Agenda item

To receive a report regarding the Better Care Fund 2018/19.

Members received an update on the Better Care Fund 2018-19.

During the discussion of this item the following points were made:

·         The Better Care Fund (BCF) had been developed to pool resources and deliver the integration of adult health and social care services, and had come into effect in 2014.

·         Locally the focus had been on making improvements in the adult services area.

·         Rhian Warner, Wokingham BCF Programme Manager, updated the Committee on the four local schemes; Integrated Front Door - The Health and Social Care Hub; Wokingham Integrated Social Care and Health (WISH) Team, including Step Down; Community Health and Social Care (CHASC) including Community Navigators and; Step Up.

·         It was noted that the top 10% of service users accounted for up to 50% of the spend in the Borough.

·         Rhian Warner highlighted the Step Up service.  Since December 2017 6 Step Up beds had been offered in Wokingham Community Hospital for residents, providing an alternative to acute hospital admission.  It had been very successful.

·         In response to a question from Councillor Richards regarding the capacity of the Step Up scheme, Rhian Warner indicated that the 6 beds had been operating at capacity for the last 6 months.  The number was considered sufficient but this would be kept under review.

·         Councillor Loyes questioned whether 24 hour a day care was provided under the Step Up scheme and was informed that it was. 

·         The Better Care Fund also funded six Berkshire West wide schemes; Care Homes (Community Support) Project - incorporating RRaT (Rapid Response and Treatment; Connected Care; Integrated Discharge Team (IDT) and Trusted Assessment; Street Triage – Mental Health; Falls and Frailty and Brokerage service for self-funders at the RBFT (provided by CHS Healthcare).

·         In response to a question from Councillor Mather, Rhian Warner clarified that the Connected Care project was running approximately 6 months behind. 

·         Councillor Loyes asked about the funding of the Street Triage scheme.  Rhian Warner commented that it was split according to usage.  Reading Borough Council paid the greatest proportion of the three Berkshire West local authorities and Wokingham the least.

·         Councillor Jones asked how successful the Street Triage Scheme was.  Rhian Warner stated that the number of people who would have gone into custody had reduced, and that savings had been made.  Councillor Jones went on to ask which organisations received these savings.  Rhian Warner explained that the scheme was partly funded by the Police and that savings were returned to the Police and health.

·         Members were pleased to note that the Falls and Frailty initiative had reduced conveyance to hospital rates by 30%.  In response to a question from Nick Durman, Rhian Warner explained that the Falls and Frailty was operated through the 999 service and that dispatchers determined whether it was more appropriate to send an ambulance or a rapid dispatch car.  Work was also being undertaken with Wokingham Medical Centre and population health management data around falls.

·         The Committee discussed the Step Down scheme which was due to cease in its current format as it was not delivering on any of its outcomes and had been in place for 2 years.  The scheme used 3 beds in an extra care facility, Alexandra Place, but only 7 people had used the scheme during 2017-18.  Councillor Swaddle asked whether the Step Down service had also been available for younger people and was informed that the provision was the same for all those who required it and were over 18.  However, the scheme had primarily been used by over 65’s.

·         The governance around the Better Care Fund had initially been commissioner led but had developed into a partnership between commissioners and providers. 

·         Rhian Warner took the Committee through some of the highlights for 2018/19.  People were being kept at home safe and for longer.  For example, for 2018/19 an average of 87% against a target of 85% had been achieved for the number of people who had been discharged from hospital into rehabilitation/reablement services that were still at home 91 days after discharge.  In addition the Integrated Hub had very high levels of user satisfaction.  The Care Homes Project had reported that at the end of Q3 of 2018/19 the project was reporting a 4% decrease in See, Treat & Convey, a 7.5% decrease in Accident and Emergency (A&E) contacts and an 11% decrease in Non-Elective Admissions (NEAs) from care homes in Berkshire West.

·         Members considered key challenges and risks that had been identified during the year including non-delivery of emergency admissions target; recruitment and retention of workforce and; culture change.

·         An underspend identified in Q2 had been redistributed in Q3 to fund three short term schemes; Paramedic Home Visiting Service, Therapy Demand for Reablement and Demand Management in Adult Social Care to support Non Elective Admissions and Delayed Transfers of Care performance through the winter period.

·         Rhian Warner stated that performance across the Berkshire West system as a whole was not the same, with Wokingham achieving the greatest level of success overall.

·         Members were disappointed to learn that Wokingham had been one of very few out of 150 Local Authorities to receive only 10% of the Improved Better Care Fund (iBCF) money due of the Relative Needs Formula allocation methodology.  Members questioned how the allocation was determined.

·         Whilst it had been planned to save £2,513,448 for 2018/19, £2,466,209, 98% of the planned target had been saved.

·         Schemes were regularly reviewed to determine whether they were delivering as intended.

·         The forward programme for 2019-2020 would align with the priorities of the Berkshire West Integrated Care System and the Wokingham Borough Wellbeing Board.

RESOLVED:  That the update on the Better Care Fund 2018-19 be noted.