A Healthwatch “take” on the 6 April Health and Wellbeing Board

For a useful summary of all the papers that came to the Board and to see the context for these Healthwatch Nottinghamshire questions, please see: www.nottinghamshire.gov.uk/media/112734/mar-2-2016.pdf

This was my last Health and Wellbeing Board before standing down as Chair of Healthwatch Nottinghamshire on April 29^th. Healthwatch must be making a positive contribution to the discussions and decisions that the Board are making because, at the end, there was a spontaneous round of applause. Something is working.

Bassetlaw CCG 5 year plan.

Healthwatch question on prevention: If Bassetlaw’s new models of care in the future are to focus on multi functioning primary care GP centres and integrated neighbourhood community nursing teams, will there be opportunities for them to commission from their budgets local voluntary and community sector preventative services for older and vulnerable people? This is important as voluntary and community sector groups are telling Healthwatch that they are finding it increasingly difficult to fund their preventative work.

Response:  The Chief Officer for the CCG, Phil Mettam, thought that there would be such opportunities.  He gave as an example the current GP commissioning of “social prescriptions” (e.g buying practical help and social support to older people from voluntary bodies) in Bassetlaw.

Update on Sherwood Forest Hospitals Trust merger with NUH

Healthwatch question on risks: Our health experts on the Healthwatch Board say that the national evidence on large hospital trust mergers is equivocal about their success. Some mergers work and improve the situation; but some don’t. The risk is that senior management can get distracted from quality of health care improvement by the shear complexity and time- consuming business of bringing together the many services and organisational cultures involved.

Response:  The two Chief Executives, Peter Herring and Peter Homa, responded by saying that they had also done a great deal of research into Hospital Trust mergers, successful or otherwise. They intend to follow the best practice of successful mergers, to avoid the kinds of risks I cited.  They referred to the earlier successful merger of QMC and City Hospitals in 2006 as a good example of what can be achieved.

Strategic public health framework for Nottinghamshire Healthcare NHS Trust

Healthwatch question on gaps in provision: Are there gaps in provision from the Trust in the provision of mental well-being services for young people before they become so serious that they actually need the help of Children and Adolescent Mental Health Services (CAMHS) or cognitive behaviour therapy as provided by the Trust?

This area of preventative mental well-being has been one of the seven agreed priority actions for the Health and Wellbeing Board. It has also been one of the areas that young people have raised with Healthwatch Nottinghamshire over the last two years.

Response:  Professor Chris Packham, Associate Medical Director at the Trust, in response agreed that there are gaps of service provision in this area, both within the services provided by the Trust and within other public agencies.

We were reminded by the Director of Public Health, Dr Chris Kenny, about the new Nottinghamshire Children and Young People’s Mental Health and Wellbeing Transformation Plan. This had been discussed and supported by the Health and Wellbeing Board in December 2015.

It places a focus on promoting (mental health) resilience, prevention and early intervention for children and young people. One of the examples in the plan is taking what it calls a “whole school and college approach” to promoting emotional health amongst young people. This is something that children and young people tell Healthwatch they would keenly support.

A Healthwatch “Take” on the Health and Wellbeing Board meeting, 3 Feb 2016

For a useful summary of all the papers coming to the Health and Wellbeing Board (HWB) please go to the following link:  http://www.nottinghamshire.gov.uk/media/111920/feb-3-2016.pdf

A pre-meeting of the HWB had been agreed at the previous meeting in December. The issue was whether the Board should give a response to the NCCs budget reduction proposals. This was particularly relevant in the light of the possible social services budget reductions. There was debate between County Councillors as to whether the Board could give such a view. The County Council’s legal advice was that, as the HWB was a Council committee, it would not be possible to give a collective view. However individual organisations on the Board would be able to do so. Both Nottingham North and East CCG and Healthwatch Nottinghamshire had already submitted their views on the negative implications of more social services budget reductions.

Healthwatch made the concluding point that it would be detrimental if this apparent legal and constitutional limitation on HWB powers meant that that it would not be able to make recommendations on future, perhaps controversial, decisions concerning health and social care funding and planning.

Update on Progress by Healthwatch Nottinghamshire

Our update report received a good response. Positive comments were made on the work over the last year on the renal patients experience on the transport service and our choice of optician services for the Question of the Month. Two of the GP members expressed concerns about the statistical validity of some of our findings on the quality of GP services in terms of numbers of responses. A useful suggestion was made that Healthwatch could also use the findings from GPs’ and other survey feedback. This we will take on. We need to remember, however, that the experiences that Healthwatch gathers from patients is primarily qualitative rather than quantitative in nature.

Mental Health Crisis Concordat

This concordat across Nottinghamshire’s agencies concerned with mental health services has reduced the urgency of Healthwatch looking further into local crisis services. At least for the moment. Yesterday’s (15 Feb) announcement of the government’s response to the major report on inadequacies in England’s mental health services, I think, reinforces the position we have taken.

Key questions from Healthwatch were:

1. Did the new 111 mental health pilot service described in the Concordat require people phoning in for help to be already known to mental health services. If this were the case, it wouldn’t help large numbers of people in distress.

Answer: The pilot 111 line will take calls from all people. This is good news.

• One of the risks that the paper identifies is the current demand on psychiatric beds, issues around hospital discharges, and having to use beds outside of Nottinghamshire. What is happening to address this?

Answer: Nottinghamshire NHS Healthcare Trust is currently undertaking an audit on delayed discharge, bed capacity and the use of out of county psychiatric beds.

A Healthwatch “Take” on the Health and Wellbeing Meeting of 3 June 2015

There is a good summary of all the papers coming to this Board that can be found at the following link:
http://www.healthwatchnottinghamshire.co.uk/?p=2646

The Health and Wellbeing Board (HWB) is a large meeting with an average of 23 members attending, often 7 or so staff attending to give papers, a number of visitors – because it’s open to the public, and sometimes the press attend. In this case the Evening Post journalist did actually pick up on one of the Board papers on the poor record in Nottinghamshire on women breastfeeding.  It was featured in a good article in the Post the following day.

But today there was generally a bit more of a buzz in the air at the Board. Perhaps it was a bit of post peer challenge Summer feel creeping in?

Most of the papers were concerned with children and young people’s health.  This demonstrates that it’s not just adult and older people’s health and social care matters that come to the HWB!

Huge changes are afoot in the way children’s health services are organised. I’m sure that most people are not aware that health visiting, school nursing and family nurses are moving across, or have already moved, to Public Health that now sits in the Local Authorities across England. So health visiting and all that goes with it (now known as the “Healthy Child Programme”) now sits locally with the Nottinghamshire County Council or Nottingham City Council. They’re no longer managed or funded within the NHS.

Two items really stood out at this Board meeting. Cllr Henry Wheeler of Gedling Council described how Gedling had become the first Council in the County to become “breastfeeding friendly” with all staff trained and all buildings having places for women to breastfeed. The council has also encouraged dozens of businesses like Asda and Sainsbury’s and local cafes to sign up to the scheme. Nottinghamshire lags behind the rest of the country with only 68% of women breastfeeding their babies.

The second item was a great bit of work, close to Healthwatch’s heart, initiated by Public Health on “How Young People Friendly Are Our health Services?” – Nottinghamshire Mystery Shopper report. Public Health had recruited 20 young people aged 14-19 in 2014 to visit GP Practices, Contraception services, and Pharmacies to assess for their youth friendliness on information, responsiveness and accessibility, but not treatment as such. A host of recommendations has come out of this mystery shopper exercise.  The Board was impressed with the work and supported the recommendations.

Becky Whittaker, Healthwatch Nottinghamshire’s Children and Young people worker, will be liaising closely with the young people involved and the Young People’s Health Steering Group that will be taking this work forward.

Healthwatch made the following points across all the papers presented:

• We supported the children and young people mystery shopper exercise and the recommendations coming out of it.
• On the role of the Public health Committee we asked for clarification about what issues came to the HWB and what to the Public Health Committee to ensure there’s no duplication or confusion between the two.
• Regarding the report on how the Better Care Fund (BCF) for Nottinghamshire (£59 million) was progressing, we asked what the relationship was between new integrated schemes for older people funded by the BCF and similar such schemes funded by other sources of money (eg CCG or LA). i.e how joined up is the planning for such services?
• Given that three streams of community health services for children and young people are being integrated under the Integrated Commissioning Hub ( which is not a well-known body to people outside the system, but clearly an increasingly important commissioning body) we asked how the Hub was managed and how it was quality assured.
• In the Chair’s report there was mention of the Department of Health £55 million fund for housing initiatives for homeless people. We suggested that, given Nottinghamshire had cut Supporting People funding to direct access homelessness hostels across the County last year, and that this had been a HWB issue, this was an opportunity to attract additional funding in.

A Healthwatch “take” on the Health and Wellbeing Board, 4 Feb 2015

There is a good summary of all the papers coming to this Board that can be found at the following link: http://www.nottinghamshire.gov.uk/EasySiteWeb/GatewayLink.aspx?alId=487028

Peer Challenge Team at the Board

In many ways this was a special meeting as this time we were being observed by a “Peer Challenge Team” organised by the Local Government Association. It’s the job of a Peer Challenge Team to critically review how well a Health and Wellbeing Board (or HWBB) is doing. Sometimes it’s described as acting like a “critical friend”.

It’s great news that the HWBB has voluntarily welcomed in a Peer Challenge Team. It reflects a health openness to challenge and change.

This was a 7 person team, led by the Chief Executive of Dorset County Council with 6 other members coming from all over England.  The members of these teams come from diverse backgrounds, such as CCGs, public health, county councillors, social care, voluntary sector, etc.

The team were here for 4 days in February and their report is expected in early March. It will say what the HWBB in Nottinghamshire is doing well and where the Peer Challenge Team think it needs to up its game. What the report actually says will be the subject of a later HWBB summary and also this blog.

NHS 5 Year Forward View

This “Forward View”, as it’s now being called, gives a medium to long term vision of what the NHS in England is going to be looking like over the next 5 years. It’s like a road map which gives us a better sense of the direction of travel of the NHS. This document is very useful, particularly in the politically charged environment that we are now in, with regards to the future of the NHS.

Some of the forward view ideas are already beginning to happen in Nottinghamshire.  For example 5 of the 6 CCGs are planning to take-over the commissioning of GP services from NHS England this year. And in the media recently we heard for the first time of the agreement for Greater Manchester taking total control of the health and social care budget by April next year. That plan is even more “forward” than the “Forward View” itself!

Where the Forward View itself becomes a bit more ambitious is with regard to the future role for the HWBB. It suggests that, in the longer term, the full joint management of commissioning of health and social care services might be achieved under the leadership of the HWBB.

We will see how our “critical friends” view the HWBB as to its current readiness for that leap into the future!

A Healthwatch “take” on the Health and Wellbeing workshop on 7 Jan 2015.

What to do about the widening gap between health and social care budgets and the demand for services? That is the question. And this was the key underlying issue at this workshop.

The workshop was designed to help members of the Health and Wellbeing Board understand this challenging financial landscape. It was also in preparation for when, in April, the Health and Wellbeing Board takes on responsibility for overseeing the Better Care Fund.  This is the new pooled budget between health and social care, worth £93 million to Nottinghamshire between 2014-6.

To get a good summary of the content of the workshop you can go to the following link http://www.healthwatchnottinghamshire.co.uk/wp-content/uploads/2015/01/HWB-Workshop-Summary.pdf

I think the public needs clearer information about the implications of these emerging budget gaps in health and social care. Political parties rightly take their positions on the future funding and make-up of the NHS, but none of the current political remedies will in reality go far enough to address this widening gap.

Meanwhile, if we are not careful, public consultations on transforming health and social care in Nottinghamshire and on how to make further budget cuts can mask the underlying reality. This is that adult social care budgets across England have been reduced by 12% since 2011 and there’s a lot more to come in the next round. Doing things differently and more efficiently between social services and health will undoubtedly help.  But it won’t magically save service users from some of the consequences of these service cuts and pressures.

The public now needs more straight-speaking by leaders of health and social care and by politicians. Cllr Joyce Bosnjak, Chair of the health and Wellbeing Board, was right when she said, “The challenge is such that we can’t just keep doing the things the way they have been done before – instead we need to be more creative and innovative if finding ways to support people of Nottinghamshire in all areas of care”.

A Healthwatch “Take” on the 3rd December 2014 Health and Wellbeing Board (HWB)

(For view the NCC summary of the meeting go to: http://www.nottinghamshire.gov.uk/EasySiteWeb/GatewayLink.aspx?alId=470650)

Three reports triggered comments from your HWN representative on the Board – two of them were  concerned with mental health services, and the third being about the plans for delivering Nottinghamshire’s Health and Wellbeing Strategy.

Chief Medical Officer’s report on mental health (in England)

This came out in September and reports on the overall state of mental health in England.  Helpfully it takes into account a wide range of factors such as the stigma effect of mental illness, the risks associated with being out of work, the importance of high quality data on mental ill-health, and mental health services achieving parity of esteem with physical health services. That’s a more holistic way of understanding mental ill-health, much more useful than the traditional, more limited range offered by a purely medical model of mental ill-health.

But it was the first recommendation that I, and a number of others at the meeting, thought most needed challenging. This was:  “Well-being interventions should not be commissioned in mental health as there is insufficient evidence to support this”.

The obvious question to be asked (which I did) was – what sorts of preventative services are these, and are there any services like that operating in Nottinghamshire.

But nobody at the meeting quite had the answer to this.

Child and Adolescent Mental Health Services (CAMHS)

Concerns about these services have led to recent reviews, both nationally and locally. The recommendations from the one in in Nottinghamshire is therefore really important for young people over the next few years.

Healthwatch points: I drew attention to the County Council’s own children’s mental health and emotional wellbeing policy in which it says that that “half of people with lifetime mental health problems first experience symptoms by the age of 14”. That’s a worrying statistic! Clearly more needs to be happening to promote positive mental health initiatives at primary and secondary school level. I was pleased that the Board’s recommendation agreed:

“The Board requests a future report on the work planned and underway to promote mental resilience and prevent mental health problems in children and young people in Nottinghamshire”

Delivery of the Health and Wellbeing Strategy

Nottinghamshire’s Health and Wellbeing Board is having a peer challenge review of its functioning in the next couple of months. One question it will ask (I know because I have recently been on a peer challenge team in Derbyshire) is whether the Board’s leadership works well across the local system.

Healthwatch points:  My question to the Board was whether there were sufficient links between the Board and the various District based health and wellbeing bodies and their working groups. The general feeling was that there are good links established.

I still think there may be more mileage to be gained in bringing closer together local District based activity across the County with the health and wellbeing priorities that we now have.

Homeless in Nottinghamshire

Imagine this: due to the breakdown in your relationship and business partnership, you descend into debt, and then find yourself in rent arrears. Helpless to do anything about the debt and arrears you are then evicted from your home. You end up homeless on the street with your three children.  The local Council initially views you as intentionally homeless and therefore not eligible for re-housing help. This is what happened this year to a local Nottingham woman.

She told us her story at the Health and Wellbeing Board’s Stakeholder Network meeting at Carlton’s Richard Herrod Centre on Nov 10th. She said that what had happened to her could have happened to any of the 70 odd people sitting in the hall.

I don’t think that there was anybody in the hall who was not shocked by the appalling implications of that statement.

The subject of the event was homelessness, and its impact on people’s physical and mental ill-health. It had been prompted by a Public Health paper on this issue that had come to the Nottinghamshire Health and Wellbeing Board last year.

At that meeting Healthwatch had pointed out that the paper, whilst describing well the impact on ill-health of homelessness, it made no reference to the County Council proposal to radically cut the Supporting People budget. It’s the Supporting People budget that funds the homelessness direct access hostels across the County.

A key part of the safety net designed to help homeless people in Nottinghamshire was about to be removed. In the discussion that followed the Board rightly decided to reconsider the homelessness paper in more detail at a later event.  Thus the organisation of this Stakeholder Network meeting on Monday night, 10^th Nov.

The meeting was well attended with some 70 people from voluntary sector organisations, District Council homelessness staff, Housing Associations, commissioners, Public Health staff, and Healthwatch.

The speakers included a Nottingham GP whose surgery opens its doors to homeless people,  Housing Dept staff from Newark and Sherwood and Mansfield District Councils, and a speaker from the national charity, Homeless Link. We learnt more about the causes of homelessness, and the dire impact on health and wellbeing of being homeless. Most importantly, we discussed and raised suggestions of what can be done locally to help prevent homelessness.

You can now see the details of those suggestions on the Healthwatch Nottinghamshire website http://www.healthwatchnottinghamshire.co.uk/?attachment_id=2073

These ideas should now be used as a guide to the health and social care community’s future plans to tackle the scourge of homelessness.

A Healthwatch “Take” on the 3rd Sept Health and Wellbeing Board (HWB)

(For a brief NCC summary of the meeting go to: http://www.healthwatchnottinghamshire.co.uk/?attachment_id=2007)

Presentation of Healthwatch Nottinghamshire’s Annual Report (2013-4) and Business Plan (2014-5)

This was an important discussion for us to see how the members of the Board viewed Healthwatch Nottinghamshire (HWN) over the previous year and also what they thought of our role on the Board itself. Here’s what they had to say:

• Much positive comment from the HWB Chair, Cllr Joyce Bosnjak, on the contribution that HWN had made to the work of the HWB. This was reassuring to hear.
• One of the GP CCG leads asked about whether there was an overlap between the work of HWN and the work of GP practices’ Patient Participation Groups (PPGs); also whether HWN could assist PPGs in getting more younger people on the groups. B we are developing some ideas on what could be done about this. Watch this space.
• Is there a role for HWN in assisting Clinical Commissioning Groups (CCGs) in having their different communities participate in the commissioning process.
• We heard about the Youth Council in Gedling and the possibility of having a HWN “champion” amongst the members.
• Concern from a Rushcliffe Councillor that HWN avoid unnecessary duplication with other engagement work being undertaken locally. N.B It’s our policy to avoid doing engagement work when other bodies are doing the same thing.
• The HWB was reminded that HWN had asked the HWB Implementation Group to monitor the impact on health and wellbeing of the budget reductions that the local authority and NHS are now subject to.

2014 Care Act

This Act is being described as the biggest shake-up of social care for decades so it is most definitely going to have huge impacts on service users. There were two issues I wanted to raise for Healthwatch:

• Was the government intention in the Act to Integrate health, social care and housing just adding to the list of previous legislation on integration that has not had any meaningful impact. Does the care Act have any additional “teeth”?

This is important because housing is key for much of the success of community care. Just to prove this point, two other papers came to this Board. One was on adults with learning disability returning to Nottinghamshire from Winterbourne View requiring amongst other things good housing.  Social services commissioners are finding it very difficult to find appropriate housing. A second paper, the new Nottinghamshire mental health strategy, again raises the importance of planning for housing for adults with mental ill-health.

The answer to the question was that the integration of housing with social care and health  would be up to local partnerships to plan for. So – I’m sorry to say – it appears that it may have no more teeth than previous legislation! Let’s hope I’m proved wrong!

• The second issue was raised by the Chair herself. She, like Healthwatch Nottinghamshire and other members of HWB, expressed concern that the Government has under-estimated the costs of the reforms and that the funding allocation to Nottinghamshire will be insufficient.

Health and Wellbeing Strategy

This is now completed and being rolled out. It’s been proposed that each of the 20 priorities have a “champion” member of the HWB. I think that this is a good idea for the HWB.  But it puts me as Chair of Healthwatch Nottinghamshire in a situation of a possible conflict of interest if, say, an area of service that I was “champion” for was to be reported as an issue for HWN. I am going to decline, therefore.

Joint Strategic Needs Assessment (JSNA)

This will be on-line shortly.  It’s looking good for people and groups to navigate through to find the resources or information they’re interested in.  HWN has said that it would be involved in the planning of the JSNA at key stages of its development.

Communications from the Health and Wellbeing Board

The new summary paper that comes out after every HWB meeting is now in use (See the link to it above). I made the point, previously made, that there needs to be better cross-referencing of communications messages between the HWB strategy and the work of the 3 transformation boards, maybe even sharing of communications resources! Also that the Nottinghamshire public needs to be helped to understand what all this means to them – in digestible and in plain English format!

Nottinghamshire Mental Health Strategy

This has had extensive consultation.  It now looks to have the right priorities and has identified key gaps in services that will need to be addressed.

The points I made were that the other report referred to – Nottinghamshire Children and Young People Mental health and Emotional Wellbeing Strategy 2014-16 – is very difficult to find anywhere.  It need to be better publicised, alongside this strategy. Secondly, I informed the HWB that Healthwatch Nottinghamshire will be running a survey later this year on adult mental health services, focusing on access to psychological therapies and crisis services across the County.

Report back on the HWB Stakeholder event with the Voluntary and Community Sector, 9 June 2014

This had been a really useful get-together of all the main players in the VCS across Nottinghamshire. Lots of good suggestions made. I asked about one of the suggestions, which was about the importance of maintaining the connections and flows of info across the VCS. My concern was that Budget cuts being made by the County Council in the VCS might weaken those links. But Cllr Bosnjak was clear that that area remains a priority for the Council.

Health, Wellbeing, and Transformation

Health and Wellbeing Board   2^nd July 2014

The most significant papers coming to this Board were the five year plans (2014-19) of the Clinical Commissioning Groups.  There are 6 Clinical Commissioning Groups in Nottinghamshire and they’ve come together to do this planning work by forming three “planning units” – Bassetlaw, Mid Notts and South Notts (which in this case includes Nottingham City).

Each of these planning units has set up Transformation Boards to develop these plans. That word “transformation” is an NHS piece of jargon.  It means the significant changes that are coming down the line in the way that we, the public, will be receiving health and social care services, and changes that will be necessary in the way they are internally organised.

These changes can be summarised by:

1. Much greater integration of health and social care services than we’ve seen to date.  This starts with the use of the Better Care Fund (the £3.8 billion pooled budget, described in a previous blog).
2. Changing how primary care (GPs, community nurses, pharmacists, etc) and hospital services work with each other.  This is (a) to save (mainly NHS) money; and (b) to make sure that services that people receive at home are more “joined up”. The aim is for fewer vulnerable older people needlessly going into hospital when they could be receiving more effective intensive healthcare at home.
3. Promoting healthier lifestyles: the idea is that we should all take greater responsibility for looking after our own health, and that we’re all potentially expert in our own “self care” – if we are given the right health and social care advice and support. This is intended to help reduce rising demand and costs on health and social care, the consequence of an ageing population and more of us living longer with long term ill-health conditions.

I made two points here, on behalf of Healthwatch Nottinghamshire.  Firstly that the 5 year plans of the three “planning units” need to better link into the Health and Wellbeing Strategy for Nottinghamshire which the Health and Wellbeing Board has just produced.  Otherwise a key point of the exercise is lost.

Secondly, if “transformation” means that we will be soon experiencing significant changes in the way we receive health and social care services, then the public needs to know the “how’s and why’s” of this.  The language of these 5 year plans is not designed to do this.  What’s needed is a communications plan that speaks in plain English to the public about the changes that are coming over the horizon.  This is something that the Health and Wellbeing Board should oversee.

The wide influences on our health and wellbeing are shown in two of the other papers that came to the Board.  One was about the effect of poor quality air in parts of Nottinghamshire effecting peoples’ breathing difficulties.  A second one described the new Derbyshire-Nottinghamshire Local Nature Partnership which aims to influence new industrial and commercial and development to better protect surrounding nature and wider environment, thus enhancing our wellbeing.

In the longer run those two papers will have infinitely greater impact on our lives, and the health and wellbeing of our descendants than any 5 year commissioning plans!

For a summary of all of the papers at this Health and Wellbeing Board click here.

The next Health & Wellbeing Board meeting will be taking place on 3^rd September from 2pm at County Hall. I’ll be presenting our Healthwatch Nottinghamshire Annual Report at this one, and the Board will be discussing the Joint Strategic Needs Assessment (JSNA), the Public Health Annual Report, the Voluntary & Community Sector Network Report and workplace health, amongst other things. Public are always invited to observe these meetings, so if you are interested in hearing the discussion then please come along.

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.