A verbal update on the responsibilities of the Gloucestershire Health and Wellbeing Board in relation to the Better Care Fund.
Minutes:
6.1 Members received an overview on the responsibilities of the Health and Wellbeing Board in relation to the Gloucestershire Better Care Fund.
6.2 Better Care Fund Projects are cross-organisational projects, the governance for which is incorporated within the framework of the One Gloucestershire Integrated Care System (ICS). The Gloucestershire Health and Wellbeing Partnership (GHWP) is a key component of the governance arrangement for the Integrated Care System, with the NHS Gloucestershire Integrated Care Board (ICB) and Gloucestershire County Council (GCC) as equal partners.
6.3 As part of the required assurance process, the Gloucestershire Better Care Fund Plan 2023-25 had been signed off by the Chair of the Health & Wellbeing Board prior to formal submission on 28 June 2023. The final version of the plan had been shared with the GHWB for information purposes on 25 July 2023.
6.4 As outlined in the One Gloucestershire 2023/24 Operational Plan, Gloucestershire was committed to delivering three key tasks for the coming year. These included: -
1. Recovering core services and productivity
2. Making progress in delivering the key ambitions included in the Long-Term Plan (LTP)
3. Continuing to transform the NHS for the future
6.5 BCF joint priorities and ambitions for 2023-25 were based on the following three themes as set out within the Integrated Care Strategy. They included: -
1. Making Gloucestershire a better place for the future - focusing on a range of issues that can impact of health and wellbeing, including existing priorities such as physical activity, healthy lifestyle, adverse childhood experiences and housing.
2. Transforming what we do - supporting prevention at local level, joining up services close to home, reducing any differences in people’s experiences, improving access to care and health outcomes, adopting a One Gloucestershire approach to developing the local workforce and ensuring services can access the skills and people required.
3. Improving health and care services today - improving access to care and reducing waiting times for appointments, treatment and operations, improvements in urgent and emergency care and supporting people’s mental health.
6.6 The four main themes within the plan, included: -
6.7 Implementation of the BCF policy objectives – a system-wide programme approach would focus on service and pathway redesign across the whole system over the next 18 months. The key focus would be on delivering care in the right place at the right time for each patient and improving access to the urgent care offer in health and social care. This included improving and expanding community care provision, with ongoing targeted recruitment initiatives across integrated teams, improving provision within the Home First Pathway initiative, as well as accelerating the rollout of urgent community response pathways. In addition, improvement plans were being implemented to reduce wait times in Emergency Departments and delivery of proactive care.
6.8 Supporting unpaid carers – Gloucestershire benefitted from approximately double the number of unpaid carers in relation to the number of paid health and care professionals. Unpaid carers provided vast amounts of support to those being cared for, enabling those being cared for to remain at home for longer periods. The level of support provided by unpaid carers during the pandemic would continue to be a key priority 2023-25 and beyond. Gloucestershire Carers Hub was a focal point of contact for many carers throughout the county.
The Gloucestershire Carers Programme provided a key area of work of support, including break options, training and development, carer wellbeing support, carer assessments and life after caring support.
Work was also underway to increase the support provided to local ethnic minority groups, and with veterans and parent carers, as well as maintaining a county-wide Partnership Board and response groups to ensure the voices of carers were reflected in strategic planning initiatives.
6.9 Disabled facilities grant and wider services - in recent months, the Strategic Housing Partnership had developed several initiatives that had resulted in interest both regionally and nationally. Examples included: working with a national organisation to increase the number of Disabled Facilities Grants with ethnic minority groups; placing a specialist nurse in the Emergency Department to improve outcomes for homeless people; continuation of the Warm and Well Project; and expanding the placement of a Fuel-Poverty Co-ordinator to support the local oncology department. The aims of these objectives have been to support prevention, contribute to savings and improve health and better outcomes for people.
6.10 Equality and Health Inequalities – the reduction of health inequalities across Gloucestershire continued to be a key priority for 2023-25 and beyond. Gloucestershire had embedded the Core20Plus5 approach to considering health inequalities within the county and to note any disparities in outcomes, in relation to race. In addition, several other initiatives across the ICS had focused on improving access to services for those potentially experiencing health inequalities, such as targeting ethnic minority community leaders to understand the needs of specific groups in relation to carer support, placing a specialist nurse in the Emergency Department to improve outcomes for homeless people, and improving access to community facilities for older people and those living with disabilities. While not specifically a BCF funded scheme, work was also underway to improve digital inclusion across our system.
6.11 It was noted that, while wider system elements supported each of the themes, those relating to the BCF would receive specific focus.
6.12 In summary, the joint priorities for 2023-25 remained largely unchanged:
1. Support improvements in urgent and emergency care: focusing on reducing waiting times and delivering high quality pathways for planned care supported by transformation across our planned and cancer care pathways.
2. Ongoing covid-19 recovery: reduce waiting times for appointments, treatments and operations.
3. Improve mental health services for people with all ages, including support for people with learning disabilities and autism.
4. Develop and support the existing workforce, while promoting recruitment into health and social care in the county.
5. Making the most of data and technology to support care reducing health inequalities.
6. Improving population health across the life-course: through place-based integrated working, placing a greater a focus on personal responsibility, wellbeing and prevention and self-care; supporting people to help themselves.
6.13 Members noted the 5 key metrics under review by the Better Care Fund.
These included: -
1. Avoidable admissions
2. Discharge to usual place of residence
3. Residential Admissions
4. Reablement
5. Falls (a new metric introduced in 2023)
6.14 A more detailed report on the Gloucestershire Better Care Fund, (incorporating all 60 programmes), would be presented to the HWB at a future meeting.