Transcript Emergency admissions reduction

Better Care Fund
why and how
Dominic Harrison
Twitter: @BWDDPH
Health Inequalities & Healthy Life Expectancy
Bottom /top 10% IMD
Disability-Free Life Expectancy at Age 16 (ONS 2007-09)
local authorities in England
Male 19/324 : Female 12/324
What is the problem to which BCF is the answer?
Allocative Efficiency: The need to
Healthy
Public Policy
shifts
Community/
family/third
sector/Comm
unity
development
Re-investing in primary/neighbourhood care.
Prevention
Primary
Care/Neighbour
hoods /Third
sector offer
Individual
Enhanced
Primary Care
Population
Enhanced Primary
Care/Neighbourhoods/
Third Sector/’digital by
default’ diagnosis &
treatment
60% of
NHS budget
Treatment
Secondary
/Tertiary Care
(Hospitals)
Better Care Fund-Background
• Pooled budget to support delivery of integrated care in
adults, particularly frail/multiple morbidities
• £12,038 million for one LA Area (NB: In that Area Total CCG
and ASC Budget about £250m)
• Success measured through:
–
–
–
–
–
–
Reduction in emergency hospital admissions
Delayed transfers of care
Reduction in long term residential care admissions
Effectiveness of reablement
Local measure - dementia diagnosis
Patient experience measure - for discussion
• Requirement for full resubmission of BCF plans on 19th
September
Recent BCF Guidance outlines
changes to:
– Clearer articulation of evidence, delivery chain and shift in
activity away from acute
– Clearer focus on risks, risk sharing and contingency
– Alignment of BCF with other local plans
– Resource for protection of social care and implementation
of the new Care Act
– Evidence of provider engagement
– Pay for performance
– Emergency admissions
Pay for performance
• Focus solely on the reduction of hospital
admissions
• Shift from avoidable emergency admissions to
total emergency admissions
• £1 billion of NHS contribution nationally
• HWBB expected to propose performance pot
based on local ambition
• Initial expectation was 3.5% reduction – further
guidance outlines when lower target can be
agreed – many agreeing about 2%.
Emergency admissions reduction
in one Local Authority Area
BCF Scenarios
Linear Trend from BCF Base data
BCF Base data
3.5% reduction from trend
20000
19500
19000
Emergency Admissions
18500
18000
Impact
Reduction of 425 hospital
admissions in 2015/16
17500
17000
16500
16000
15500
15000
2009-10
2010-11
2011-12
2012-13
2013-14
2014-15
2015-16
Typical BCF Plans
• Early intervention, prevention and self care through
– Voluntary sector
– Co-ordination of dementia services
– Support for carers
• Integrated health and social care through development of 4 locality
teams
– Include primary and community health, social care, mental health and
voluntary sector
– Identify those most at risk of hospitalisation
– Provide proactive joint up care planning and case management
• Directory of Services for Frail Elderly and co-ordination of community bed
provision
• Review and redesign of intermediate care/community beds
• Integrated discharge from hospital
• Intensive Home Support
Community Wellbeing System
Health/Social Care System
In neighbourhoods and communities
in NHS/LAs
Diagnosis & Treatment
Shortening episodes of illness
Personal and family diagnosis and
treatment
Community self help groups
Care
Reducing disability and suffering
Personal voluntary and family support
Increasing personal and community skills to
care/cope
Community funded-Non-Monetised
Primary care
Keeping people well
Actions and policies to promote healthy
environments
Healthy public policy (HIAP)
Disease specific Public Health Programmes,
Screening , case finding, etc
Prevention
Hospitals
Secondary and
Tertiary Care &
Adult Social
Care
Tax -funded-Monetised & Professionalised
Blackburn: Neighbourhood Profile
..We need to invest in health not
hospitals…
• At present more than 90% of patient contacts with the NHS occur
outside hospitals but 60% of the NHS budget is spent within them.
• And within that, a further 60-70%% of hospital bed days relate to
long term conditions- whose incidence is expected to double over
the next 20 years.
–
•
CBI (2010) Best Of Health: Improving lives through smarter care
‘Hospitals are increasingly unable to meet the needs of the
modern healthcare system whose key challenge is to improve the
quality of life of people with long term conditions; not the 20th
century challenge of providing short episodes of short term care to
reduce mortality rates from major diseases’
–
Reform (2010) ‘Fewer Hospitals More Competition