Clinicians commissioning healthcare
for the people of Northumberland
Better Care Fund
Health and Wellbeing Board
Wednesday 12 February 2014
What we are asking from the Board:
• to endorse the draft plan for the Better
Care Fund for submission to NHS England
and the LGA on 14 February
• to note that the plan will be further refined
before final submission on 4 April, taking
account of further consultation with
providers, and any comments on the draft
received from NHS England
Outline
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Better Care Fund
Alignment to vision and priorities
Financial implications & challenges
Schemes
Engagement
Performance
Next steps
Better Care Fund
• 3.8bn pooled budget in 2015/16
• Based on joint CCG/LA plans signed
off by Health and Wellbeing Boards
(and Integration Board for us)
• Plans must deliver on national
conditions
• £1bn of £3.8bn is ‘payment by
performance’
Aims of the Better Care Fund
To improve outcomes for the public, provide better value
for money, and be more sustainable, health and social
care services must work together to meet individuals’
needs.
The Government will introduce a £3.8 billion pooled budget
for health and social care services, shared between the
NHS and local authorities, to deliver better outcomes and
greater efficiencies through more integrated services
for older and disabled people.
Spending Review 2013, HMT
Health & Wellbeing Board Priorities
• Supporting people with long term
conditions to be independent and have
control
• Making sure that all partners work well
together and are clear about what they
themselves need to do to help improve the
health and wellbeing of local people
• Part of the development of our five year
system planning
The challenge
• Local Authority are expecting protection for social care
services
• Acute sector are expecting evidence of ability to reduce
the demand for hospital care before any major changes
are agreed to acute care
• Simply taking money out of the acute contracts will
destabilise the system
• How do we do this in a way that
maintains quality of care, builds on
our partnerships and does not
fragment or destabilise the system?
The National Conditions
plans to be jointly agreed
protection for social care services (not spending)
as part of agreed local plans, 7-day working in health and social care to support
patients being discharged and prevent unnecessary admissions at weekends
better data sharing between health and social care, based on the NHS number (it is
recognised that progress on this issue will require the resolution of some Information
Governance issues by the Department of Health)
ensure a joint approach to assessments and care planning
ensure that, where funding is used for integrated packages of care, there will be an
accountable professional
risk-sharing principles and contingency plans if targets are not met – including
redeployment of the funding if local agreement is not reached
agreement on the consequential impact of changes in the acute sector – the plan
must capture any necessary changes.
What does this mean for
Northumberland?
National Funding
Northumberland Share
Description
£1.9bn Based on existing funding in 2014/15 that is allocated across health and wider care system. Composed of:
£130m Carers' Breaks
funding
£300m CCG reablement
funding
£0.8m
Mixture of carers' funding and CHC respite
£1.87m
LINS £600k, Frail Elderly £320k, NEL Transformation funding £900k
£354m capital funding
(including £220m of DF
Grant)
£0.9bn existing transfer
from health to social care
c£2.3m
Implementation and ICT costs associated with the implementation of the Care Bill
and social care funding reform
£5.5m
As per current transfer - signed off by H&WB
£0.2bn additional 2014/15
transfer from health to
social care
£1.4m
Total BCF additional allocation
Identifying the funding for the
Better Care Fund
Allocations for 14/15 + 15/16 £12.65m
Balance of £24.5m TOTAL Better Care Fund less amounts identified above
Made up of:
£2.0m
£2.0m
Community Hospitals
£2.6m
£1.0m
Mental Health s256
Community reablement
£0.9m
Acute reablement
£4.2M
Ongoing commitment and work with key partners to identify funding
Integrated community investment (conditional on Acute savings per Medium Term
Financial Plan)
New investment 2013/14 - additional to
reablement above and reduces 'new'
BCF requirement
High Risk Patient Programme
Risk stratification of most at risk
of admission
Proactive integrated care with
resource aligned
Intermediate care, re-ablement &
rehabilitation
New community hospitals model of
care
Maintenance and development of
acute and community re-ablement
services
BCF
Schemes
Admission avoidance & post
discharge support services
Short term support services
Long term home care services
Hospital to home services
Mental Health Services
Improved assessment & diagnosis
of dementia
Building on existing well established
integrated community mental health
services
Engagement
• The importance of engagement with
providers, patients/ service users and
the public to shape services (citizen
empowerment, ownership and
choice)
• Working with Healthwatch and other
partners
Performance Measures
• Permanent admissions to residential care
• Effectiveness of reablement (% still at
home 90 days after reablement)
• Delayed Transfers of Care (all causes)
• Number of Emergency Admissions
• Patient Experience (Carers?)
• Local Measure (Dementia?)
• Process measures (% shared records?)
Admission rate
200
100
0
781.8
766.7
North West
Newcastle
upon Tyne
659.8
809.7
Durham
Northumberland
831.4
North East
670.3
856.8
Stocktonon-Tees
Cumbria
857.8
Hartlepool
697.2
862.6
South Tyneside
ENGLAND
889.1
Gateshead
756
911.1
Middlesbrough
North Tyneside
916.2
Redcar &
Cleveland
988.4
300
Darlington
400
988.6
500
Sunderland
Permanent admissions to care homes, per 100,000 population
- 2012/13
1100
1000
900
800
700
600
89.6
85.4
84.9
84.7
84.3
83.6
83.3
81.4
79.9
79.1
79
78.9
76.3
Durham
North East
Gateshead
Cumbria
Hartlepool
Middlesbrough
ENGLAND
North West
Stocktonon-Tees
South Tyneside
Newcastle
upon Tyne
Sunderland
0
North Tyneside
10
90.4
20
Darlington
30
90.8
40
Northumberland
97.6
50
Redcar &
Cleveland
Proportion of patients
Proportion of older people still at home 91 days after
discharge (2012/13)
100
90
80
70
60
Rate per 100,000 population
4
2
0
5.8
5.3
5.0
5.0
4.0
South Tyneside
Northumberland
North Tyneside
Stocktonon-Tees
7.7
North West
Hartlepool
8.3
Newcastle
upon Tyne
6.1
9.3
North East
10.8
9.4
Gateshead
14.5
16.4
12.6
ENGLAND
Durham
Sunderland
Cumbria
Middlesbrough
18.9
6
Redcar &
Cleveland
8
19.2
10
Darlington
Delayed transfers of care per 100,000 population - monthly
figure (2012/13)
20
18
16
14
12
Avoidable emergency admissions (composite measure)
2012/13
The
challenge
Scaling up
and creating
the space to
achieve
change
A&E
Elective & Acute Care in Base Hospitals
Creating capacity
here
Community Hospitals/ CGA
Nursing & Residential Care
Ambulatory Care/ Minor Injury Units
Hospital to Home Team
High Risk Patient Programme
ShortAmbulatory
Term SupportCare
Services
Single Point of Access/ Ticket Home
Wider MDT including Community Geriatrician/
Matron/ Pharmacy/ SWs/ MH/ Third Sector/
Therapies
General Practice
Community Nursing
Home Care and other
Social-care Funded Support
Patient/
Service User
Family
Community
To fund
capacity
here/
harness
experienced
resources
here
Any questions or
feedback?
Endorsement of our
approach?