1. Evaluation of Leicestershire’s Better Care Fund programme Elizabeth Orton, Consultant in Public Health Janine Dellar, Head of Public Health Intelligence Monday 22 nd June 2015

2. Aim of the Better Care fund Evidence-based improvements to integration of health and care Increase community capacity Transfer activity from acute to community Pooled budget to sustain integration

3. Better Care Fund Unified prevention e.g. Local Area Co-ordination Integrated proactive response for people with long term care e.g. case management for >75s Integrated urgent response (admission avoidance) e.g. Falls pathway redesign, older persons unit, 7 day GP service, ICRS Hospital discharge and re-ablement e.g. integrated reablement Reduce the number of permanent admissions Increase the number of service users still at home 91 days after discharge Reduce the number of delayed transfers of care Reduce the number of avoidable admissions Reduce the number of emergency admissions due to falls Improve Patient experience Expected outcomes4 Themed areas

4. Evaluation framework Outcome evaluation What are the outcomes for communities and individuals – LAC Participatory Action Research, asset mapping Has an admission or residential care been avoided? Clinical audit/case note review Was it the intervention that made the difference? Data linkage cohort analysis Structure/Proces s evaluation Does the process work as well as it could? Lean systems analysis and patient satisfaction

5. Routine Data analysis Example: Integrated crises response service GP sees patient and refers to integrated crises response service Professional contacts LPTs single point of access Allocated to specialist nursing service If 09:00 to 17:00 this is an existing service. BCF enhancement is extending this to night nursing Is this an improvement for the patients?

6. Tracking this through the data Inputs – LPT SPA Data Linkage to ambulance data Epidemiology of patients using ICRS Linkage to A&E data Understanding of full set of activity data for ICRS cohort Linkage to Inpatient data Patient pathways pre and post ICRS Inputs – LPT community nursing data Linkages to outpatients data Costs of the full patient pathway Linkages to adult social care data Future – matched cohort analysis

7. PSEUDONYMISATION Data Flows UHL and LPT SUS PbR Data Community nursing data EMAS Ambulance Data Adult social care data from 3 local authorities GEM DSCRO GEM CSU Safe Haven Release to PI

8. Information Governance Overarching framework for IG –signed by all participating organisations Responsibility sits with Senior Information Responsible Officer (SIRO) NHS data is flowing under s251 exemptions linked to original NHS act allowing the transmission of pseudonymised data for secondary use Councils release data to ASH for pseudonymisation Only risk is at point of transfer to the ASH All data that is released to PI is pseudonymised using a single encryption key

9. Limitations How good will our data linkage be (65-80% anticipated on ASC data) Ambulance data – low for NHS Number At this time – only data from main acute provider, so cross border flows will be an issue No costing of social care data No primary care data Diagnoses flagging will be 1 st five diagnoses codes in hospital inpatient data Only three years data Social care data only has NHS number for patients who are currently active Care home patients – only identifying clients that are social care funded No mortality data included at this time We need to start somewhere!

10. Next steps…. Going out to procurement for LAC evaluation Ongoing Lean research with Loughborough University Clinical audit proposals being agreed Cohort analysis before and after for admission avoidance schemes