Agenda item

Sheffield's 2017/18 and 18/19 Draft Better Care Fund Narrative Submission

A joint report of the Executive Director People Services, Sheffield City Council and the Chief Officer, NHS Sheffield Clinical Commissioning Group.

Minutes:

 

The Board considered a joint report of the Executive Director Communities (now People Services), Sheffield City Council and the Chief Officer, NHS Sheffield Clinical Commissioning Group (CCG). Peter Moore, the Director of Strategy and Integration, Sheffield Clinical Commissioning Group introduced the report together with Rachel Dillon, Sheffield CCG.

 

 

 

The CCG and City Council were required to submit a plan for 2017-2019 to describe plans and targets by 11 September. The Health and Wellbeing Board would need to approve the narrative plan for Sheffield’s Better Care Fund 2017/18 and 2018/19.

 

 

 

The Board was informed that the Better Care Fund was key to bringing about parts of the transformation the NHS, the Local Authority and local communities and was linked to public sector reform, place based plans and the Shaping Sheffield plan. There were challenges both at national and local level which related to Sustainability and Transformation Plans and integration. Nonetheless, Sheffield had remained clear to its outcomes. There had also been successes, including a pooled mental health budget, a pooled budget for equipment, the building of stronger relationships and the delivery of care through the development of community partnerships.   The adoption of a neighbourhood model would mean that care could be delivered by groups of clinical and social care teams and allow earlier intervention and prevention and early diagnosis.

 

 

 

There were challenges around provider integration and the involvement of providers. There was also enabling work to be done in relation to infrastructure such as ICT. The financial position was also challenging and the Board had to be mindful of that and an example of a positive response was the planning of a pooled budget for mental health services. Sheffield was to receive an additional £24m non-recurrent funding in total over 3 years to spend on adult social care services. It was intended to progress the inclusion of provision for Children and Young People into the pooled budget from April 2018. There was also a plan relating to reducing delayed transfers of care out of hospital and in relation to management and governance. The ambition was to move to a more fully integrated system.

 

 

 

Members of the Board were asked to consider whether they were satisfied that the plans would progress the Board’s ambition to transform the health and care landscape, reduce health inequalities and deliver better outcomes for Sheffield people; and to identify where there might be further opportunities for integration and joint working, in particular reference to commissioners and providers working together as an Accountable Care Partnership.

 

 

 

Members of the Board asked questions and commented on the issues and the comments and responses are summarised below:

 

 

 

It was hoped that with a less fragmented approach to commissioning of health and social care, there would also be less fragmented provision. The challenge was to use the existing resources more efficiently and not a reduction in the overall amount spent. There were some interventions, such as social prescribing, which provided benefit in other parts of the system, including secondary and tertiary care. However, at the present time, there was considered to be a capacity issue in relation in community provision and managing demand for social prescribing.  It was thought that there should be cost effectiveness in all interventions.

 

 

 

It was considered that the Board would be assisted if there were appropriate metrics relating to the progress and impact of integration. Whilst the ambition for change presented in the draft narrative to the plan could be supported, the plan also required greater precision.   

 

 

 

There was agreement that the term ‘integration’ should be something as seen from the perspective of the citizen and not an organisational viewpoint.   

 

 

 

It was necessary for the Board to keep sight of what it wished to achieve and to demonstrate leadership, using the Better Care Fund to enable the use of resources where needed in the community and through providers.

 

 

 

There were examples of good practice in relation to the self-care strategy, where patients were enabled and supported to take on those tasks in relation to which they felt comfortable relating to their own health and wellbeing. In relation to patient satisfaction, outcomes were thought to be better if patients were properly involved.

 

 

 

Whilst issues of culture and cultural change had been put forward, it was acknowledged that it was difficult to define what was meant by the term ‘culture’ and therefore difficult to say how it might be changed. There were issues relating to clinical and professional boundaries which needed to be taken into account.

 

 

 

The main emphasis and audience for the narrative plan needed to be considered. Factors such as the implications for risk and the risk management associated with the movement of resources from one area to another might need to be more clearly detailed. Similarly, the factors specific to Sheffield may need to be more clearly set out.

 

There was acknowledgement that the issues for Sheffield’s population were also contained in the Joint Strategic Needs Assessment and the State of Sheffield report, which gave a snapshot of the City.  Moreover, the changes brought about through the Accountable Care Partnership and Better Care Fund should also become apparent in those documents.

 

 

 

As regards the intended audience for the narrative document, the Better Care Fund Plan was to be submitted to NHS England and it was a subset of the Shaping Sheffield Plan. The guidance in relation to the Better Care Fund required it to be ‘signed off’ by the Board, although it was not specific as to the detail. There was a balance and choice for the Board as to whether it wished to see a highly detailed document or a narrative one, which might be high level or easier to follow.  

 

 

 

The Better Care Fund might also be seen as a catalyst for change in terms of building partnerships and relationships. The plan might be considered to set the tone and expectations for integration of health and social care. This included the use of the plan to think about the Board’s ambitions relative to the present state of things. As part of that thinking, the detail of the plan and issues such as public accountability would be considered.

 

 

 

There needed to be more in the narrative specifically about Sheffield and there were links to the content of the Public Health Strategy, which was to be considered by the Board later at this meeting. Whilst there were a number of different strategies, the Board would need to be clear about whether those strategies were sufficiently joined up. The right metrics needed to be worked upon. It was recognised that there had been sizable change in the past two years in the extent to which organisations were beginning to work together and understand their respective issues. This type of cultural change took time, but it was important to take into account risk, limitations and dynamics in organisations and the extent of public buy-in and understanding.

 

 

 

At its forthcoming development day, the Board might look at questions of leadership to enable cultural change and how strategies could be co-produced with patients and employees.

 

 

 

Appropriate metrics relating to the Better Care Fund might include measurement of what was being achieved and other aspects including cultural change and influence that the plan was bringing about.  This included evaluation from the patient’s perspective of their experiences. Actual health improvement may not be easy to measure and proxy measures might need to be utilised. Reference could be made to the JSNA, to clarify which of the populations in the City the plan was to target. There were various methods of measuring and evidencing the extent of achievement and change and these could include quantitative and qualitative measures, such as numbers, expenditure and patient voice by asking patients how they might articulate change. The measures could be based around the outcomes, themes and priorities in the plan.

 

 

 

It was RESOLVED that:

 

1.     Approval is given to the narrative of the Better Care Fund plans;

2.     the Health and Wellbeing Board delegates finalapproval of the Better Care Fund submission to NHS England to the lead executive officers in the Council and the CCG.

3.     the Health and Wellbeing Board receives an update on progress at its public meeting in November 2017.

 

Supporting documents: