Better Care Fund why and how Dominic Harrison

Health Inequalities & Healthy Life Expectancy Bottom /top 10% IMD

Disability-Free Life Expectancy at Age 16 (ONS ) 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 Re-investing in primary/neighbourhood care. Prevention Treatment Population Individual Primary Care/Neighbour hoods /Third sector offer Healthy Public Policy shifts Community/ family/third sector/Comm unity development Enhanced Primary Care/Neighbourhoods/ Third Sector/’digital by default’ diagnosis & treatment Secondary /Tertiary Care (Hospitals) 60% of NHS budget Enhanced Primary Care

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 Impact Reduction of 425 hospital admissions in 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

Prevention Keeping people well Actions and policies to promote healthy environments Healthy public policy (HIAP) 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 Disease specific Public Health Programmes, Screening, case finding, etc Primary care Hospitals Secondary and Tertiary Care & Adult Social Care Community funded-Non-MonetisedTax -funded-Monetised & Professionalised Community Wellbeing System In neighbourhoods and communities Health/Social Care System in NHS/LAs

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