The Lancashire Health and Wellbeing Board met to discuss the Better Care Fund, adaptations to help people live independently, and national policy changes to the NHS. The board ratified the Lancashire Better Care Fund 2024/25 end of year submission and the 2025/26 Better Care Fund plan. Members agreed to form a working group to consider the implications of the NHS's 10-year plan.

Better Care Fund Update

Sue Lott, attending for Helen Coombes of Adult Services in LCC, presented an update on the Better Care Fund (BCF), including a request to ratify the 2024/25 end of year submission and the 2025/26 BCF plan. The board ratified both of these.

The Better Care Fund is a government programme that seeks to join up health and social care services, so that people can manage their own health and wellbeing, and live independently in their communities for as long as possible.

The end of year submission outlined that Lancashire broadly met the locally set targets for all four metrics¹ in 2024/25. The 2025/26 BCF plan comprises a narrative plan, a detailed planning template, and an intermediate care demand and capacity template. The plan sets out how Lancashire will meet the two new national BCF objectives through promoting independence, focusing on prevention, reducing time spent in hospital or residential care, and supporting people closer to home through integrated working. The three new metrics for 2025-26 are: emergency admissions to hospital for people aged 65 plus; average length of discharge delay for all acute adult patients; and long-term admissions to residential care for people aged over 65.

Following submission of the plan, Lancashire was asked to provide more clarity on value for money aspects and on the reduction in service capacity on intermediate care.

Sue Lott also mentioned the 2025-26 BCF quarter one submission, which is due on 16 August, and will come to the next health and well-being board for ratification.

Councillor Judith Driver asked for more information on the 'Front Door to Care' new model. Sue Lott responded that the Neighbourhood Health Transformation is looking at bringing teams of frontline professionals together across health, social care, and the voluntary sector, closer to where people live.

Teri Stephenson asked about over-provisioning of care, and Sue Lott said that the aim is to ensure people are as independent as possible, and that capacity is used in the best way. Teri Stephenson also commented that the report says that Lancashire has a good offer supporting carers, but that only 27.8% of carers said they were satisfied with social services. Sue Lott said she would get more information on that. Teri Stephenson asked whether the BCF board had considered voluntary sector representation, and Sue Lott confirmed that this was planned.

Councillor Judith Driver asked about social prescribing teams in Lancashire, and whether more information could be made available to residents about them. Sue Lott agreed to gather more information.

Unlocking the Potential

Clare Mattinson and Chris Sinnott presented a report on a collaborative effort to improve how Lancashire delivers equipment, adaptations and home improvement services, to help residents live independently for longer.

Chris Sinnott said that disabled facilities grants² (DFGs) are a statutory responsibility of district councils, but that in the complex world of two-tier local government, the occupational therapist assessment sits with the county council, and minor aids and adaptations also sit with the county council. Appendix C of the Unlocking the Potential report set out the findings of a previous report, which said that DFGs can be extremely important to helping people to live independently, and are generally well delivered across the district councils of Lancashire. However, there are different approaches taken, and so the report recommended trying to make sure there is as consistent an offer as possible, simplifying it as far as possible, and improving data provision and data sharing.

Appendices A and B of the Unlocking the Potential report covered the outcomes of a workshop and a draft action plan. The action plan looks at implementing the recommendations from the DFG review, having a single referral process, and revising the arrangements for the delivery of main rates and adaptations. Discussions are happening with the 12 district councils across Lancashire about whether they can deliver that service on behalf of the county council alongside the DFGs. The plan also aims to focus more on prevention and early intervention, picking up the points around social prescribing.

Councillor Margaret France commented that the problem accessing DFGs has been the assessment by the OT services, which has been a huge bottleneck. She said that basic stuff like grab rails and handrails needs to be done a lot sooner with a more basic assessment by trusted assessors rather than OT experienced specialists. She also said that Chorley has access to a grant that is not means tested for a single large item such as a stair lift or a wet room, and that recommendation number three should be to adopt that model across Lancashire.

The board agreed on the recommendations in the report.

National Policy Changes

Dr Sakthi Karunanithi introduced the topic of national policy changes, saying that the NHS's 10-year plan had been launched the previous week, and that there were some significant changes being proposed. He said that the intention was to have a discussion about what members of the board feel are the key local implications, and what it means for the board in terms of membership and priorities.

Dr Sakthi Karunanithi said that the plan signifies a significant intention from the government to shift care from treatment to prevention, from analogue to digital, and from in the hospital to in the community. It also signifies putting more power and empowerment with residents and patients so that they can be more in control of their health and wellbeing, using technology.

Nationally, NHS England and the Department of Health are merging, and a number of arms-linked bodies and regulatory agencies will cease to exist, including Healthwatch England. There is also an intention to move more devolved powers to the local areas through ICBs becoming strategic commissioners of local health services, and the oversight of acute trusts being more regionalised.

Dr Sakthi Karunanithi said that integrated care partnerships are working across the Lancashire and South Cumbria level footprint, and there is a proposal for that geographical partnership board to seize. The health and wellbeing boards are thought of as the place where neighbourhood health plans are developed, and those will be adopted as population health improvement strategies by the ICB. There is also a move to have a neighbourhood health service type contract, and for hospital trusts to move from being hospitals to integrated health organisations.

Dr Sakthi Karunanithi said that the plan is a little bit silent on social care, and that the core implication for the health and wellbeing board is that its relationship with the ICB and the provider collaborative board should be of interest. He proposed that the board do some work between now and October to consider any changes to the membership, focus, or strategy of the board, so that it can be located as an important platform to continue working towards improving health outcomes and reducing inequalities.

Asim Patel said that he welcomed the plan, but that he was cynical as these things have been heard before. He agreed that the health and wellbeing board should be the platform to take out the different aspects of the plan. He said that the abolition of Healthwatch comes at a time when public satisfaction in the NHS is at the lowest level, and that the ICB has been tasked with reducing its running costs by 47%, which will mean significant changes and headcount reduction. However, he was hopeful that the ICB will become a strategic commissioner, commissioning across the pathway. He said that the plan does not have a chapter on cancer or diabetes, but that the focus is on prevention.

Kerry Prescott said that Healthwatch interpreted the plan as the health part of their work going into the ICB and the social care going into the local authority. She said that they were committed to continuing to provide a good Healthwatch service up until they know that is going to happen, and to supporting the transition. She encouraged people to think about the power of independence that Healthwatch brings to people's voices, and for that not to be lost in new plans, as well as the voices of seldom heard communities.

CC L More said that he was surprised at the 47% reduction for the ICB, and asked for more information. Asim Patel said that this was part of the ICB blueprint, and that the ICB will divest itself of some of the responsibilities that it has, such as digital.

Teri Stephenson said that she welcomed the prevention agenda, but that she was concerned about the digital piece and who can get left behind. CC G Dalton said that he was very interested in the digital aspect, and that we need to think wider than just our phones or expecting an old person or a blind person to click a button.

Dave Carr said that we need to build on what we've already got, and try to join the dots between the things that we've got. Councillor Margaret France said that she was concerned about the move from hospital to community without an extra injection of cash, and that she thought we were leaving the door wide open for the big independent health companies. She said that we need to look at what our philosophy is with this, and whether we are going to adopt an NHS first approach.

Dr Sakthi Karunanithi summarised the discussion, and proposed that the board take this as an action to reconvene as a working group to give it a little bit more thinking and develop some propositions that might have implications to change the way the board works. The next possible opportunity for changing that is through full council in October. The board agreed to this.