because of those adjustments or are they because we would expect those reductions because those people are going through CRS and therefore there's less demand on those services? They are, the budgets have been reduced because there is, we haven't got a sufficient budget, not because of forecast demand. If that makes sense. Well, demand in theory, the acute demand is 5% higher than last year. So that's what has been put into the plan in terms of demand and capacity. So we're expecting a 5% increase in patients needing support and discharge, for example. Well, parts of the budget have gone down. So the improved Better Care Fund budget has stayed the same, but obviously as most of those schemes need an inflation uplift, effectively the budget has effectively gone down. But the base budget, which for the majority of the services, including the NHS contribution, has had an inflation uplift. It's the IBCF element, which comes to the local authority, which hasn't gone down, but has stayed the same. Yeah. That came to the meeting in January. Yes. Yes. Yeah. We did. The IBCF is funding, the funding comes directly into the local authority from the Department, the Ministry for Health and Social Care. That's the only one that comes directly into the local authority. Yes. And that's for the third year running. Yeah. Yes. It is. Yes. Which the report also indicates as well. Yeah. Sorry. Yeah. But we've still managed to get everything to balance, but obviously what it does is create more pressures on both the local, particularly on the local authority, but also on the ICB as well. Yeah. So those two pages indicate the changes we've made. I say the IBCF ones you will all be aware of anyway, because that has been approved separately. And then on page 18 of 26 are two new schemes that are being funded through the IBCF. The first one, scheme ID55, isn't a new scheme as such. We funded it for many years, but we didn't fund it through the IBCF last year, but we are funding it back through the IBCF this year. So it's classed as a new scheme because it wasn't in the plan last year. So page 29 is just guidance. Sorry, just on that one, that new scheme that's coming out of the IBCF, which is in effect reduced in funding. Yes. It reduced even more. So what we're saying is this used to be funded separately, and now that money's got to come out of the IBCF, which is what we need more pressure on. Yes. Yeah. They were previously funded out of the IBCF in previous years. I know it's difficult, but we had some money in the development fund last year, so we were able to fund it from there to relieve the pressure off the IBCF last year. Oh, I see that. But what I'm saying is... It has. Which is really why we could do with an inflationary uplift for the IBCF, definitely for next year. So, yes. Is it generally accepted that a person being on hospital day is costing more money than that person being anywhere else, almost? It is, yes. It is accepted, but because they don't need acute care, then obviously they do need to be moved out. And the problem always is that the acute can always fill that bed. So as soon as somebody comes out of that bed, somebody else goes into it. So it's not like you can actually... You can't pocket the money. You can't reduce the bed. That's part of the problem. So basically what happens is somebody who needs the bed does not get any more. That's basically what comes down to it. It does, yes. Which is not real money, actually. No. So that's why it is. Which is why we really need to focus on, hopefully, some of the admission avoidance work and some of the support in the community to try and prevent as many people. If you can get downstream and have less people going into the acute, deconditioning and having needs on exit, then in theory that's where we can help reduce some of the cost. Pajama, was it pajama paralysis? Yes, I think that was what it was called. You don't. No. Well, now obviously a lot of the physio is done outside of the acute setting. So that's partly why we've got the community recovery in that service so more people are getting the physio and support and therapy outside of the acute setting when they're back at home. And also obviously in the step-down beds there. But it is challenging. There's a lot of pressure on the system. So page 20 of 26 is effectively then... We haven't been asked to provide a narrative plan. You'll remember that normally we provide a narrative plan and a planning template. So we don't have to do the narrative plan as such, but this is just some narrative in terms of what we've taken into account and what we've done around our capacity and demand plan. So what's changed, what we've taken into consideration. So as I've mentioned in here, obviously it references the community recovery service, which was a pilot last year, and the demand for that has far exceeded expectation, which we are continuing with. It also references that the new commissioning model for pathway 2 discharges and the move to a block capacity for some of it, which is obviously... It is helping in terms of moving people from... Discharging people quicker into those beds rather than having to try and spot purchase a bed and find a placement. It is a cheaper model. So there are some benefits to that, but we need to see more... We need more evidence really. That only went in towards the end of February. And it also references just some of the changes to the activity as well. I'm just trying to think if there's anything else I need to draw to your attention. It does also reference that it explains what I mentioned earlier, that we have a shortfall in funding for pathway 1 and potentially pathway 2 looks like we've got over capacity, but we don't think that's the material over capacity. So that just explains that because that's our opportunity to explain anything. You look like you want to say something, Jerry? No, I'm just thinking about this and all the other local authorities that do it and how many people down in London are looking at this stuff? Well, not necessarily in London, it could be Newcastle. It just goes through an insurance process. It's on local authorities to land a zen and you think of the bureaucracy and everything else that's coming through. Even if they look to teach you, it makes you wonder what they do with it. What do they do with all this information? It does help us because it helps us look at our, particularly demanding capacity. In terms of the funding, it does show and highlight where the ICB and the local authority are spending money in similar areas and we are one of the top areas in terms of sharing transparency of our funding. So if you look at other areas planned, so we do usually get a summary report of all of the submissions and any kind of key learning. So Warwickshire is one of the few areas where our funding is one of the highest in the country that is in our plan because we share our spending on aligned budgets. So that is a really positive because we are really transparent as a system, so we understand where the spend is, which is really helpful. We should get a summary report as well, which indicates where we might be an outlier. So I will be able to draw out Coventry and/or Warwickshire, look different to other areas and then I can try and find out why. And also we should be able to, we might get something as well, a regional summary around the actual, the Midlands region. And again, are we doing anything different to any other area? We do know that previously we struggled with permanent admissions to residential and nursing care, which we have discussed a number of times. And it does look like we are, we do have more people going into those placements. We have not quite understood and got into the reasons why, but at the same time we are one of the best areas in terms of discharges to use your place of residence. So it's, you know, you look at the two together, you know, but there are some things that will come out of the summary information we get. The residential care homes now are very different from what they were in the past seven years. They are, yes. inaudible Well probably because there's better community care, so it's only a, you know, that sort of crisis point where people go into residential care. And also there's a financial point, isn't there, there's a financial point from our point of view where it's cheaper to put people in a residential home and give them even more care at home, particularly overnight. I think, I know talking to Pete said it's overnight care that's usually the trigger. People can't go from eight in the, at night to eight in the morning. inaudible inaudible inaudible Well yeah, I mean the support that the provider market, you know, provides is fantastic, you know. And obviously the Better Care Fund helps try to support and keep that market sustainable and, you know, viable. So page 23 of 26 nicely leads on to metrics. So we, one metric has dropped off, so the reablement metric has dropped off, so we no longer have to set a target for that. We've still got then the four remaining metrics. So avoidable admissions, falls, people discharged to usual place of residence, which I just mentioned, and then also residential admissions. So the key thing to be aware of in here is, is that we haven't set as stretching targets for this year as we did for last year. So we've still set, it's like a tongue twister, we've still set stretching targets, but they aren't as stretching. So yeah, we're trying to, as it indicates here, so the ICB have led on setting the target for avoidable admissions, falls and discharge to usual place of residence, and the local authority is led on the residential admissions one. So that means that these are consistent with the ICB plans and also the council's local authority plan. So Pete Sidgwick's obviously metrics for corporate board. So we are still trying to improve, and there's a lot of work and activity that contributes to these. So hopefully we'll get a bit closer to the targets than last year. But despite, obviously you'll be aware from the health and wellbeing board, we didn't meet the majority of targets other than the reablement and the discharge to usual place of residence, which we are very good at, over 95%. But hopefully we will get a bit closer to the targets through all the work that is happening and all the funding that's going into it. It is, yes, it is, yeah. It is still the main reason for admissions into care homes, and obviously people who do fall are generally conveyed into the hospital, which is a lot of the work the urgent community response team is trying to do in the community. But there's also then a lot of work going on with care homes as well. So only admitting or conveying people who need to be after a fall. (inaudible) Let me mention that at the housing partnership board, yeah. (inaudible) She does, yeah. (inaudible) We're just setting the plan actually for the next two years. So let me pick that up. (inaudible) All of them other than Stratford. (inaudible) The one that always fascinates me is the avoidable admissions. I want to know who it is that looks at people coming to the hospital and say that was avoidable, that wasn't. Who knows? I presume that's the ED department, yeah, so the emergency department. (inaudible) I don't actually know. I'm not sure. I can try and find out. (inaudible) Well obviously they'll know about planned admissions, so anybody planned to come in. (inaudible) Because that's a bit flawed, isn't it Nigel? But if that's all what they're doing. (inaudible) Yes, it probably is just a total admission, less planned admissions and that. It does exclude a few things obviously like maternity and things like that. Doesn't include some key metrics as well. But yeah. So and then the final, so that's the metrics and then the final page 35 and 36 is just effectively us confirming that we have met all the requirements of the template, i.e. we've filled in properly and we've answered the questions, etc, etc. So apologies, it doesn't really present very well when you try and save it as a PDF. So if something that has been requested, can they build it when they build the template? Because it is all locked down, so you can't do anything with it in terms of can it present better. So just going back to the report, obviously we are requesting obviously that you obviously note and are aware of the changes for this year, i.e. the updates. Obviously you will be aware that just support, we did submit a two-year plan last year and everything we're trying to do obviously just support the health and wellbeing prevention priorities. And the final thing is obviously just to approve the plan that we've gone through so that we have your support as part of the assurance process. And obviously if we get any feedback or whatever, then we'll come back to health and wellbeing board with any feedback or questions about our plan if required. Brilliant. Well, first of all, well done. It's a huge amount of work, and there's somebody in the authority that really knows these things. Because we definitely need somebody with that. I do my best, but obviously a lot of people have contributed to this submission, both NHS colleagues and local authority colleagues. So a lot of people contribute, and I just basically coordinate and pull it all together and make sure we meet the deadlines. Yeah, so we have to be a bit formal now. So the recommendations are there. Do we need a proposer? Our proposer in the chair, and Jerry will second. Thanks. And it's Nigel nodding. So we all agree. So thank you. Thanks very much. So yes, we approve the recommendations. And thank you very much for your report. Excellent. And I will pick up their thoughts. Yeah. Good. Thank you. Thanks, everybody. And that's the end of the meeting. Thank you.

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