Agenda item

To receive a presentation from the Programme Director, Better Care Together providing an overview and update of the Better Care Together Programme.

The Programme Director, Better Care Together gave a presentation providing an overview and update of the Better Care Together Programme (BCT).

During the presentation the following comments were noted:-

a)         That the timetable for consultation on Better Care Together had been delayed further due to requirement for 42 national health areas to provide  Local Health System Sustainability and Transformation Plansunder  ‘The Delivering the Forward View – NHS Planning Guidance  2016/17– 2020/21’ issued in December 2015.  This required placed based health providers to create an ambitious local blueprint for accelerating its implementation of the Forward View.  These Sustainability and Transformation Plans (STPs) would cover the period between October 2016and March 2021, and would be subject to formal assessment in July 2016 following submission in June 2016.

b)         The Guidance had been published jointly by NHS England, NHS Improvement (Monitor and the NHS Trust Development Authority), Care Quality Commission (CQC), Health Education England (HEE), National Institute of Health and Care Excellence (NICE), Public Health England(PHE).  The guidance asked the NHS to spend the next six months delivering core access, quality and financial standards while planning properly for the next five years.

c)         The local health area covered Leicester, Leicestershire and Rutland and whilst the Better Care Together pre consultation Business Case had been reviewed favourably by the NHS Review Panel they had asked for further details on finance, capital and capacity. 

d)         NHS England had issued advice that as the BCT was a part of the STP, it would not be possible to proceed with consultation on BCT until the STP had been formally approved.  This meant that the Business Case required amendment and it was therefore available for public consideration at this time.

e)         A letter had been sent to NHS England expressing the need to move forward locally on the BCT and this could be shared with the Commission members.

f)          The delay to the consultation, however, only delayed changes to services that required public consultation, such as the University Hospitals of Leicester NHS Trust’s proposals to reduce acute care from 3 sites to 2, which involved the significant shift of services from the General Hospital Site to the LRI and Glenfield Hospital sites.  It would also affect the proposals for the Maternity Services and the Women’s Hospital at the LRI.  These services were also subject to capital finance approvals before proceeding.

g)         Some changes to services could still go ahead as these were operational changes which did not require statutory consultation. These included the Integrated Community Support Services and Review of services for people with mental health conditions and learning difficulties.

Following questions from members it was noted that:-

a)         Any planned transfer of patient care from the acute sector to community hospitals and the social care sector would not occur until service plans were in place in these sectors.

b)         The provision of hospital beds at home was not suitable in all cases and would only happen if this was the patient’s preferred option and the patient’s home was suitable to accommodate a hospital bed.  Where this was not suitable an alternative offer of rehabilitation in a community hospital would be provided.

c)         Where a hospital bed at home was provided, qualified nursing staff would visit the patient 4 times a day to give clinical treatment and there would also be an input from social care services.

d)         The NHS were funding the twin tracking of services to allow the transfer of patients from the acute sector to the primary care and social care sector.

Following the presentation Members made the following comments and observations:-

a)         Members were concerned at the delay to the BCT process as a result of the STP process.  A further initiative being rolled out on top of one that had yet to be implemented gave rise to further concerns.

b)         The delays to the consultation process made planning between the health and social care economy difficult especially given the current budgetary constraints and the need to target budgets at areas of need.

c)         The Programme Director BCT was asked to provide a further briefing paper on the service transformations that could proceed without statutory public consultation.   In response it was noted that these details may be available at the end of June.

d)        Healthwatch could provide feedback on patient experiences of the new service changes.

The Chair stated that she would discuss the concern at the delay on the BCT consultation with the Deputy City Mayor and agree a response to NHS England which would be shared with members of the Commission.

The Strategic Director of Adult Social Care commented that:-

a)         The Council received £14m from the Better Care Fund (BCF) to enable the transformation and integration of services with health partners.  Leicester, as a local authority, was at the higher end of the proportion of BCF funds invested through adult social care services and delivery in comparison with other local authorities.

b)         BCF funds had been used to improve the poor performance in the discharge of patients from hospitals back to the community/their own homes.  Joint working in partnership with UHL and LPT had moved the performance from the bottom quartile to the top quartile in the last year.

c)         The growing pressures on the social services budget came from increasing demand but particularly from working age adults over and above that from the increasing care and support needs of older people.  There were increasing numbers of people aged 40 -65 years old who had multiple physical and mental health conditions which impacted on their own self-care

d)         The national living wage had also placed additional pressures on the budget as it resulted in an additional cost of £4m per year.  Whilst the government had allowed Council’s to raise an extra 2% through Council Tax: this would only raise £1.8m per year.  This extra cost was for existing service provision and not a service increase.

The Chair indicated that she would discuss the issues raised with the Chair of the Adult Social Care Scrutiny Commission with a view to undertaking joint scrutiny on the BCF investment and the measures being taken to address emerging issues such as the pressures being put on the budget by people of working age.

AGREED:

            That the Programme Director be thanked for the presentation