Better Care for Haringey Community Event

Marco Inzani

Commissioning Lead for the Better Care Fund, Haringey Council / NHS Haringey Clinical Commissioning Group

Housekeeping

Aim of today

• What is the Better Care Fund?

• How has your feedback shaped the Haringey Better Care Fund?

• What services are part of the Haringey Better Care Fund?

Meet Harry Gray

• 75 year old widower • Has several health conditions: COPD,

Dementia, Depression, Falls • Visited A&E 32 times in last year, admitted

10 times. • Cared for by his daughter

What is the Better Care Fund?

The £3.8bn Better Care Fund (formerly the Integration Transformation Fund) was announced by the Government in the June 2013 spending round, to ensure a transformation in integrated health and social care. The Better Care Fund (BCF) is one of the most ambitious ever programmes across the NHS and Local Government. It creates a local single pooled budget to incentivise the NHS and local government to work more closely together around people, placing their well-being as the focus of health and care services. (Accessed 28/11/14, NHS England Website, http://www.england.nhs.uk/ourwork/part-rel/transformation-fund/bcf-plan/ )

Haringey’s commitment to deliver better care

Beverley Tarka, Acting Director of Adult Social Care, Haringey Council

Jill Shattock, Director of Commissioning, NHS Haringey Clinical Commissioning group

Haringey CCG Priorities 2015/16

1. Alternative models of care

2. Integration

3. Engaging communities

4. Proactive and holistic primary care

Haringey Council Priorities 2015/16

1. Best start in life

2. Healthy lives

3. Clean and safe

4. Growth and employment

5. Choose to live

Haringey Better Care Fund Vision

“By April 2019, we want people in Haringey to be healthier and to have a higher quality of life for longer. We want everyone to have more control over the health and social care they receive, for it to be centred on their needs, supporting their independence and provided locally wherever possible.”

London Borough of Haringey/Haringey Clinical Commissioning Group

By 31st March 2016 we will:

• Have 705 fewer emergency hospital admissions • Support people to remain at home and avoid 2

more people from going into a care home • Support 6 more people so that they don’t return

to hospital within 91 days of being discharged • Maintain the number of people discharged from

hospital on time • Improve the experience of people with health

conditions measured with a patient survey • Have 10 fewer injuries due to falls in the over 65s

Beyond 2016: Value Based Commissioning

Supporting a single pathway and a single provider to:

• Measure outcomes that are important to you

• Design and run services to deliver these outcomes

• Provide financial incentives to achieve these outcomes

Haringey Better Care Fund

Marco Inzani

Commissioning Lead for the Better Care Fund, Haringey Council / NHS Haringey Clinical Commissioning Group

Haringey Older People (65+)

200 Local People Engaged

Public/Service User Priorities

1. Easy to access

2. Well managed

3. Person Centred

4. Provide good and timely information

5. Enable individuals to do things for themselves

6. Work together as one team

7. Promote wellbeing and reduce loneliness

Intervention Impact

Comprehensive geriatric assessment Reduces hospital re-admissions

Enhanced discharge planning Reduces hospital re-admissions

Re-ablement Reduces residential admissions

Strength and balance exercises Reduce falls

Medicines review Reduce falls

Home safety assessment Reduce falls

Advanced care planning Reduce hospital admissions at end of life

Befriending/community navigators Reduction in loneliness and isolation

National and International Evidence

Programme Impact

MDT discussions • Felt to be positive by MDT professionals. • Fall in acute activity following MDT discussions (but no

control group)

Rapid response service • Appears to be effective at preventing admissions

Integrated locality teams • Breaking down barriers between professionals • Successful case studies • Impact on cost and activity unclear • Selecting right patients is crucial

Home from hospital • Successfully supporting people on discharge from hospital

Local Evidence

BCF Scheme & Service Overview Scheme Service 2015/16

Scheme 1: Admission

Avoidance

Locality Team

£13.5m

MDT

Lymphedema

Rapid Response

Overnight District Nursing Service

Dementia Day Centre

Recovery College (incl. MH Employment)

Falls Prevention

Scheme 2: Effective

Hospital Discharge

Reablement

£3.9m Step Down

Home From Hospital

Scheme 3: Promoting

Independence

Neighbourhood Connects (incl. Info & Advice)

£0.6m Palliative Care

Supported Self-Management (Generic)

Supported Self-Management (Diabetes)

Scheme 4: Integration

Enablers

Interoperable IT

£2.6m Workforce Development (incl some service delivery)

Disabled Facilities

Care Act Responsibilities

Contingency £1,260,000

TOTAL £22m

Admission Avoidance

Named Care Co-ordinator

Health and Social Care Plan

Referral for bereavement counselling

Effective Hospital Discharge

Less time in hospital

Support to return home

Regain confidence to prevent falls

Promoting Independence

Identification

Link to an ‘expert patient’ group

Link to a local gardening group

Integration Enablers

All relevant professionals know important information

Services in the evening

Support for Harry’s daughter

Are We Meeting Public/Service User Priorities?

Public Priority Better Care Fund

1. Easy to access Named care co-ordinator; Single point of access; Evening/weekend services

2. Well managed Training and education

3. Person Centred Health and social care plan

4. Provide good and timely information Information, advice and guidance

5. Enable individuals to do things for themselves

Self-management; reablement

6. Work together as one team Multi-disciplinary team; access to information

7. Promote wellbeing and reduce loneliness

Neighbourhood Connects; support for carers

Key milestones

Aug 2013 – Mar 2014

• Haringey residents and professionals engaged

• Initial BCF plan developed and submitted

Apr 2014 – Sept 2014

• Implementation plan developed • Review of current services • Revised BCF plan submitted

Oct 2014 – Mar 2015

• Services piloted • Business plans and service models developed • Services procured • BCF Plan approved (7th Jan 2015)

Apr 2015 – Mar 2016

• BCF Plan implemented • Monitoring and review of services • Planning for future years

Beyond April 2016…

• Continued commitment to integration

• Outcome focused: e.g. No infections; I feel I am not a burden on my family/friends; I feel listened to; I am a carer and I feel supported; Person died without pain and where they wanted to be

• Lead provider for a whole pathway

What you can do

KNOW – Spread your knowledge of the Better Care Fund

FEEL – Get passionate about improving care for ‘Harry Gray’

DO – Find out what you could do to make a difference