Agenda item

Following previous consideration at meetings held on 4 April 20114, 17 July 2014 and 16 September 2014, the Better Care Fund Plan 2014/15 and 2015/16 is now attached in the form of a covering report (HWB5); a narrative template including detailed schemes (Appendix A); and a qualitative template including expenditure, benefits and performance metrics (Appendix B).

Please note that Annex 2 of the narrative document will be forwarded on as an Addendum next week once all parties have had the opportunity to formally sign the document off.

The Board is RECOMMENDED to agree the Better Care Fund Plan 2014/15 and 2015/16 for submission to NHS England by 9 January 2015, subject to the inclusion of any changes following the meeting, as agreed by the Chairman and Vice-Chairman of the Board.

John Jackson, David Smith and Cllr Mrs Judith Heathcoat introduced the Plan, all commenting on the excellent progress made on the Plan between the four organisations (OCC, OCCG, OH and OUHT) since the Board’s September meeting. The Board was reminded that the £37.5m funding was not new money and that there remained financial pressures on the NHS and on Social Care but that that this was a different way of using the funding available and of using it more efficiently.

David Smith reported significant changes to the overall resources for NHS since the Board had last met in November. Instead of the expected £18m funding for 2015/16 for growth purposes (which had already been committed for routine pressures), the Chancellor had given the south east £41m for 2015/16 and a further £20m for 2016/17. He pointed out that Chief Executives from all four organisations (OCC, OCCG, OH and OUHT) were already thinking collectively about which schemes would require funding, and trying to coordinate in -year delivery in accordance with governmental processes, in line with the transformational change and integrated approach ethos.

During the course of the debate areas of discussion and views expressed comprised the following:

·         The requirement for the patient and public involvement input to be worked out in the light of the large numbers of groups of people using the services, so that any concerns and experiences could be fed into the process;

·         From a Public Health point of view, the Plan addressed the symptoms of the problems, and not the causes. For example, if nothing was done about problems such as the demographic challenge, loneliness and isolation or chronic illness arising from obesity then this would sweep away all the transformational changes made. The intention was that a single Social Care /Health Plan for Oxfordshire would address both the causes and the symptoms and therefore more work and discussion between Health and Social Care and commissioners and providers and with the residents of Oxfordshire would be needed in order to join the two together;

·         The additional monies could be spent on a prevention/intervention programme;

·         The mental health budget must not be eroded and the service needed to be treated as an equal service to others - a new set of standards were to be introduced;

·         The intention was that Integrated Centres for patients would cover the whole county and work had already started on them, with Social Care having committed to enter by a certain date. There were many issues to iron out, but Health and Social Care needs would be met within local communities where possible. Work was in train on the Outcome Based Contracting programme for Mental Health/Older People/ Community Nursing Services which included a possible need to approach requirements in slightly different ways depending upon the location. Stuart Bell warned that the transformational change should not take too long, or the benefits would not be realised;

·         Elected members needed to think about how to communicate with constituents on issues such as the correct use of Health and Social Care services.

In response to a question, David Smith commented that the targets relating to reductions in Accident & Emergency visits were indeed a challenge but achievable as long as all organisations could deliver. Andrew Stevens paid tribute to staff from all agencies and carers for the way they were managing the pressures, adding that if there was operational equilibrium, it would follow that the financial element would also ease. He declared that the Better Care Fund Plan was a good start towards this and pledged the support of the OUHT. He added that he had recently attended a meeting with Dr McWilliam about how the OUHT could contribute to the integration agenda, as well as to that of the transformation agenda. He agreed that a single plan was required in order to give a reference point with which to measure the contribution and effectiveness of individual schemes. Furthermore, that monitoring was of paramount importance in order to redirect resources if there was a need to.

Stuart Bell also pointed out that the changes would serve to create a strong forum for strategic discussion on how to combat risk, such as the ability to recruit staff. The Chairman agreed, adding that a key function of the Growth Board, for example, was for District Councils and the County Council to consider all issues relating to infrastructure delivery to schemes such as to extra care housing developments.

The Board AGREED (unanimously) to agree the Better Care Fund Plan 2014/15 and 2015/16 for submission to NHS England by 9 January 2015, subject to the inclusion of any changes following the meeting, as agreed by the Chairman and Vice-Chairman of the Board.