Decision details

19.1     The Board considered a report providing a summary of the Better Care Fund (BCF) requirements for 2017-19, a summary of the East Sussex plans, and the arrangements for the Section 75 Pooled Budget.

19.2     In response to questions from the Board the following answers were provided:

·         The Delayed Transfer of Care (DToC) targets were announced by the Government part way through the financial year in July. There have been significant tensions between the Department of Health, Department of Communities and Local Government, local authorities, and NHS England about the lack of consultation and the deliverability of the targets.

·         The targets are extremely challenging and expectations are high for delivery, with the threat of withholding Improved Better Care Fund (iBCF) funding for those local authorities that fail to deliver them.

·         Despite the national tensions, the partnerships in East Sussex have been in place for a long time and have not been impacted by the BCF demands – if anything they have made collaboration stronger. 

·         BCF money is being focussed on supporting independent sector provision by stabilising nursing home capacity and increasing home care capacity, which has helped the discharge arrangements. Patients can be discharged from hospital at the earliest possible opportunity and moved into a nursing home or residential care home bed. From there they can receive reablement services, their care assessment and make a choice about their own care arrangements – rather than receiving them in a hospital bed. This does create capacity pressures in the nursing home sector, so it is important that the patient is moved onto their long term care arrangements as soon as possible. The aim is to sustain this process over the next few months.

·         A greater amount of manager and practitioner time is now being spent increasing the pace of discharge of patients. The pace at which people are discharged could pose a potential risk to patients due to the inherent risk in increasing the work rate. The process is, however, being managed as robustly as possible in East Sussex through strong managerial oversight of the discharge process.

·         East Sussex County Council (ESCC) is one of the 32 local authorities that has been written to by the Government and warned that funding for 2018/19 may be reviewed if improvements are not made to DToC figures in the next month. This is a disappointing outcome but it is unclear as yet how these sanctions may work in practice. The money could be handed to other commissioning organisations in the area, but the impact of this eventuality would be fairly minimal because where money is spent in the ESBT area has already been agreed by ESCC and the CCGs via the Strategic Investment Plan (SIP).

·         Responsibility for DToC is split roughly 50/50 between health and social care. Improved bed management and patient flow in East Sussex Healthcare NHS Trust (ESHT), including discharge to community beds, forms part of the ESBT programme and this will help to reduce DToC. Patient flow in the Connecting 4 You area is effected by the administrative boundaries of Brighton & Sussex University Hospital NHS Trust (BSUH) and Maidstone and Tunbridge Wells NHS Trust (MTW) and the Connecting 4 You programme is working to tackle this. 

19.3     The Board RESOLVED to:

1) note the report;

2) endorse the East Sussex Better Care Fund Plans 2017-19 and their alignment with the East Sussex Better Together and Connecting 4 You Programmes; and

3) endorse the plans to have signed Section 75 Pooled Budget arrangements in place by 30th November in line with BCF planning requirements.