Agenda item - Better Care Section 75 Pooled Budget

1)       That it is noted that the requirement that the Better Care Fund is operated as a pooled budget between the Clinical Commissioning Group (CCG) and the Council and that the mechanism for establishing a pooled budget, is through entering into a Partnership Agreement under Section 75 NHS Act 2006.

2)       That the Executive Director Adult Services and CCG Chief Operating Officer are authorised to finalise and agree a new Section 75 Partnership Agreement between the Council and the Clinical Commissioning Group relating to the commissioning of health and social care services from a pooled Better Care Fund.

3)       That it is noted that the Section 75 Agreement referred to paragraph 3.2 in the report will include the schemes and schedules as detailed in the body of the report and will take effect from 1^st April 2015 with a three year term and with provision to review the Agreement after 12 months.

Introduction

70.1    The Board considered a report of the Executive Director of Adult Services, and the Chief Operating Officer which reminded members that the Better Care Fund was announced in June 2013 and set out the expectation that the Clinical Commissioning Group and Local Authority have agreed plans and pooled budgets to oversee the plans.  The funding was not new money but would need to demonstrate that it is meeting objectives of the plans. The Health and Wellbeing Board would be responsible for overseeing the agreement.  The report was presented by Denise D’Souza and Geraldine Hoban. 

70.2   Denise D’Souza referred to paragraph 4.2 of the report which highlighted the work that was progressing in a number of areas. Paragraph 4.5 detailed the budgets aligned to these schemes.   The total spend was £19.6m. 

          Questions and Discussion

70.3    The Chair emphasised that this was the first Section 75 for this service.  It was a step on the journey for integrating health and social care.  Denise D’Souza stressed that GPs were also involved not just nurses and social care.  

70.4    Tom Scanlon welcomed the report.  He drew attention to homelessness and hoped this was an area which could be picked up in the Health and Wellbeing Strategy.  The city was seeing an increasing number of homeless people and there needed to be a strong stream of work linking not only to health and wellbeing but to housing as well.

70.5    Denise D’Souza stressed that as the Better Care pooled budget progressed more funding would be added.  For example, she would like to see money allocated for housing support and community care added to the Better Care Fund Programme. 

70.6    George Mack stated that pooled budget was a tremendous opportunity but he was concerned that the work was very rushed.  He stressed the need for sufficient robust governance and scrutiny.  He supported the proposals but felt that the there was a need to get mechanisms right to control and manage the process properly. 

70.7    Frances McCabe referred to performance measures particularly in relation to non-elective admissions. She questioned how robust the figures were and asked how confident were officers that a reduction could be achieved?   Geraldine Hoban explained that some performance measures had been provided, for example non-elective admissions metric was a national mandatory outcome.  The reduction of 3.7% was considered achievable.  The other performance measures were comparing the city against benchmarks with other areas.  The City was benchmarked very high with residential admissions compared to other areas.  Reablement was less robust as a measure as the baseline was very complicated.  Officers were very clear that there needed to be a reduction with delayed discharges of care.  A local measure had not yet been set for patient/service user experience. An outcome measure was required that was patient determined.  Officers would report back to the Health & Wellbeing Board on the delivery of all the measures.  

70.8    Denise D’Souza referred to reablement figures.  The figures were complex and there were two sets of baselines and two sets of data collected.  The figures were out of kilter but the city put more people through reablement than many other local authorities.  There was a need to differentiate between people who needed a short recuperation and those who needed more assistance.  

70.9    Councillor Morgan referred to the patient metric.  He stressed that members of the public would want to know what this meant for them and their families in terms of how they measured progress, & how they interacted with the services.  How would officers interact with the acute trusts and the mental health trust?  Dr Christa Beasley replied that this was a valid point.  There needed to be a difference to patients and their families.  There needed to be a change in hospital care both in the acute trust and within the mental health trust.  This was not part of the Better Care Fund plans yet but was part of the CCG plans.   

70.10  RESOLVED:

1)       That it is noted that the requirement that the Better Care Fund is operated as a pooled budget between the Clinical Commissioning Group (CCG) and the Council and that the mechanism for establishing a pooled budget, is through entering into a Partnership Agreement under Section 75 NHS Act 2006.

2)       That the Executive Director Adult Services and CCG Chief Operating Officer are authorised to finalise and agree a new Section 75 Partnership Agreement between the Council and the Clinical Commissioning Group relating to the commissioning of health and social care services from a pooled Better Care Fund.

3)       That it is noted that the Section 75 Agreement referred to paragraph 3.2 in the report will include the schemes and schedules as detailed in the body of the report and will take effect from 1^st April 2015 with a three year term and with provision to review the Agreement after 12 months.