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Better Care Fund (BCF) Update

Dr Sharon HadleyGP lead for Unplanned Care

11th June 2015

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Better Care Fund (BCF)• New initiative

announced in June 2013 • The NHS and Social Care

will share £3.8bn in 2015/16

• Every CCG + LA has to jointly agree a spending plan for integrated care

“A lack of joined up care is one of the biggest

frustrations for patients, service users and carers.

Getting it right will make a huge difference to quality,

safety and people’s experience of care.”

(Jeremy Taylor, CEO National Voices)

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Agreed Spend

National Conditions

Plans will be locally determined, but with some nationally mandated elements: plans to be jointly agreed between the LA and CCG protection for social care services (not spending); 7 day working in health and social care to support patients being

discharged and prevent unnecessary admissions at weekends, aligned to; better data sharing between health and social care, based on the NHS

number to ensure a joint approach to assessments and care planning; a lead accountable professional for integrated care packages agreement on the consequential impact of changes in the acute sector.

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Local ChallengesHigh levels of Emergency Admissions Target reduction is 656 emergency

admissions for 15/16 (3.5%)High levels of residential placements Target reduction is 23 residential

placements for 15/16High levels of complex care packages Target reduction is 39 complex care

packagesBCF funds committed to existing services No new funding

Achieving truly integrated teams/services New ways of contracting services for true integration

Data sharing Consent & inter-operability

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BCF for Southend1. Community Recovery Pathway

2. Primary Care Hub

3. Redesigning Social Services

4. End of Life Services

5. Prevention & Engagement

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Community Recovery Pathway - 1First Contact, admission avoidance/prevention, urgent response- Review of SPOR and SBC Access Team format and

function.- Potential to pool resource and co-locate to improve

effectiveness- Review access to crisis response for admission

avoidance- Review discharge process and protocols- Review MDTs in Primary Care

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Community Recovery Pathway - 2Reablement, Intermediate Care beds, Step up/down beds, Short term placements- Review current reablement capacity and contract

terms/performance- Review current bed capacity (intermediate care, step

up/down) and contract terms/performance- Develop the market to find new providers, promote

innovation and new ways of working.- Consider re-commissioning of reablement and bed

based services

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Community Recovery Pathway – 3Long term community support- Frail elderly & Long term conditions focus- Maximise independence by supporting people in

the community wherever possible- Bring together health & social care functions- Reduce fragmentation and duplication- Scope options for care co-ordination- Closely aligned to Multi disciplinary teams &

Primary Care Hub

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Primary Care HubProvide proactive health and social care and support, to avoid health crises and improve person/family/carer experience- GP practices are the entry point into the health system,

accounting for 80% of patient contact.- Patients will only go into hospital when they need specialist

care and there is no alternative available in the community- Appropriate services are available and accessible to the local

population – right care, right place, right time. - 7 day services where possible- Personalisation, care planning & support to self manage- Partnership working with all stakeholders

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End of LifeRedesign services to increase the number of people supported to remain in their home and community setting who achieve their preferred place of care during the final stages of their lives.- Increase patient numbers on EOL register- Review current service provision- Redesign new model of care/pathways- Reduce the number of emergency admissions for patients

during end of life phase- Increased compliance with patients preferred place of care- Personalisation, ensure the person and those important to

them are involved in planning and care.

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Redesign of Social ServicesRedesign of social care services, contributing to admission avoidance and timely hospital discharge- Review & redesign of social work model- Review of current contractual arrangements

with care homes- Contribute to reduction in complex care

placements and residential care placements

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Prevention & EngagementOffering effective solutions for lifestyle related health behaviours- Led by Public Health- Lifestyle hub for assessment and treatment or

onward referral for intervention- Patient activation measures, 8 practices signed up

to pilot encouraging self care- Social prescribing- Falls prevention and postural stability