Agenda and minutes

The Board noted the apologies listed at Appendix A. There were no declarations of interest.

Professor Sir Malcolm Grant will attend the meeting to discuss NHS England’s priroties for 2016-17 and take part in a discussion with Board Members.

The Chairman introduced Professor Sir Malcolm Grant, Chairman of NHS England, who had been invited to attend the Board to address Members on NHS England’s priorities for the forthcoming year and to present views on the health and care agenda.

Sir Malcolm provided the Board with background information on the history of NHS England, who lead the NHS and encourage and inform the national debate on how to improve health and care, and the current national picture in terms of funding and provision of services. NHS England allocated £106 billion in funds and held organisations such as Clinical Commissioning Groups (CCGs), Primary Care Trusts, pharmacies and dentists surgeries to account for spending money effectively. They had a level of independence which was underpinned by a model to look at outcome and not process. NHS England had a good working relationship with local government, but Sir Malcolm commented that there remained a certain amount of silo working, particularly over funding from the Government.

He highlighted that demand mist be controlled and reduced; attendances at A&E, and general admittance to hospitals, was increasing, the GP workforce was struggling to meet demand, and the country had an ageing population. It was anticipated that an additional £30 billion in funding was required by 2020/21 to keep the current service, with additional money required for improvements.

On STPs, Sir Malcolm explained that NHS England were seeing profound results. The focus was on pathways of care and moving away from silo funding to pooled funding, enabling local leaders to think about population health in the round and how funding flows could be redirected in more efficient ways. NHS England hoped that STPs would provide a better service to patients with limited budgets. They presented a unique opportunity to bring about change and, although there had been challenges, all STPs would be published by the end of December 2016. Good local leadership was required, and all STPs had some level of local authority engagement, although there was huge variety across the country and some would require a significant review of services. The STPs would not include full financial modelling, but it was hoped they would start the process of communities and local leadership coming together to improve services.

In the discussion with Sir Malcolm which followed Members raised the following points:

·         A number of councils had agreed to move to an accountable care model, although geography was still an issue in some areas. One Member highlighted that his council had agreed to run this as a shadow for a year and that all local Trusts were involved. It was hoped that this would help to improve local services and allow partners to have a larger amount of funding to spend collectively. Public engagement on STPs was important, but the discussion should focus on structured principles and how a better package of care could be delivered.

·         Members highlighted that STPs should be transparent, democratically accountable and person-centred, and this was unfortunately not the case in all localities.  ...  view the full minutes text for item 2.

Alyson Morley, Senior Adviser, introduced the report and explained that it provided a summary of the LGA’s key messages on the forthcoming policy framework for the Better Care Fund (BCF) 2017-19, graduation from BCF, and the achievement of integration of health and social care by 2020. She explained that it had been anticipated that the BCF policy framework would have been published prior to the meeting, but this was still awaited from the Government.

It was highlighted that the Board Chairman had made a statement following the Autumn Statement that the LGA was disappointed on the lack of announcement on additional funding for adult social care, but it was now anticipated that announcements on BCF and the publication of the policy framework would be released alongside the Local Government Finance Settlement. The policy framework would be circulated to the Board in due course following publication.

In the discussion which followed Members raised the following points:

·         Members welcomed the fact that the LGA had released clear policy messages ahead of the publication of the BCF policy framework. In particular, Members emphasised the need for Government to publish the minimum CCG allocation for transfer to adult social care services as soon as possible, in order for this to be included in the budget making process for councils.

·         It was expected that an announcement on adult social care funding in the Finance Settlement would be through an increase in local taxation.

·         Future BCF work should focus on sustainable community health and social care in order to realistically reduce demand, which would prevent more people going into hospital.

·         Funding for people with learning disabilities was included in the BCF and would be a large cost pressure.

Decision

The Community Wellbeing Board noted the report.

Actions

BCF Policy Framework to be circulated to the Board when published.

David Mowat, Minister for Health and Care, to be invited to attend a future meeting of the Board.

Andrew Hughes, Head of Implementation for the Care and Health Improvement Programme (CHIP), introduced the report which included the programme for the LGA’s sector led improvement for care and health for 2017/18 to 2019/20.

The CHIP’s objective was to use sector led improvement to support local systems leaders to develop resilience in adult social care, effective care and health systems, and to fulfil the role of local government in the Transforming Care Programme. This was undertaken through local and regional support and engagement, and regional networks of support. The CHIP team would continue to develop the adult social care self-assessment risk awareness tool with strengthened social care financial risk assessment and links with corporate financial risk management.

Members noted the model of integrated self-assessment, which had been well received by councils and Clinical Commissioning Group partners. They would also continue to ensure funding was transferred to local government to support people at the local level.

In the discussion which followed Members raised the following points:

·         The Programme for 2017/18 – 2019/20 was supported as a positive means of working with health colleagues.

·         Sharing of data was a potential barrier to success, and it was important that meaningful data was shared so that individuals could find the right care pathway. There should be a monitoring standards framework led by the local authority which could be used to ensure people were placed in the best care setting for their need. The Head of Implementation confirmed that data sharing would be undertaken in a more person-cantered way from 2017.

·         Digital solutions were important, and new approaches to tele-care presented good methods of monitoring social care. However introduction of technological solutions was challenging in a social care setting as some people were not computer literate.

·         The adult social care market was under great pressure nationally and more should be done to increase the resilience in adult social care and adult safeguarding.

·         Members commented that peer support had been very helpful in improvement work for local authorities and, although not mandatory, all authorities should take part for the benefit of the whole sector.

Decision

The Community Wellbeing Board noted the sector led improvement of care and health programme 2017/18 – 2019/20.

Abigail Gallop, Senior Advisor, introduced the item which set out the current Government positon on the future funding of supported housing and outlined key questions in the consultation for the Board’s discussion.

Members noted that the Government had previously announced proposals in the 2015 Spending Review to introduce a limit on the amount of housing benefit that could be claimed for supported housing to the level of the local housing allowance (LHA) cap. Following representations from the LGA, as well as a number of other organisations, that this would present a risk, particularly to elderly residents, the Government subsequently announced that it intended to supplement the amount of funding above the LHA cap via a local top up fund to councils.

The Government had recently published a consultation on the implementation of the local top up fund and future funding for supported housing. Measures which had been announced by the Government were detailed in the report, but included a ring-fenced grant to meet costs through a commissioning model. The consultation would impact all areas of supported housing, including homelessness, domestic violence and veterans housing.

In the discussion which followed Members raised the following points:

·         Members welcomed the introduction of ring-fenced funding for supported housing, which had previously been in place in the past, but highlighted that more needed to be done to help vulnerable people from all levels of society find housing. Funding should be set at a realistic level and implemented in a person-centred way.

·         Enabling local authorities to have an advanced role in the commissioning of supported housing was also welcomed, particularly in relation to housing for vulnerable people.

·         The consultation proposes making the top-up funding available to other organisations, such as health.  Members raised concerns about any requirements to make the ring-fenced funding available to other organisations, if the responsibility for provision was with councils.  Members agreed that decisions on collaboration or joining up funding should be made at the local level.

·         It was suggested that councils should work together to find more ways to develop supported housing and house people across local authority borders.

·         Members supported the proposal to develop a national commissioning framework, which would provide transparency and value for money for residents. Officers advised that the LGA’s current view was that if the framework was useful then councils would use it, but the full consultation response was still being prepared.

·         Regarding the list of types of people who were eligible for supported housing it was explained that councils had a statutory instrument to make sure all groups of vulnerable people were covered. A broad spectrum of cover was in place and the consultation response would include information on eligible groups.

·         Members agreed that it was important that the consultation response call for local top-up funding to be implemented in an accountable way, and so should be retained by local government. Councils could also be trusted to allocate funding locally according to local need.

·         It was highlighted that some local authorities had supported housing stock  ...  view the full minutes text for item 5.

Paul Ogden, Senior Adviser, introduced the report which provided an update to the Board on the Court of Appeal’s judgement on the legal action between the LGA, National AIDs Trust and NHS England over who would fund the service to block Human Immunodeficiency Virus (HIV) infection and who had the power to commission pre-exposure prophylaxis (PrEP).

Members welcomed the news that the appeal by NHS England had been dismissed by the Court of Appeal, and that all legal costs would also be paid for by NHS England. Letters would be sent to all local authorities who had pledged money toward the legal costs to explain that this would no longer be required.

NHS England were due to shortly make an announcement on PrEP, and the LGA would work with them on implementation. The Chairman and Members congratulated officers for their hard work and success in the legal case.

Decision

The Board noted the update provided in the report and welcomed the Court of Appeal’s judgement.

Mark Norris, Principal Policy Adviser, introduced the report, which presented updates on various areas of the Board’s work which were not included as part of other items on the agenda.

The Chairman drew particular attention to the LGA’s response to the Chancellor’s Autumn Statement which had been delivered the previous week. Members agreed that the LGA’s ‘on the day brief’ on the day of the Autumn Statement had been very useful, but that it was disappointing that no additional funding for adult social care had been announced. A letter from the Chairman of the Board to the Secretary of State for Health regarding this issue would be sent out later in the week.

Decision

The Board noted the updates contained in the report.

Decision

The Board agreed the minutes of the previous meeting held on 7 October 2016.