Transcript Better Care Fund North Yorkshire.

The Better Care Fund
A New Era for Health and Social Care in North Yorkshire
Presentation to NY Health and Wellbeing Board 1st April 2014
Presentation Content
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Background
Vision
Journey for North Yorkshire
Feedback on the draft plan
National Conditions
Local priorities and schemes
Investment
Metrics
Governance
Risks
The Better Care Fund - A New Era for Health and Social Care in North Yorkshire
Background (reminder)
• £3.8bn nationally, North Yorkshire = £39.8m: this is not new money
• BCF is a pooled budget between the NHS and NYCC
• BCF represents only a small % of total NHS and Council spend but must
lever changed outcomes and new models of integration
• Schemes should support shift from secondary to community, primary and
social care
• Fund includes some centrally distributed capital and needs to cover
elements of the costs of implementing the Care Bill
• Element of reward for performance against national indicators, measured
from April 2014 with payment points in April ‘15 and October ‘15
• Guidance and process ‘mixed success’
• First draft submitted in February
• This version to be submitted on 4th April
The Better Care Fund - A New Era for Health and Social Care in North Yorkshire
Vision for North Yorkshire
• To become an exemplar for how CCGs and Local Government
can work together to lead a complex health and social care
system.
• To improve self –help and independence
• Invest in Primary and Community Services
• Create a sustainable local system which protects Adult Social
Care and partners with Secondary Care to reduce reliance on
acute services and residential care.
• Care centred on the needs if the individual and their carers,
empowering people to take control of their health and
independence.
The Better Care Fund - A New Era for Health and Social Care in North Yorkshire
Staging the journey
Preparing the ground:
2013/14
• CCGs gain authorisation and address legacy deficit
• Health & Wellbeing Board and Integrated Commissioning Board
established
• Council launches its ‘2020 North Yorkshire’ programme
• Pilots and trials established for integrated services
Building the foundations:
2014/15
• Addressing the key gaps (particularly in community, primary and social
care), which will give the county the range of services which are needed
for an ageing population
• Testing and evaluating our approaches and planning the next stage
• Review and revise our governance to ensure it is fit for purpose
Integrating our services:
2015/16
• Implementing our new models of care, across primary, secondary and
social care which are integrated around individuals and communities and
which begin to make a step change
Delivering a difference:
2016 - 2018
• Developing our model of care to ensure that all parts of the system
perform to the standards of the best
The NY BCF represents a paradigm shift – breaking the cycle of the past and preparing a new,
effective, collaborative approach to providing the best possible care for North Yorkshire
National Conditions
Condition
Our Approach
7 Day services to support discharge:
Reablement/Intermediate Care, 7 day ward rounds,
Primary Care
Protecting Social Care Services:
CCGs have agreed 2015/16 level of funding at circa
£17m to include:
• current spend on reablement
• supporting 7 day working
• avoiding admissions
• health related social care packages
• protecting core services
Integration, joint assessments and accountable
lead professionals:
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Information/data sharing:
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Agreed plans: planned jointly and agreed by
Health and Wellbeing Board
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Programme underway to deliver a new model of
care for Reablement and Intermediate Care services
BCF schemes in place to put MDTs in place across
the County to enable joint assessments and
accountable lead professionals
Information Management and Technology
programme getting underway covering risk
stratification and shared assessments
Liquid Logic system implementation for Social Care
imminent
Plan developed with strong support from Integrated
Commissioning Board and Local Transformation
Groups
The Better Care Fund - A New Era for Health and Social Care in North Yorkshire
Feedback on First Draft
Issues raised
Commentary
Ensure that NHS Providers fully understand the
impact on their services.
Providers are already involved, now we need to ensure they understand their role in
supporting the system to deliver our common aims.
Ensure that Mental Health Services are protected
and developed.
Ethos: No Health without Mental Health.
Action: A number of specific schemes In-reach, dementia services, Improving Access to Psychological Therapies (IAPT) and
integrating MH Specialists into M-DTs.
Prevention: Tackling emotional wellbeing linked to social isolation and loneliness.
The document has been strengthened in the context of the transformation underway in Adult
Services. We are also clear that the guidance is that the transferred resources are there to
ensure the maintenance of core social care services.
Be more explicit about how the resources
allocated to protect Social Care will benefit the
system and add health benefit to North Yorkshire
residents.
Reduce avoidable emergency admissions by a
higher level than we had targeted.
Reduce delayed transfers of care by a higher level
than we had targeted.
Target was set in line best belief of achievable progress within the timescale.
Difficult as the template does not allow measure against the current trajectory. We have
questions about how realistic this expectation is.
Target was set recognising NY’s high current performance. The national ‘scoring’ doesn’t
recognise that good performers may have less scope for improvement.
Increase the % of people who remain at home 91
days after a reablement package.
Our current performance is very good at over 85%, increasing this while also increasing
volumes is very risky.
Ensure there is capacity at Integrated
Commissioning Board (ICB) to deliver the
programme of work.
The ICB is a countywide group and will ensure that each locality has the capacity needed. In
addition we have identified resources to fund infrastructure such as the Information
Management and Technology (IM&T) Programme, Communications and additional project
management.
Local Priorities
Agreed high level priorities and desired outcomes for local
implementation in four broad areas:
• Prevention
• Integrated Reablement and Multi-disciplinary Teams
• High impact interventions re: Mental Health, Dementia,
Falls, Support to Care Homes
• Underpinning funding also to increase core levels of
community staffing
Supported and enabled by enhanced capacity at NY wide level
developing infastructure, IT and Communications.
The Better Care Fund - A New Era for Health and Social Care in North Yorkshire
Community
Resilience and
Self-help
Prevention /
Information &
Advice
District / Borough Services
• Housing / Leisure
• Disabled Facilities Grant
Early Intervention
/ Low level Needs
Long Term
Conditions
Reablement /
Intermediate Care
High Impact
Pathways
Assessment
Multi Agency / Multi Disciplinary Teams
Intermediate Care
Primary Care
Investment profile of BCF Schemes,
to be underpinned by Social Care and wider NHS services
Urgent Care
Impact on the Acute sector
• Investment in Intermediate
Care Services including
Reablement
• Fewer placements into
Residential Care increases
independence and reduces
health support, increases need
for Intermediate Care services
or community support services
• Reduces the number of avoidable
admissions
• Ability to intervene with
intermediate care will increase
options to avoid admissions
Reablement /
Intermediate
Care
Avoidable
Emergency
Admissions
Permanent
Admissions to
Residential /
Nursing Care
Delayed
Transfers of
care
• Which reduces the likelihood
of discharge to Residential /
Nursing Care
Investment plans
Minimum
contribution
(14/15)
£'000
Organisation
NHS England / CCGs *
Spending on Minimum
Actual
BCF
contribution
contribution
schemes
(14/15)
(15/16)
(14/15)
£'000
£'000
£'000
Spending on
Actual
BCF
contribution
schemes
(15/16)
(15/16)
£'000
£'000
11,109
15,452
9,791
36,412
36,412
9,398
North Yorkshire County Council **
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12,751
9,500
1,350
1,350
18,850
District / Borough Councils – Disabled
Facilities Grant ***
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-
2,033
2,033
2,033
Primary Care / Specialised
Commissioning
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19,291
39,795
39,795
30,281
Public Health - profile to be agreed
Total
11,109
Contingency Fund
28,203
8,912
9,514
* Assumes National 'additional funding' of £2.02m (14/15 only)
** 15/16 spending includes Care Bill
*** DFG passes straight to Districts/Boroughs
The fund for both 2014/15 and 2015/16 currently identify c£9m of unallocated funds against the total pool. This is
deliberate and allows us to:
• Invest further in schemes that demonstrate positive results from the first phase
• Hold funds in reserve to cover the performance element of the fund in case of underperformance
• Invest to tackle seasonal pressures
• Invest in other initiatives or schemes, such as the expected need to bolster falls prevention and carer support
services
Metrics
The NY BCF is about building on what is good:
• We already place less people in long term care than any other County
Council
• We already perform well on delayed transfers of care
• We have an excellent record on reablement outcomes – to push harder
risks giving an incentive to cherry-pick
And investing where we can do better:
• Committed to enabling more people to benefit from
reablement/intermediate care, especially to prevent admissions to
hospital
• Putting a Falls Strategy in place across the County
• Plan to build up ambition over 2 years
We have to be realistic about how quickly we can put the resources and
infrastructure into place to deliver on the ambitious target we set ourselves
for 2015/16 and beyond
The Better Care Fund - A New Era for Health and Social Care in North Yorkshire
Metrics – the timing Issue
Governance
The Better Care Fund - A New Era for Health and Social Care in North Yorkshire