Agenda item

Joint report of the Executive Director, People Services, Sheffield City Council and the Chief Officer, Sheffield CCG.

The Board considered a report of the Director of Delivery Care out of Hospital on the progress and challenges of the Better Care fund and its future strategic objectives.

A presentation was also provided to explain what had been achieved, how it feels now in Community Services and what was hoped for in the future.

The Better Care Fund was a term to describe the pooling of health and care commissioning budgets across Sheffield Clinical Commissioning Group and Sheffield City Council and had been in operation for over three years.

It was the key enabler to bring about parts of the transformation of the NHS, the Local Authority and local communities via Shaping and Sharing Sheffield as articulated in the Sheffield Place Based Plan.

The Better Care Fund covered transformational programmes and business in the following workstreams;

·         People Keeping Well;

·         Active Support and Recovery;

·         Ongoing Care;

·         Independent Living Solutions;

·         Mental Health;

·         Urgent Inpatient Admissions;

·         Disabilities Grant.

The Board were advised that the funding received in Sheffield to buy services had flat lined and cut, so it was increasingly difficult to buy all the services needed for the increase in demand.  The CCG and SCC looked at what was currently spent and found that there was a lot of duplication across the services that were commissioned, if this was done jointly it could reduce the duplication. There was emerging evidence that it would be better to shift some funding which was spent on unnecessary high cost care and better use it on preventing people or reducing the need for high cost care. 

People of Sheffield had also said that they wanted more joined up care, wished to be more in control of their care and did not want to be in hospital unnecessarily.

Sarah Burt, Interim Deputy Director of Delivery - Care Outside of Hospital, Sheffield CCG and Helen Kay, Operations Director, Sheffield Teaching Hospitals NHS Foundation Trust outlined some of the achievements through the Better Care Fund.

There had been a development of a new model for wound care in communities with collaborative working with the community nurses, tissue viability experts, primary care representatives and CCG colleagues to use local patient and staff experience  and national guidance to design a model which would provide a more effective and sustainable model of care.

The Active Recovery Service which had both admissions avoidance and facilitated return to home function was currently undergoing a redesign process. The service had, had a separate health and local authority employed support worker workforce for many years, with the local authority team taking over from health once patients were at the point of just needing the usual treatment care.

It was recognised that this caused duplication and handovers which were unnecessary and difficult for elderly people, and over the past nine months the project team were working hand in hand from the consultation phase to arranging workshops and meetings to develop the recommendations for change and begin implementation.

The creation of a multidisciplinary community hub, to enable simple referrals to extra support if needed after discharge from hospital, was being discussed.

Elsewhere in the city a huge amount of work was ongoing to support person centred care planning. There were strong links with social prescribing services in practices, and in some areas of the city the health and wellbeing partnerships were providing a good range of services which primary care could directly access or access via social prescribing signposting.

Other targeted work going on in the Community was the ‘Okay to Stay’ and ‘Virtual Ward’ which helped people with long term conditions stay safely at home.

In addition to what was expected of the local authority and CCG, the services worked within a very challenging financial situation and the populations needs were increasing, so the aim was to utilise all the resources better and smarter and shift the focus on avoiding or reducing high cost care by doing much more, closer to or in people’s communities/homes.

There was a consensus amongst the board members that the programme needed to be improved and the Board should set out more clearly what it expects of the Better Care Fund.  Dr Tim Moorhead advised that moving money was difficult, so it would not be easy to set a target on this, wider conversations would be needed around what budgets were set for different services and reflect on how the money was being spent.

Councillor Cate McDonald (Co-Chair) suggested that the points raised in today’s discussion be taken forward to a further meeting to be arranged, after the feedback from the recent CQC review was available.

RESOLVED that the board;

1)    discussed the opportunities for 2018/19 and noted the progress so far;

2)    requests that the points raised be included in discussions at a further meeting to be arranged, after the feedback from the recent CQC review was available; and

3)    agrees to receive a further report in November 2018.