April Health & Wellbeing Board – More on the Better Care Fund…

(For a summary of the discussion at the Board please go to the County Council website.)

The main part of the Nottinghamshire Health & Wellbeing Board meeting on 2^nd April was given over to agreeing to the plan for how Nottinghamshire health and social care services intend to use the new Better Care Fund (BCF). This is government money, top-sliced nationally from NHS England budgets (so it’s not new money), and given to local health and social care planners as a “pooled budget”.

Requiring a pooled budget is quite a radical step on the part of the government and in my view is absolutely essential. As a previous blog described, the last 40 years of attempting to better integrate health and social care has failed, and it’s failed largely due to the difficulties of bringing together the respective budgets and agreeing the priorities for their use.

These plans have now been agreed by the 6 Nottinghamshire Clinical Commissioning Groups (or CCGs for short), and the County Council’s Adult Social Services. No mean feat in such a short time-scale! The Nottinghamshire people who are going to be helped by the Better Care Fund services are predominantly older people with physical frailty or mental ill health and young adults with disabilities.

The government has laid down some conditions on the budget over and above it having to be a “pooled budget”. An interesting condition, not surprising with all the concerns about pressure on hospital admissions, is the requirement that health and social care have integrated 7 day services to help people (predominantly older people) being discharged from hospital to return home with adequate services in place, and to prevent unnecessary admissions to hospital at the weekend by providing effective care at home.  This is also a provision long overdue in my view.

The two points I made which have been raised with Healthwatch Nottinghamshire (HWN) were:

1. Was it the intention in the Better Care Fund planning to integrate personal budgets in social care (already well established) with the proposed personal health budgets (coming in this year for people with continuing health conditions and raised with HWN as an issue)? The answer to this was yes.
2. I made the point – something that has frequently come up at meetings attended by HWN – that the BCF plans should include the provision of preventative services in the community for people (particularly for frail older people, people with disabilities and for carers) who were showing early signs of beginning to need help. Unless this was built into the planning of services (particularly with the assistance of the voluntary and community sector), future population pressure demand on health and social care services would almost certainly undo the achievement of more integrated services in the community made possible by the Better Care Fund.

The Board agreed with this point.  A number of GPs representatives at the meeting said that their BCF planning groups (there are 3 planning groups covering Bassetlaw, mid Notts and South Nottinghamshire) were aware of the importance of providing early preventative services for just this reason.

It remains to be see how effective those plans turn out to be.  HWN will be taking an interest in monitoring progress on this, as well as making sure that opportunities are given to people across Nottinghamshire and in different communities to contribute to the implementation of these ambitious plans.