Agenda item - Better Care Plan Dashboard

RESOLVED: That the Health & Wellbeing Board noted the update.

31.1      Chris Clark introduced the report which focused on Delayed Transfers of Care (DToC). Delayed transfers resulted in a poor patient experience and were the driver in inefficiencies in the local health care system. The data for July and August was not reported in the paper but there had been a significant increase and there was a need to take urgent action. DToC placed pressure on the flow through hospital which had a knock on effect on A&E. There was a need for the Council, Hospital and CCG to work together to take a whole system approach to the issue. There was also a reported overspend in the Community Equipment Fund but there was potentially issues with the accuracy of the reporting and this would be confirmed by the next meeting.

31.2      Malcolm Dennett stated that it was a positive step to have metrics reported to the Board regularly and it was now important for these metrics to be examined overtime and to be seen in context so that the impact of spending could be assessed and scrutinised. Several metrics had flat lined over time and it was important to understand if this was a sign that the money being spent in these areas was moderating against increasing pressures or whether it showed that there was actually little impact of the spend. He also noted that the Community Equipment Fund had been overspent last year as well and stated that it would be worth investigating the cause of this persistent overspend.

31.3      Chris Clark responded that he could bring more detail on the Community Equipment Fund to future meetings.

31.4      Councillor Mears stated that it was key to identify where there was increasing pressure in the city to inform commissioning and to monitor trends over the long term. She also stated that a priority in the city needed to be keeping people in their homes for as long as possible.

31.5      Councillor Page stated that he supported Malcolm Dennett’s call for further investigation into the Community Equipment Fund which provided a vital service. He stated that he was full of admiration for the amount of work which had resulted in the flat lining of indicators in the context of an aging population. He asked if officers could elaborate on the urgent actions being taken to address the DToC issue.

31.6      The Chief Executive, Brighton & Hove City Council stated that over the summer DToCs increased in the City which was the situation nationally. Partners from the system came together to try and rectify this both though immediate operational action and also by looking at a strategic approach to build capacity to be able to better respond in the future. He stated that it was important to understand how patients flowed through the hospital, how staff on the ground responded to this and how the Board could influence this.

31.7      Councillor Wealls stated that the Better Care Fund had existed for around three years and it had been difficult for members to evaluate its effectiveness from the reports presented which did not include targets or give context through comparator data to the metrics. He hoped that future reports would state what the targets were and expand on why these targets were or were not being met. Officers needed to be able to justify why the targets had been set at the levels they had and that they were realistic. He did not feel that the reports demonstrated that the Council and CCG understood why spends had been effective or not and did know what was working elsewhere. Councillor Wealls also wanted to have more evidence of the long term planning which had been reported verbally at committee to demonstrate that there was not just a series of knee jerk reactions.

31.8      The Chair stated that it was a challenge to find a balance between putting as much as possible into the public domain and still producing readable, useful reports. She stated that November’s Board was already due to receive a large number of reports and that there were other forums were Members may be better able to examine performance data on DToC in particular and the Better Care Fund in general.

31.9      Wendy Carberry stated that DToC was a national issue but was a particular issue in the South East and required and entire pathway response. The CCG was leading a ‘stock take’ across to the whole system to identify gaps and to see what was missing.

31.10   Chris Clark responded to the debate that Better Care Planning was on an annual cycle and the plan could be circulated to Members. The key message was to look at what was being done and where the impact was not as great as the CCG and Council would like. As part of the CCG and Council’s joint planning the Better Care Fund and other commissioning that would impact DToC.

31.11   The Executive Director, Health & Adult Social Care stated that there was a need to examine the difference between budget and spend in Community Equipment. If an individual could be kept in their own home for a £100 spend on equipment this represents better value for the local health care system and a better patient experience than that individual being hospitalised. He stated that a report to the Board on the Community Equipment Fund would focus on reporting activity and showing value for money of the fund.

31.12   The Chair asked officers to bear the feedback in mind about how the metrics are reported when preparing future reports.

31.13   RESOLVED: That the Health & Wellbeing Board noted the update.