The Health and Wellbeing Board met on Tuesday 26 September 2017 to discuss the Better Care Fund Plan and the Joint Strategic Needs Assessment. Decisions were made regarding the approval and future revisions of both the Better Care Fund Plan and the Joint Strategic Needs Assessment.

Better Care Fund Plan 2017-2019

The Board reviewed the joint report from Wandsworth Council and the Clinical Commissioning Group (CCG) regarding the Better Care Fund (BCF) Plan for 2017-2019. This national initiative aims to improve health and social care services, with a particular focus on preventing delayed transfers of care from hospital, reducing emergency admissions, supporting reablement, and increasing support for carers.

Mrs Liz Bruce, Director of Adult Social Services, explained that the BCF submission covered two financial years, allowing for more comprehensive planning. Mr Josh Potter, Director of Commissioning for the CCG, highlighted that Wandsworth was performing well in reducing delayed hospital transfers, ranking second highest in inner London.

Councillor Mark Thomas raised concerns about the use of the Disabled Facilities Grant (DFG), questioning specific changes planned for its application. Mrs Bruce clarified that the DFG is primarily used for housing adaptations to enable people to return home, though significant adaptations might require temporary placements. Councillor Thomas advocated for a more flexible approach to DFG usage to address a broader range of needs.

Discussions also touched upon the reduction of non-elective emergency admissions, with it being noted that this relates to both the Enhanced Care Pathway cohort and the general population. The challenges of identifying the specific Enhanced Care Pathway cohort due to population changes were acknowledged by Dr Nicola Jones, Clinical Lead and Chair of the CCG.

Councillor Thomas also pointed to delays in hospital discharge at St. George's Hospital attributed to waiting for homecare packages, highlighting pressures on the homecare market. Mrs Bruce confirmed these pressures were a national issue and that the Council was exploring solutions, including tendering for homecare services, utilising technology, and supporting families. Investment in KITE (Keeping Independent through Enablement) was ongoing. The need for increased skills to manage a growing number of frail individuals with complex needs was also identified. Councillor Thomas sought information on short-term actions to maximise the impact on reducing delayed discharges. Mrs Bruce indicated that negotiations were underway with the top 20 homecare providers to foster better partnerships and address issues collaboratively, emphasising the importance of quality and safety in care provision for increasingly frail individuals.

The Board was informed that public and patient involvement in the BCF was captured through feedback from patient questionnaires and the all care together planning process. The BCF plan had been submitted to NHS England and was awaiting feedback.

Decisions made:

• The Board noted the Council and CCG's Better Care Fund (BCF) narrative plan 2017-2019.
• The Board noted that the BCF plan might require further revisions based on feedback from NHS England and authorised the Director of Commissioning (WCCG) and the Director of Adult Social Services (WBC) to make these amendments.
• The Board authorised the Director of Commissioning (WCCG) and the Director of Adult Social Services (WBC) to make revisions to the 2018/19 plan in response to outcomes during 2017/18 and changes in wider health and social care priorities.

Joint Strategic Needs Assessment Story

The Board received a report from the Director of Public Health on the Wandsworth Joint Strategic Needs Assessment (JSNA) Story. This annual assessment identifies priority local needs to inform commissioning intentions, focusing on themes of place and life-course stages such as start well, live well, and age well. Ms Anna Raleigh, Consultant Public Health, presented the JSNA, outlining its purpose, the Board's role, Wandsworth's assets, identified needs, and strategies for addressing them.

Loneliness was highlighted as a key area for further consideration, with existing programmes targeting isolation and loneliness through voluntary sector investment. Mr James Blythe raised the connection between housing and mental health, and Mrs Bruce mentioned a new house-sharing scheme being explored.

Councillor Mark Thomas expressed a desire for a clearer understanding of how needs identified in previous JSNAs were being met and whether the situation had improved. Ms Raleigh explained that a partnership steering group was developing the JSNA to focus on responses to needs, and a scorecard attached to the report aimed to indicate progress in various areas. The Chairman requested periodic updates on JSNA outcomes and success stories.

Dr Nicola Jones advocated for initiatives to address homelessness, referencing a homeless tool being rolled out in some areas. Dr Mike Lane reported a significant increase in domestic violence reporting, with Ms Houda Al-Sharifi, Director of Public Health, noting that this had been raised with the Community Safety Team.

Ms Rachel Egan, Assistant Director of Early Help, Children's Services, discussed the early help strategy, including the promotion of PACTs in primary schools to develop emotional management skills and resilience in young people. The issue of domestic violence was identified as a key trigger for children coming to the attention of social care, and work was underway with the Community Safety Team for early intervention.

Councillor Mrs Sarah McDermott suggested re-publishing a leaflet for the JSNA and comparing current identified needs with previous ones to assess the JSNA's success. Ms Raleigh agreed that comparing previous needs and creating user-friendly public information would be beneficial.

Several areas were suggested for inclusion in future JSNAs:

• Changing the terminology of story.
• Inclusion of specific diseases, particularly cardiovascular disease.
• Homelessness.
• Mental health, with a specific focus on lesbian, gay, bisexual, and transgender needs.
• Social care and mental health needs of offenders and ex-offenders.

Decisions made:

• The Board noted the key health and wellbeing needs for Wandsworth as identified in the JSNA.
• The Board approved the Wandsworth JSNA Story 2017/18 for publication, subject to the inclusion of the suggested areas for consideration.