To note the following changes in membership of the Health and Wellbeing Board Commissioning Sub Committee:

a)  Catherine Underwood has replaced Helen Jones as Director of Adult Social Care, Nottingham City Council

b)  Dr Hugh Porter has replaced Dr Marcus Bicknell as the GP Lead, Nottingham City Clinical Commissioning Group

c)  Michelle Tilling, Locality Director – Nottingham City, has replaced Gary Thompson, Chief Operating Officer, as the Greater Nottingham Clinical Commissioning Partnership representative

RESOLVED to note the following changes in membership of the Health and Wellbeing Board Commissioning Sub Committee:

(1)  Catherine Underwood has replaced Helen Jones as Director of Adult Social Care, Nottingham City Council

(2)  Dr Hugh Porter has replaced Dr Marcus Bicknell as the GP Lead, Nottingham City Clinical Commissioning Group

(3)  Michelle Tilling, Locality Director – Nottingham City, has replaced Gary Thompson, Chief Operating Officer, as the Greater Nottingham Clinical Commissioning Partnership representative.

Katy Ball – Christine Oliver attending as substitute

Alison Challenger – Helene Denness attending as substitute

Catherine Underwood – Linda Sellars attending as substitute

Councillor Webster declared an interest in two of the proposals being discussed under Agenda Item 9 Better Care Fund Savings Proposals 2019/20 because he is a Board member of Nottingham City Homes.  He left the meeting prior to discussion about these proposals.

To confirm the minutes of the meeting held on 28 March 2018

The minutes of the meeting held on 28 March 2018 were agreed as an accurate record.

To agree to meet on the following Wednesdays at 4pm or at the rising of the Health and Wellbeing Board if that is later:

·  28 November 2018

·  30 January 2019

·  27 March 2019

RESOLVED to meet on the following Wednesdays at 4pm or at the rising of the Health and Wellbeing Board if that is later:

·  28 November 2018

·  30 January 2019

·  27 March 2019

Ciara Stuart, Deputy Locality Director – Nottingham City, Greater Nottingham Clinical Commissioning Partnership, presented the report providing information on the Better Care Fund and Improved Better Care Fund performance metrics for Quarter 4 2017/18.  She highlighted the following information:

a)  The national conditions for Quarter 4 and for the year were met.

b)  Metrics for residential admissions and reablement were categorised as ‘green’ for Quarter 4 and for the year.

c)  The delayed transfers of care metric was particularly challenging and categorised as ‘red’ all year.  The reasons for this were outlined in the quarterly return submitted to NHS England. 

d)  During 2017/18 there was concern about the methodology for measuring delayed transfers of care.

e)  Performance against the 8 expected elements of the High Impact Change Model and the additional non-mandated Red Bag element was good with a score of Established for 6 of the 8 mandated elements and for the Red Bag element.

f)  During the year savings were built into the Better Care Fund Plan.

g)  There was positive feedback at the end of 2017/18, with successful reprocurement of the Out of Hospital Services contract and continued management of integration alongside such changes.

h)  In terms of the Improved Better Care Fund, funding was used across the three mandated areas.  Additional funding helped to reduce the risk of homecare providers withdrawing from operating in the local area; meeting the homecare national living wage; and meeting challenges associated with Discharge To Assess.

i)  Performance on the Improved Better Care Fund metrics was mixed.  The reablement metric showed improvement but there was deterioration on some other metrics.

RESOLVED to

(1)  note performance in relation to the Better Care Fund and Improved Better Care Fund performance metrics for Quarter 4 2017/18; and

(2)  note the quarterly returns which were submitted to NHS England that were authorised virtually by the Chair and Vice Chair of the Health and Wellbeing Board.

Ciara Stuart, Deputy Locality Manager – Nottingham City, Greater Nottingham Clinical Commissioning Partnership introduced the report providing information about the Better Care Fund and Improved Better Care Fund performance metrics for Quarter 1 2018/19.  She highlighted the following information:

a)  All of the national conditions for Quarter 1 2018/19 were met.

b)  The residential admissions and reablement metrics were categorised as ‘green’ for Quarter 1.

c)  Performance against the delayed transfers of care metric remains categorised as ‘red’ (only April data available for Quarter 1 at the time of reporting).

d)  The methodology for delayed transfers of care has been revised for 2018/19 but it remains a challenging target.

There was a discussion about the reason for challenges in reducing delayed transfers of care and the extent to which all partners recognise the same issues and are working towards the same objectives.  In response the following additional information was provided:

e)  A review of delayed transfers of care was carried out across system partners and feedback shared with organisational leaders.  This led to a shared understanding of the issues.

f)  While there are lots of things that could be done to reduce delayed transfers of care, the key issue is lack of capacity in the community. 

RESOLVED to

(1)  note performance in relation to the Better Care Fund and Improved Better Care Fund performance metrics for Quarter 1 2018/19; and

(2)  note the quarterly returns which were submitted to NHS England on 18 July 2018 and were authorised virtually by the Chair of the Health and Wellbeing Board.

Clare Gilbert, Lead Commissioning Manager, introduced the report presenting the financial elements of the 2018/19 Better Care Fund Plan and proposing principles for the future operation of the Fund.  She highlighted the following information:

a)  As a result of an ongoing over-commitment in the Plan and the need for Nottingham City Council to make further savings in order to meet its Medium Term Financial Plan and for the Greater Nottingham Clinical Commissioning Partnership to make additional savings, there has been a reshaping of schemes and the Better Care Fund Plan needs updating.

b)  The proposed principles for future operation of the Fund will provide greater flexibility and improve management of schemes.

c)  The Year 2 submission for the 2017/19 Financial Plan is very light touch and represents a ‘holding position’ in anticipation of more substantial changes.  This approach was approved at a regional level.

RESOLVED to

(1)  approve the 2018/19 Better Care Fund Financial Plan as attached as Appendix 1 to the report;

(2)  approve the revised principles for the management of the Better Care Fund as set out in Appendix 2 of the report and agree to their incorporation into a revised Section 75 Agreement; and

(3)  approve the Year 2 submission for the 2017/19 Financial Plan as set out in Appendix 3 of the report.

Clare Gilbert, Lead Commissioning Manager, introduced the report outlining savings proposals from the 2019/20 Better Care Fund. She highlighted that:

a)  The savings are being proposed to meet budget requirements for 2019/20.

b)  In 2017/18 there was an agreement to make £1.5m savings from the Better Care Fund to enable Nottingham City Council to meet its Medium Term Financial Plan.  It was agreed that savings would be split on a 90/10 basis in favour of Nottingham City Council.  From 2019/20 the split has been set on a 50/50 basis after additional contributions have been removed.  Therefore there is a shortfall of £354,000 against the Council’s Medium Term Financial Plan.  Further savings are required to meet this shortfall.

c)  The savings proposals total £442,000 and represent an over achievement against savings requirements because there are risks associated with implementation of some of the proposals.

RESOLVED to

(1)  agree the level of savings required to meet Nottingham City Council’s Medium Term Financial Plan requirements as set out in the exempt minute; and

(2)  approve the saving schemes that have been identified for delivering the saving as set out in the exempt minute.

To consider excluding the public from the meeting during consideration of the remaining item in accordance with Section 100A(4) of the Local Government Act 1972 on the basis that, having regard to all the circumstances, the public interest in maintaining the exemption outweighs the public interest in disclosing the information.

RESOLVED to exclude the public from the meeting during consideration of the remaining item in accordance with Section 100A(4) of the Local Government Act 1972 on the basis that, having regard to all the circumstances, the public interest in maintaining the exemption outweighs the public interest in disclosing the information.

The Sub-Committee considered the information set out in the exempt appendices, the details of which can be found in the exempt minute.