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Better Care Fund Plan 2017-19 for Nottinghamshire | March 2017 | of 32

Updated March 2017 Draft version 5 - 27 February 2017

Better Care Fund planning template – Part 1

Please note, there are two parts to the Better Care Fund planning template. Part 2 is in Excel and contains metrics and finance.

Contents 1 Plan Details ................................................................................................................ 2

A Summary of Plan ..................................................................................................... 2

B Authorisation and signoff ......................................................................................... 4

C Related documentation ............................................................................................ 6

2 The Local Vision for health, care and housing integration .......................................... 6

A Delivering the Five Year Forward View .................................................................... 7

Nottingham and Nottinghamshire STP ....................................................................... 7

South Yorkshire and Bassetlaw STP .......................................................................... 8

B Case for change .................................................................................................... 10

C Alignment between our STPs and the Nottinghamshire BCF ................................ 12

D Integration in Nottinghamshire by 2020 ................................................................. 13

Digital Interoperability ............................................................................................... 18

Resource targeted at key cohorts to prevent crises and maintain wellbeing ............ 21

Value for money ....................................................................................................... 21

Single assessment and care plans, integrated community care, timely and safe discharges, and social care embedded in urgent and emergency care .................... 22

3 A coordinated and integrated plan of action for delivering change ........................... 23

4 BCF National Conditions .......................................................................................... 27

A Plans to be jointly agreed ....................................................................................... 27

B Maintain provision of social care services .............................................................. 27

C Agreement to invest in NHS commissioned out of hospital services, which may include a wide range of services including social care ................................................. 28

5 Financial risk sharing and contingency ..................................................................... 28

6 Metrics ...................................................................................................................... 30

A Non-elective admissions (NEA) (General and Acute) ............................................ 30

B Admissions to residential and care homes ............................................................. 30

C Effectiveness of reablement ................................................................................... 31

D Delayed Transfers of Care (DTOC) ....................................................................... 32


1 Plan Details A Summary of Plan

Clinical Commissioning Groups Bassetlaw CCG

Mansfield and Ashfield CCG

Newark and Sherwood CCG

Nottingham North and East CCG

Nottingham West CCG

Rushcliffe CCG

Local Authorities Nottinghamshire County Council

Ashfield District Council

Bassetlaw District Council

Broxtowe Borough Council

Gedling Borough Council

Mansfield District Council

Newark and Sherwood District Council

Rushcliffe Borough Council

Boundary Differences

There is a 2.1% difference between the estimated number of Nottinghamshire County residents and the count of patients on GP lists that are resident in Nottinghamshire County. This small figure is not expected to impact significantly on delivery of this Better Care Fund (BCF) plan.

Date agreed at Health and Wellbeing Board:

29th March 2017 - TBC

Date submitted: Submission deadlines TBC

Minimum required value of BCF pooled budget: 2017/18

TBC

Total agreed value of pooled budget: 2017/18

TBC

Minimum required value of BCF pooled budget: 2018/19

TBC

Total agreed value of pooled budget: 2018/19

TBC

A summary of the funding contributions by organisation can be seen in the table below. There are no additional contributions on top of the mandated minimum requirements for 2017-19.

1. Funding contributions by organisation Organisation 2016/17 2017/18 2018/19

NHS Bassetlaw CCG £7,554,470 £7,689,695 £7,835,799

NHS Mansfield and Ashfield CCG £12,589,768 £12,815,124 £13,058,612


Organisation 2016/17 2017/18 2018/19

NHS Newark and Sherwood CCG £8,002,985 £8,146,239 £8,301,017

NHS Nottingham North and East CCG £9,243,676 £9,409,138 £9,587,911

NHS Nottingham West CCG £6,265,761 £6,377,919 £6,499,099

NHS Rushcliffe CCG £6,973,951 £7,098,785 £7,233,662

Ashfield District Council £743,713

TBC ~£6m TBC ~£6.5m

Bassetlaw District Council £917,848

Broxtowe Borough Council £676,273

Gedling Borough Council £820,019

Mansfield District Council £993,620

Newark and Sherwood District Council £803,085

Rushcliffe District Council £520,855

Nottinghamshire County Council £0 TBC ~£1m TBC ~£11.5m

Total £56,106,024

Having reviewed BCF schemes as part of the BCF 2015/16 and 2016/17 evaluation process, there are no material changes to schemes / services within the Nottinghamshire BCF plan. However some schemes have been refocused in light of emerging priorities and changes within the Nottinghamshire planning footprint, for example, since BCF planning in 2014, Nottinghamshire has been awarded Vanguard status in a number of areas (Mid Nottinghamshire Better Together PACS, Principia Partners in Health MCP, Greater Nottinghamshire Urgent and Emergency Care, East Midlands Radiology Consortium, Primary Care Home models in Nottingham North East and Bassetlaw CCGs) and we have considered this in forming our BCF plan. For the 2016/17 BCF the Health and Wellbeing Board agreed that some of the Disabled Facilities Grant (DFG) would be retained for use at a countywide level to support health, care and housing priorities. DFG funding will be allocated in the same way for 2017-19 and includes specific allocations for each District Council:

Mandatory DFGs – local

Discretionary DFGs – local

Handy Persons Adaptation Scheme (HPAS) – countywide

Local transformation initiatives agreed in partnership (funding permitting)

2. Scheme level spending plan summary Ref no.

Scheme Locality 2016/17 2017/18 2018/19

A. Seven Day Working

South Nottinghamshire

£693,389 £706,939 £720,948

B. Delayed Transfers of Care


£5,316,000 £5,420,725 £5,527,947

C. Reducing non-elective admissions


£5,936,000 £6,887,054

TBC £7,023,280

TBC

D. Support to social care


£1,071,000 £257,984

TBC £263,087

TBC

E. Enabling


£401,000 £408,900 £416,988

F. Proactive care (community based)

Mid-Nottinghamshire

£11,090,000 £12,425,170 £12,684,446

G. Patient and carer support

Mid-Nottinghamshire

£851,000 £267,122 £272,707

H. Better Together Implementation Support

Mid-Nottinghamshire £937,752 £440,100 £449,283

I. 7 day access to North £495,470 £666,307 £753,567


Ref no.

Scheme Locality 2016/17 2017/18 2018/19

services Nottinghamshire

J. Mental Health Liaison

North Nottinghamshire

£440,000 £440,337 £440,777

K. Discharge / Assessment incl. Intermediate Care

North Nottinghamshire £3,105,000 £3,105,229 £3,107,723

L. Respite services


£21,000 £21,000 £21,000

M. Improving Care Home quality


£100,000 £75,000 £75,000

N. Telehealth


£518,000 £455,305 £455,610

O. Support for carers Countywide £1,223,000 £1,227,689 £1,232,187

P. Protecting social care Countywide £16,445,000 £16,740,134 £17,073,833

Q. Disabled Facilities Grant

Countywide £5,475,412 TBC ~£6m TBC ~£6.5m

R. Enabling Care Act statutory responsibilities and meeting demand implications

Countywide

£1,987,000 £1,991,906 £1,997,718

S. Improved BCF (adult social care)

Countywide N/A TBC ~£1m TBC ~£11.5m

B Authorisation and signoff

Signed on behalf of the Clinical Commissioning Group

Bassetlaw CCG

By Idris Griffiths

Position Chief Officer

Date XXX


Mansfield and Ashfield CCG

By Amanda Sullivan


Date XXX


Newark and Sherwood CCG

By Amanda Sullivan


Date XXX


Nottingham North and East CCG

By Sam Walters

Position Chief Operating Officer

Date XXX


Nottingham West CCG


By Vicky Bailey


Date XXX


Rushcliffe CCG

By Vicky Bailey


Date XXX

Signed on behalf of the Council Nottinghamshire County Council

By David Pearson

Position Corporate Director, Adult Social Care, Health and Public Protection

Date XXX

Signed on behalf of the Council Ashfield District Council

By Councillor Jim Aspinall

Position Cabinet portfolio holder for health and wellbeing

Date XXX

Signed on behalf of the Council Bassetlaw District Council

By Dave Armiger

Position Director of Regeneration and Neighbourhoods

Date XXX

Signed on behalf of the Council Broxtowe Borough Council

By Ruth Hyde

Position Chief Executive

Date XXX

Signed on behalf of the Council Gedling Borough Council

By Councillor Henry Wheeler

Position Portfolio Holder Housing, Health and Wellbeing

Date XXX

Signed on behalf of the Council Mansfield District Council

By Hayley Barsby

Position Deputy Chief Executive and Director of Communities

Date XXX

Signed on behalf of the Council Newark and Sherwood District Council

By Councillor Tony Roberts

Position Chairman of Leisure and Environment Committee

Date XXX


Signed on behalf of the Council Rushcliffe Borough Council

By Councillor Debbie Mason

Position Portfolio Holder for Safety and Well Being

Date XXX

Signed on behalf of the Health and Wellbeing Board

Nottinghamshire Health and Wellbeing Board

By Chair of Health and Wellbeing Board Councillor Joyce Bosnjak

Date XXX

C Related documentation

Document or information title

01 Our strategy for Health and Wellbeing in Nottinghamshire 2014-2017

02 Nottinghamshire BCF Logic Model

03 Planned BCF Schemes and Themes

04 BCF Scheme Implementation Plans

05 Nottinghamshire BCF Audit Report – pooled budget

06 Nottinghamshire BCF Audit report – 2015/16

07 Nottinghamshire BCF Risk Log

08 Maintaining progress on the 2016/17 national conditions

09 Integrated Commissioning Carers’ Strategy and Action Plan 2015-18

10 BCF Metrics - performance report summary

2 The Local Vision for health, care and housing integration The Nottinghamshire Health and Wellbeing Board (HWB) continues to work towards its four key ambitions of:

- For everyone to have a good start in life - For people to live well, making healthier choices and living healthier lives - That people cope well and that they are supported to improve their own health and

wellbeing and maintain independence - To get everyone to work together

This fourth ambition underpins all of the Board’s work to improve efficiency, maximise value for money, and provide joined up services and care pathways. Our overall vision is that, through working together, we will enable people living in Nottinghamshire to live longer, be healthier, and have a better quality of life, especially in the communities with the poorest health. This is a shared vision, and steps have already been taken across Nottinghamshire to transition towards this person-centred model of health and social care. What matters most to local people, commissioners, and providers are the improvements we make together for the benefit of patients and service users by optimising choice, where possible. The final strategy was agreed by the HWB in March 2014, and supporting delivery plan in September 2014. The strategy is attached in document 01. The strategy will be refreshed during 2017 and will consider where the Board can utilise its partnership approach to deliver maximum impact. The refresh will consider possible areas of overlap between the Nottingham & Nottinghamshire STP & the South Yorkshire & Bassetlaw STP and the Director of Public Health’s annual report for 2016 with a particular focus on prevention.


A Delivering the Five Year Forward View The Nottingham and Nottinghamshire Sustainability and Transformation Plan (STP) footprint includes Local Authorities, CCGs and providers within Nottingham and Nottinghamshire with Bassetlaw as an associate to the plan and a partner in the South Yorkshire and Bassetlaw STP footprint. This footprint differs from that of the BCF where Nottingham City has a separate BCF plan. Nottingham and Nottinghamshire STP The Nottingham and Nottinghamshire STP confirms the intention that the majority of the initiatives will be implemented at local system level through the two place based transformation partnerships units within the footprint - Greater Nottingham and Mid Nottinghamshire - with accountability for delivery, allocation of resources and tracking of impact at that level. The two systems within the STP footprint – Greater Nottingham/South Nottinghamshire and Mid Nottinghamshire – are testing different business models through the Vanguard programme for managing and improving population health. These units are based on patient flows, and have existing delivery plans in differing stages of implementation:

Mid Nottinghamshire has a Primary and Acute Care Systems Vanguard committed to delivering outcome focussed, population based services to the Mid Nottinghamshire population through a capitated budgeting model, with joint commissioning of health and social care services where possible.

Greater Nottingham Health and Care Partners have a high level strategy which was completed in June 2016 and influenced the development of the STP. Greater Nottingham also has a number of underpinning plans including the Principia Multi-Specialty Community Provider Vanguard; the Nottingham City Support to Care Homes Vanguard; and the Greater Nottingham Urgent Care Vanguard.

Change is supported by six main aims:

Organise care around individuals and populations - not organisations - and deliver the right type of care based on people’s needs, for example:,

o Help those who are largely well today (most of the population) stay well through prevention and health education and manage minor issues themselves in so far as it is possible

o Help those with a complex or advanced long-term condition that needs professional expertise and support to be as enabled as possible to manage their own care, to have an identified system to escalate care quickly in the event of exacerbations, and to have regular monitoring to identify changes in their health and social care needs as early as possible

Help people remain independent through prevention programmes and offering proactive rather than reactive care, which will also reduce avoidable demand for health and care services

Support and provide care for people at home and in the community as much as possible – which implies shifting resources into those settings – and ensure that hospital, care home beds, and supported housing are available for people who need them

Work in multi-disciplinary teams across organisational boundaries to deliver integrated care as simply and effectively as possible


Minimise inappropriate variations in access, quality, and cost, and deliver care and support as efficiently as possible so that we can maximise the proportion of our budget that we spend on improving health and wellbeing

Maximise the social value that health and social care can add to our communities At a more detailed level, the approach is to drive change in five high-impact areas, supported by continuous improvement in housing and environment, acute services, and system efficiency and effectiveness, and enabled by workforce and organisational development, estates utilisation, and proactive communication and engagement. The five high-impact areas include:

Promote wellbeing, prevention, independence and self-care

Strengthen primary, community, social care and carer services

Simplify and improve urgent and emergency care

Deliver technology enabled care

Ensure consistent, evidence based pathways in planned care South Yorkshire and Bassetlaw STP Bassetlaw is the northernmost district within the Local Authority boundaries for Nottinghamshire County Council, which provides both social care and public health services. Nottinghamshire Healthcare Foundation Trust is also a key partner providing both mental health and community services. Bassetlaw is a partner to the South Yorkshire and Bassetlaw (SYB) STP, and an associate to the Nottingham and Nottinghamshire STP. The SYB footprint has a strong history of collaboration, both across the footprint and with local partners. The plan has a strong emphasis on “Place” with five locality Place plans emphasising eight overarching strategic priorities:

Healthy lives, living well and prevention

Primary and community care

Mental health and learning disabilities

Urgent and emergency care

Elective and diagnostic services

Children’s and maternity services

Cancer

Spreading best practice and collaborating on support services These priorities sit alongside the plan objectives:

Reduce inequalities

Join up health and care services

Invest and grow primary and community care

Treat the whole person, mental and physical

Standardise acute hospital care

Simplify urgent and emergency care

Develop our workforce

Use the best technology

Create financial sustainability


Work with patients and the public The Bassetlaw Place Plan is aligned to the two STPs in the following way:

3. Alignment with STPs

STP Priorities Bassetlaw Place Plan alignment

SYB Notts

Healthy lives, living well and prevention

Promote Wellbeing, Prevention, Independence and Self-Care

SYB and Nottingham and Nottinghamshire STP due to statutory responsibilities


Strengthen primary, community, social care and carer services

SYB and Nottingham and Nottinghamshire STP due to statutory responsibilities

Mental health and learning disabilities

The approach is that Mental health and physical health are fully integrated within the other priorities

Nottingham and Nottinghamshire STP due to patient flow

Urgent and emergency care

Simplify Urgent and Emergency care

SYB STP due to patient flow

- Deliver Technology enabled care

SYB and Nottingham and Nottinghamshire STP: Bassetlaw are working with SYB and Connected Nottinghamshire for some areas as appropriate

Elective and diagnostic services

Ensure consistent and evidenced based pathways in planned care


Children’s and maternity services

The approach is that childrens and maternity care is fully integrated within the other priorities


Cancer included with the consistent and evidenced planned care


- Improve Housing and Environment

Nottingham and Nottinghamshire STP

- Strengthen acute services


- SYB STP

Enablers

Workforce Future proof Workforce and Organisational development

SYB and Nottingham and Nottinghamshire STP: There are some overlaps, e.g. deanery links are with SYB (for acute), but primary care, community and mental health have a Nottingham and


STP Priorities Bassetlaw Place Plan alignment

SYB Notts

Nottinghamshire focus.

Digital and IT services this is included in Technology Enable care which has a wider remit

SYB and Nottingham and Nottinghamshire STP: Bassetlaw are working with SYB and Connected Nottinghamshire for some areas as appropriate

Procurement and estates

Maximise Estates Utilisation

SYB STP

Finance Drive System Efficiency and Effectiveness

SYB STP

Wider public service reform

- SYB and Nottingham and Nottinghamshire STP as appropriate to organisational boundaries

- Proactive Communication and Engagement

SYB STP with collaboration when necessary

B Case for change

Our case for change has been considered against the 2016/17 BCF plan and the priorities identified in the STPs. We recognise that the current health and social care system in Nottinghamshire is unsustainable without transformational change. Our health and social care economy is facing a very clear set of challenges. Some of these are universal to commissioners and providers throughout England, and require fundamental changes to the way we commission and deliver services. Others are specific to Nottinghamshire, and take into account our local communities and organisations. Our most pressing challenges are identified below against the triple aim: Health and wellbeing

The proportion of local people living in ill health is growing, and while people are living longer, an increasing proportion of their lives is spent in ill health. Our healthy life expectancy is lower in Nottinghamshire than many other parts of England. This is due to: - An increase in conditions such as diabetes, heart disease and respiratory

disease that are often the result of lifestyle choices - A result of people living longer, with growing numbers of people with dementia

or at risk of experiencing loneliness or social isolation

We have significant health inequalities, with more than one-quarter of our population living in the most deprived areas of England. These need to be reduced.

There are big differences in deprivation levels across the city and county affecting older people and children and young people, and a concentration of higher levels of economic deprivation in Mansfield, Ashfield and Bassetlaw

Care and quality


Access to care - Nottinghamshire is among the worst performers in the following areas:

Non-elective hospital admissions – in December 2016 935 admissions per 100,000 population in Nottinghamshire compared to 928 admissions per 100,000 in England.

A&E four-hour target; variation between units of planning, but still national outlier overall (86% in December 2016)

Our ambulance response times are lower than the national average

Waiting times for treatment for cancer are higher than the national average

Nottinghamshire has a higher rate than the national average for people with learning disabilities or autism being admitted to hospital

Young people with mental health needs are receiving care within 10-13 weeks of being referred, against an aspiration of four weeks

Access times to see a GP vary significantly across Nottinghamshire

Quality of care - we have wide variation within Nottinghamshire in the following areas:

Our providers have good/outstanding regulatory ratings, but Sherwood Forest has a ‘requires improvement’ rating and is continuing to work to improve the quality of services it provides.

Our social care performance includes some of the best in the country, but we are facing sustainability challenges, particularly in the care at home market

We are performing well against the remaining BCF metrics:

Effectiveness of reablement at 83% locally compared to 82% national average (December 2016).

Delayed transfers of care (total days delayed) with a 2016/17 year to date rate of 2,789 delayed days per 100,000 population compared to 2,999 nationally.

In 2015/16 permanent admissions of older people (aged 65 and over) to a care home per 1000,000 population was 598.6 admissions per 100,000 in Nottinghamshire compared to 628.2 in England and 612.7 in East Midlands.

Finance and efficiency

While demand is growing, healthcare services are receiving small budget increases, while social care faces significant decreases

If we do nothing next year, we are forecasting an overall system gap of £314m for the local authority social care and public health budget.

By 2021, this would grow to an overall system gap of £155m for the local authority social care and public health budget

Closing this gap would require a reduction of 4.5% in spending growth every year against our historic performance of 2%.

The Nottinghamshire JSNA continues to inform key strategic plans, including the Health and Wellbeing Strategy. The JSNA Steering Group is responsible for directing the JSNA process for Nottinghamshire on behalf of the HWB. The JSNA in Nottinghamshire comprises life course sections: Children and Young People, Adults, Older People and Cross-cutting themes. The current JSNA topic chapters have been reviewed in 2016/17 to ensure that they are achieving the agreed objectives, reflect current priority issues, identify and address gaps, align with commissioning arrangements and approaches and have clear ownership across all the topic chapters. This review will conclude in March 2017. Unmet needs are quantified in our JSNA available online:


http://jsna.nottinghamcity.gov.uk/insight/Strategic-Framework/Nottinghamshire-JSNA.aspx The impact of our BCF plan is reflected in the BCF metrics – further detail can be found in the BCF template and Section 6 Metrics below.

C Alignment between our STPs and the Nottinghamshire BCF The Nottinghamshire BCF plan is aligned to activity within the following themes:

4. Scheme level alignment with STPs Ref no.

Scheme Locality Alignment with STP

Notts SYB

A. Seven Day Working South Nottinghamshire Strengthen primary, community, social care and carer services Simplify Urgent and Emergency care

-

B. Delayed Transfers of Care South Nottinghamshire Simplify Urgent and Emergency Care

-

C. Reducing non-elective admissions

South Nottinghamshire Simplify Urgent and Emergency Care Strengthen primary, community and social care and carer services

-

D. Support to social care South Nottinghamshire Strengthen primary, community, social care and carer services

-

E. Enabling South Nottinghamshire - -

F. Proactive care (community based)

Mid-Nottinghamshire Strengthen primary, community, social care and carer services Simplify Urgent and Emergency Care

-

G. Patient and carer support Mid-Nottinghamshire Strengthen primary, community, social care and carer services

-

H. Better Together Implementation Support

Mid-Nottinghamshire Strengthen primary, community, social care and carer services Deliver technology enabled care

-

I. 7 day access to services North Nottinghamshire - Primary and community care

http://jsna.nottinghamcity.gov.uk/insight/Strategic-Framework/Nottinghamshire-JSNA.aspx

http://jsna.nottinghamcity.gov.uk/insight/Strategic-Framework/Nottinghamshire-JSNA.aspx


Ref no.

Scheme Locality Alignment with STP

Notts SYB

J. Mental Health Liaison North Nottinghamshire - Mental health and learning disabilities

K. Discharge / Assessment incl. Intermediate Care

North Nottinghamshire - Urgent and emergency care

L. Respite services North Nottinghamshire Strengthen primary, community, social care and carer services


M. Improving Care Home quality

North Nottinghamshire - Primary and community care

N. Telehealth North Nottinghamshire Deliver technology enabled care

-

O. Support for carers Countywide Strengthen primary, community, social care and carer services

-

P. Protecting social care Countywide Strengthen primary, community, social care and carer services

-

Q. Disabled Facilities Grant Countywide Improve Housing and Environment

-


Countywide Promote Wellbeing, Prevention, Independence and Self-Care

-

S.

Improved BCF (adult social care)

Countywide Strengthen primary, community, social care and carer services

-

D Integration in Nottinghamshire by 2020 Within the context of the STPs, the three place based transformation partnerships within our BCF footprint, and the Integration Pioneer in Mid and South Nottinghamshire our vision for integrated care combines county-wide transformation with locally tailored services. We have an inclusive Health and Wellbeing Board which includes broad representation from our partners including health, social care, District Councils, Healthwatch and the police. There are a number of interventions that will act across the county to provide large scale transformation for our citizens whilst remaining tailored to the specific needs and challenges of the three planning units. All of the schemes forming our integration strategy are underpinned by a focus on improving independence and control through personalisation of care.

In Nottinghamshire integrated health and care is defined as the process, methods and tools which facilitate integrated care with the citizen at the centre. In Nottinghamshire we see good integrated systems as having the following characteristics and work is underway to embed these characteristics across the footprint:


5. Integration in Nottinghamshire

Integration in Nottinghamshire Our vision: Sustainable, joined-up high quality health and social care services that maximise the health and wellbeing of the local population

How we operate as a system – culture, values and our joint vision

A system which encourages integration and integrated care

Maximising the potential of available facilities, workforce, citizens and other resources

Effective leadership at all levels, with a focus on system, and clear ownership and responsibility for integrated care

Organisational The signatories to this plan are committed to working together to deliver integrated care, with the use of pooled funds

Shared governance arrangements are in place at unit of planning level, with learning and sharing at a Nottinghamshire level

TORs are in place to determine how we will work together

Enablers Robust information systems and information sharing

Information technology that supports the delivery of integrated care, for example, risk stratification in place and NHS number used as primary identifier

Information governance policies and procedures which support the sharing of data

The use of assistive technology to support citizens and their families and carers to maintain their independence and support self-care

Care planning integrated with available datasets to enable stratification of patients into specific cohorts at defined risk

A financial framework that encourages integration

Support innovative approach to commissioning integrated services

An integrated workforce and organisational development strategy

Further work on areas such as Estates, Back office functions

Clinical integration Strong clinical leadership

Collaborative culture that emphasises team working

Establishment of multidisciplinary teams which include clinicians and practitioners across primary, secondary, community, mental health, social care, housing and the voluntary sector (as appropriate to the team setting)

Use of guidelines to promote best practice, support care coordination across pathways and reduce unwarranted variation

Defining health and wellbeing in its widest sense

Resources will be shifted to preventative, proactive care closer to home

A focus on promoting independence and involvement of citizens and their carers

Build community resilience

Integrated seamless care across the system

People will be supported to develop the confidence and skills to be as independent as possible

Services will be strategically sound but locally sensitive to the


for citizens needs of the local population

Respects the rights of service-users

Take into account the dignity of service-users

Protects and improves the safety of service-users

Services are planned and led locally in a way which is engaged with the community

Consistent approach to person centred care plans

Integrated pathways which facilitate coordinated care and aid transition through the system

Support people with physical and mental long-term conditions to manage their condition well and live full and integrated lives in society

A focus on outcomes

Monitoring and evaluation embedded

Improving the quality of services

Outcome measures that encourage integrated service provision

Invest in quality improvement

Evaluation and learning dissemination

The BCF schemes continue to prioritise short- to medium-term actions to build capacity in the health and social care system, and respond to patient and carer feedback to improve the quality and effectiveness of services. By focusing on supporting patients’ post-acute illness (reablement, maintenance, and independence), mental health services, care home and specialist accommodation for older people, care for the elderly in the community, and the urgent care system, we aim to re-design intermediate care offered in the patient’s own home to be more flexible, and consequently reduce the number of acute and mental health patient beds. Our BCF schemes are designed around the person, not the condition, and aim to address the multiple needs of individuals through better joined up work, communication, and integration. In this way, the BCF is a key component to delivering not just the health commissioners’ integration plans, but also the overall Health and Wellbeing Strategy. We have accordingly structured all BCF schemes into six overarching themes:

1. 7 Day Service Provision and Access 2. Supporting Integration 3. Transforming Patient Satisfaction 4. Protecting Social Care Services 5. Accelerating Discharge 6. Infrastructure, Enablers, and Other Developments

This structuring and a logic model for the Nottinghamshire BCF programme can be found in the attached document 02 and 03. We held a further extended board meeting with partners to review our BCF plan using the Better Care Support Team self-assessment tool in January 2017. We had good engagement in the event and have identified a number of successes and areas for action during 2017/18. Successes include:

Domain 1. Leading and managing a successful Better Care Implementation – 8/10 (7/10 in 2015/16)

o HWB engagement is good. o Relationships between commissioners improved and has led to the

development of other initiatives.


o Relationships have improved through the development of the STP, e.g. understanding of partner work areas, acceptance of need, acceptance of responsibilities.

o Information sharing across units of planning to spread best practice within Nottinghamshire and scale up initiatives.

o Strong governance in place which received substantial assurance from internal and external audit.

o Patient engagement and evaluation of services embedded in commissioning.

o BCF is being seen as secondary to STP and this is leading to the diversion of management resources.

Domain 2. Delivering excellent on-the-ground care around the person 7/10 (7/10 in 2015/16)

o Work progressing on linked datasets. o The JSNA includes the local assets and commissioning gaps and informed

development of BCF schemes / services. o Pockets of good practice across the county o Both formal and informal processes in place for engaging citizens in service

development and the development of transformation plans. For example, carers are engaged through carers groups throughout Nottinghamshire on service developments, and a smaller number of carers are members of a Carers Implementation Group along with health and care commissioners to develop and transform services.

Domain 3. Develop underpinning, integrated datasets and information systems 8/10 (8/10 in 2015/16)

o Good progress on this domain with a strong Local Digital Roadmap in place.

o Good stakeholder engagement and clinical buy in. o Processes and systems in place for sharing information for direct care, e.g.

NHS number recorded in 85% of cases. o Engagement with district and borough councils has improved, e.g. through

the STP an assistive technology workstream has been established which districts are contributing to.

o Framework for secondary uses data signed across health and care organisations.

Domain 4. Aligning systems and sharing risks and benefits 8/10 (8/10 in 2015/16) o Work in development and mid Nottinghamshire Better Together Vanguard

leading nationally on capitation. o Risk stratification tools embedded in practice and profiles understood

across the county. The impact of new service models needs to be continually reviewed.

o Providers are engaged at a local level. For example, the Integrated Care Board in North Nottinghamshire has tasked providers with working together to develop a system wide outcome focussed falls pathway for 16/17.

o A better understanding of spend on priority population groups across the system is needed.

Domain 5. Measuring Success 7/10 (6/10 in 2015/16) o Evaluation frameworks in place at a service level for the majority of

services, however this could be more comprehensive. o Reporting and monitoring of DTOCs has improved in 2016/17. o Some progress made on measuring citizen outcomes has been made.


Domain 6. Developing organisations to enable effective health and social care working relationships 7/10 (6/10 in 2015/16)

o A focus on place rather than organisation with citizens at the heart of service delivery and development.

o Positive relationships are in place and the vision is coherent. This has developed as part of the STP.

o Protocols and processes are in place between front-line teams to enable them to work proactively across organisational boundaries, e.g. the Bassetlaw Integrated Discharge Team has been nominated for the Care Team of the Year at the East Midlands Care Awards.

During the 2015/16 evaluation we identified a number of areas to progress:

Action for 2016/17 Progress to date

Further develop relationships with providers and district councils to ensure that information is understood and filters through these organisations

During 2016/17 we have built on our relationships with key stakeholders as part of the development of STP plans.

Patient / service user / carer representation at a programme board level – Healthwatch are part of the HWB, and units of planning have embedded patient / service user perspectives in commissioning. However, at the Nottinghamshire BCF Programme Board we do not have representation.

Healthwatch have been invited to attend the BCF Steering Group (previously Programme Board)

Build on the JSNA to include mapping of assets.

Asset mapping included within the JSNA guidance to topic authors.

Further progress needed on procurement processes to enable smaller providers to engage fully in the developing market. It was recognised that as we scale up initiatives, this increases the risk of excluding providers.

Development of a primary care provider infrastructure in Mid Nottinghamshire to provide governance and structural support to go live on 1 April 2017.

Engage all district councils in data sharing protocols.

Some progress has been made during 2016/17 with further actions outlined in the Nottinghamshire Local Digital Roadmap.

Work to evaluate outcomes at a programme / pathway level is needed with reference to the impacts on health and care commissioners and providers.

Areas for us to progress in 2017/18 include:

Steering Group membership and attendance to be reviewed, including revisiting conversations with Healthwatch

Local staff, patients and service users are communicated to in a timely way, and are – and feel – involved in the design and delivery of the change process. Decisions are communicated in a well-timed way.

Delivering excellent on-the-ground care around the person on a wider scale so that we have a consistent and systematic offer for our citizens.

Comment [PNL1]: Paula adding Alliance and TEAM update


Further engagement with the voluntary and community sector in the development and delivery of services.

Progress in the proportion of the workforce utilising technology.

Establish what good looks like for the District councils in relation to integrated datasets and information systems.

A better understanding of spend on priority population groups across the system is needed.

Having reviewed schemes as part of the evaluation process, there will be no material changes to schemes / services within the BCF plan. However we have refocused some schemes in light of emerging priorities and changes within our planning footprint. There are no material changes to our BCF schemes; some schemes have been rephrased due to developments. Against the Social Care Institute for Excellence (SCIE) Integration Standard Nottinghamshire is performing well. The following sections outline progress to date on these domains. Digital Interoperability A countywide programme “Connected Nottinghamshire” is leading on information systems integration. This includes work on integrated datasets, Information Governance, underpinning infrastructure and standards. The work is progressing well with engagement across all partners and supporting the integration of services by enabling the sharing of key information. As part of the overall planning for BCF and STP, Connected Nottinghamshire have developed the Nottinghamshire Digital Roadmap setting out the plan for 2015-2020. The Nottinghamshire Digital Roadmap is aligned to BCF and STP plans with HWB approval. This includes the following workstreams with key milestones shown in the diagram below:

Share information in a way that makes citizen data available at the right place at the right time

Improve infrastructure and communication tools

Improve access to information for citizens

Improve overall digital maturity

Continually search for new technologies and implement to support independent living, care at home and better self-management of conditions


All project boards have citizen representation, and through existing engagement forums we ensure that citizens and patients play an active part in the design of solutions. To engage the wider population we have developed a set of leaflets and posters, which are utilised across partners, and explain how information is being used. Alongside this, website privacy notices have been updated to incorporate these messages. We plan to develop a comprehensive communications plan to support the Digital Roadmap.


Excellent progress has been made in populating systems with the NHS number. Agreement of the use of the NHS number has been in place for some time. With modern systems in place, the timeliness of NHS Number matching is primarily at the point of contact via Personal Demographics Service (PDS) linked Process Monitoring Infrastructure (PMI) trace. Recent research puts tracing/use of NHS number at 98% in the main providers, with the Ambulance Service matching approx. 60% of electronic records within 24 hours. Matching and recording of NHS Number across social care systems is in place and on-going via direct entry or batch tracing of NHS number via PDS. Key systems have been modified to support the storage and use of the key identifier. Using the Migration Analysis & Cleansing Service (MACS), social care system data has been submitted from the local authorities and matched to NHS Numbers, which are then data quality checked and uploaded. Progress to date is 85% of current caseload records matched. All procurements now have a set of requirements addressing the requirements for Open application programme interface (APIs). Recent procurements have addressed this specifically and now basing development of these APIs on the NHS England API standards document. Our position at Quarter 3 2016/17 is as follows:

6. Progress with Open APIs at Quarter 3 2016/17 Progress towards installation of Open APIs to enable information to be shared with other organisations G

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Progress status Installed (not live)

Installed (not live)

Installed (not live) Unavailable

In development

In development

Projected 'go-live' date (dd/mm/yy)

01/10/17 (interim sharing

solution in place)

01/10/17 (interim sharing

solution in place)

N.A (interim sharing solution in place)




Connected Nottinghamshire has oversight of the Nottinghamshire Health and Social Care Records Information Group. This GP, Caldicott Guardian led group is leading the way in relation to IG requirements and ensuring Nottinghamshire has good information sharing for direct care and risk stratification. In addition to this and in line with Caldicott 2 recommendations and best practice, pseudonymised or annonymised information is used sharing for reporting. A Nottinghamshire Data Sharing Protocol is already in place across all partners and due for review in summer 2016. Sharing to date has been using existing messaging capability and shared access to multiple systems. This has been supplemented with the use of the Medical Interoperability Gateway (MIG) and is now moving into the key phases of MIG2 and implementation of the Care Portal. As part of the overall delivery and assurance framework, benefits of the Connected Nottinghamshire programme are reported into Connected Nottinghamshire. The Programme Director provides regular updates to the Better Care fund Implementation Board and the HWB.


Resource targeted at key cohorts to prevent crises and maintain wellbeing We have made strong progress against our 2016/17 BCF plan with risk stratification embedded and good practice being shared across Nottinghamshire. Across Nottinghamshire we continue to adopt risk stratification delivered by Nottingham's eHealthScope project and based on the Devon CPM (Care Plan Management) solution in Mid and South Nottinghamshire. The CPM uses information about admissions, outpatient attendances and A&E attendances to calculate the risk of future admissions. North Nottinghamshire are using a locally-developed approach in partnership with the South Yorkshire and Bassetlaw Commissioning Support Unit. This information is then joined to care management information that GPs add information onto about the use of community services such as COPD matrons, heart failure matrons, and Crisis Intervention Services. This information is used in multidisciplinary team (MDT) meetings to make management decisions about who should be the care co-ordinator and which services should be offered to patients. MDTs concentrate on patients with a risk greater than 50% of admission, as this group has the greatest evidence for benefit (though the teams can view patients with lower risk). Value for money Further analysis of our system health and care gap and approach to closing it is outlined in our STPs. The Nottinghamshire BCF footprint currently faces a health system gap of £102m (FY 16/17), this includes a £76m NHS gap and a £26m Local Authority gap. In a ‘do-nothing’ scenario this gap is expected to rise to £628m by FY 20/21, this includes a £473m NHS gap and a £155m Local Authority gap. To meet this financial challenge while continuing to improve the quality of care for the people of Nottinghamshire will require two key actions. Firstly, delivering annual organisation internal efficiency savings and secondly, transformational changes to the way we deliver care to reduce activity or shift it to a lower cost setting of care. Providers will need to improve their operational efficiency enabling them to treat the same patient for a lower cost. Improvements to provider efficiency will mainly come from each organisations own internal efficiency savings (£313m by 20/21; 2%+ per year). In addition, £187m of system wide initiatives, and £20m of required additional support in relation to the PFI at Sherwood Forest Hospital. Operational efficiency will not be enough to close the gap alone and therefore transformational change to the model of care will be required. Seven sets of initiatives will focus on transforming the model enabling removal of ~£200m worth of cost by 2020/21. These initiatives will aim to both reduce the demand for healthcare and shift activity into lower cost settings of care within the community and closer to people’s homes. The sets of initiatives aimed at transforming the way we delivery care are estimated to save up to £187m. A core principle agreed by partners in the STPs is that we are one health and social care system, with a shared responsibility to manage the whole system finances to meet the populations’ needs. Plans set out the finances currently available across local authority and NHS organisations until 2021 and with citizens the right mix of services for the population will be determined according to need and achieving the best outcomes. Partners will work together to make the best use of the public purse.


Single assessment and care plans, integrated community care, timely and safe discharges, and social care embedded in urgent and emergency care As outlined in BCF plans in 2015/16 we have an overarching model of care built around the principles of ‘Support to Thrive’, ‘Choose to Admit’, ‘Transfer to Assess’, and ‘End of Life Care’ that we use to drive our county-wide and locality-based interventions. This approach is being taken to move towards more co-ordinated care for adults, including older people.

7. Nottinghamshire model of care

Layered on this are locality-specific approaches designed to respond to local system pressures, and based on rigorous analytical modelling. There is an identified case management approach across the County with risk stratification tools being used to identify those people most at risk of a hospital admission as outlined in our BCF 2015/16 plan. All areas use a MDT approach, the specific details vary by Unit of Planning e.g. multi-disciplinary, multi-agency teams are established; Care Delivery Groups in South Nottinghamshire, Local Integrated Care Teams in Mid Nottinghamshire, and Integrated Neighbourhood Teams in North Nottinghamshire. As outlined in Section 3, risk stratification tools are used in the management of multidisciplinary care teams for direct care. There are two NHS England approved risk stratification tools in use across our 6 CCGs. Our risk stratification algorithms uses a threshold of the top 5% (numerically) of patients with a score generated from the last 2 years’ of SUS data (i.e. a subset of our total resident / registered population who have interacted with secondary care in the past 2 years). Practices use the information to manage their active caseloads across the whole care team and prioritise the at risk patients. Practices typically focus on those with a score of 40-50% and above, lowering that threshold as time and resources permit. Work is also underway to introduce Social care data to this modelling. Self-management support is available to individuals within both the standard disease management, and primary prevention categories representing approximately 95% of the population.


8. Mid Nottinghamshire Integrated Model of Care for Long Term Conditions

Within wider transformation plans, mental health and dementia are priorities. There are already a number of integrated teams in place both within and outside of the BCF schemes. For example, outside of BCF plans there is a Nottinghamshire wide Intensive Recovery Intervention Service (IRIS) in place. IRIS is a 12 week intermediate care service delivered by a multidisciplinary care team (available 7 days a week) for older people with mental health problems and/or dementia to facilitate hospital discharge and/or prevent hospital or care home admissions. Within our BCF plan, there is funding for the Compass Workers carers service which is complementary to IRIS. The Compass Workers are peer support workers who have personal experience of being a carer. Compass Workers provider support to people of any age caring for someone with moderate to severe dementia who lives at home and is under the care of a Community Mental Health Team (CMHT) or IRIS for up to 12 sessions. We are developing this service in 2016/17 to expand the capacity of the service and include support to those not registered with the CMHT.

3 A coordinated and integrated plan of action for delivering change

Our detailed BCF implementation plans can be found in the attached document 04. These set out the timing and phasing for all individual schemes, as well as the associated milestones and activity changes anticipated. Schemes contained within the plan include:


9. High level scheme overview Ref no.

Scheme Locality

A. Seven Day Working South Nottinghamshire

B. Delayed Transfers of Care South Nottinghamshire

C. Reducing non-elective admissions South Nottinghamshire

D. Support to social care South Nottinghamshire

E. Enabling South Nottinghamshire

F. Proactive care (community based) Mid-Nottinghamshire

G. Patient and carer support Mid-Nottinghamshire

H. Better Together Implementation Support Mid-Nottinghamshire

I. 7 day access to services North Nottinghamshire

J. Mental Health Liaison North Nottinghamshire

K. Discharge / Assessment incl. Intermediate Care North Nottinghamshire

L. Respite services North Nottinghamshire

M. Improving Care Home quality North Nottinghamshire

N. Telehealth North Nottinghamshire

O. Support for carers Countywide

P. Protecting social care Countywide

Q. Disabled Facilities Grant Countywide


Countywide

S. Improved BCF (adult social care) Countywide

Governance and accountability arrangements remain in place as outlined in our BCF 2015/16 plan with the HWB being ultimately responsible for maintaining oversight of the health and social care system. The countywide BCF Steering Group continues to oversee development and delivery of the plan, with monitoring undertaken by the BCF Finance, Planning and Performance subgroup. As a system we are committed to undertaking an annual evaluation of our BCF schemes and system progress following the national template. This process includes sharing and learning across the system, and identifying and addressing underperforming schemes. The supporting governance structure of the HWB is as follows:


10. Nottinghamshire Health and Wellbeing Board governance

Operationally, each locality already has an established board or group to oversee the development and implementation of integrated care plans and schemes within the BCF: the Integrated Care Board in North Nottinghamshire, the Alliance Board in Mid Nottinghamshire, and the South Nottinghamshire Integrated Health and Social Care Board. A dedicated BCF Programme Manager has also been appointed, and has dual accountability to the Local Authority and CCGs. This post is hosted by the Mid-Nottinghamshire CCGs. Our countywide BCF governance structure is shown on the following page:


11. Nottinghamshire BCF governance structure

As in 2016/17, housing colleagues and providers have been involved in the development and agreement of this plan. District Council colleagues from our seven districts have been involved in the development and implementation of the BCF with representation on the HWB, BCF Steering Group, and Finance, Planning and Performance subgroup. We have a lead Chief Executive and a lead Officer on behalf of these organisations. Key health providers are similarly engaged with representation on the BCF Steering Group and Finance, Planning and Performance subgroup, along with representation on Transformation Boards in the three Units of Planning. Since 2014 we have undertaken four audits of the BCF programme. Copies of the 2016/17 audit reports are attached as document 05 and 06. In summary for each audit we received significant / substantial assurance concerning processes for our BCF pooled fund and governance arrangements. As an overarching principle, accountability for performance, mitigation of risks, and any remedial action is managed wherever possible at Unit of Planning level and is monitored and overseen through the aforementioned BCF governance process. The Nottinghamshire BCF risk log can be found in the attached document 7. The Finance Planning and Performance subgroup regularly review and update the risk log. The BCF Steering Group review on a quarterly basis and escalate high risks to the HWB quarterly as part of performance reporting.


4 BCF National Conditions NATIONAL CONDITIONS This plan addresses the four national conditions outlined in the 2017-19 BCF policy framework. The former BCF national conditions is summarised in document 08.

A Plans to be jointly agreed As in the previous plans, housing colleagues and health providers have been involved in the development and agreement of the BCF plan. District Council colleagues from our seven districts have been involved in the development and implementation of the BCF with representation on the HWB, BCF Steering Group, and Finance, Planning and Performance subgroup. We have a lead Chief Executive and a lead Officer on behalf of these organisations. Key health providers are similarly engaged with representation on the BCF Steering Group and Finance Planning and Performance subgroup, and Transformation Boards within the Units of Planning. For the 2016/17 BCF the Health and Wellbeing Board agreed that some of the Disabled Facilities Grant (DFG) would be retained for use at a countywide level to support health, care and housing priorities. DFG funding will be allocated in the same way for 2017-19 and includes specific allocations for each District Council:

Mandatory DFGs – local

Discretionary DFGs – local

Handy Persons Adaptation Scheme (HPAS) – countywide

Local transformation initiatives agreed in partnership (funding permitting) Our BCF plan continues to be set within the context of longer term plans for the integration of health, care and housing, and the success of our BCF programmes and work of the HWB have fed into the development of the STPs.

B Maintain provision of social care services Our definition of protecting adult social care services remains consistent with our BCF 2015/16 plans with the BCF allocation for protecting social care services being targeted at the same areas as outlined in our previous plan. As detailed in the list of schemes contained in Part 2 of this plan, each of the three localities has explicitly allocated the mandatory funds for the specific purpose of protecting social care services, enabling Care Act statutory responsibilities and meeting demand implications, and support to carers (summarised in the below tables) in a manner consistent with 2015/16 planning. This commitment is made in addition to other BCF schemes that will also be providing additional support to social care, both directly and indirectly.

12. Protection of social care services

Locality Protecting Social Care Services

2014/15 2015/16 2016/17 2017/18 2018/19

North £2,277,000 £2,277,000 £2,342,000 £2,383,922 £2,429,217

Mid £6,245,000 £6,245,000 £6,423,000 £6,537,972 £6,662,193

South £7,645,000 £7,645,000 £7,680,000 £7,818,240 £7,982,423


Total £16,167,000 £16,167,000 £16,445,000 £16,740,134 £17,073,833

13. Enabling Care Act statutory responsibilities and meeting demand implications

Locality Enabling Care Act statutory responsibilities and meeting demand implications

2015/16 2016/17 2017/18 2018/19

North £294,000 £301,000 £305,906 £311,718

Mid £863,000 £806,000 £806,000 £806,000

South £788,000 £880,000 £880,000 £880,000

Total £1,945,000 £1,987,000 £1,991,906 £1,997,718

14. Support to carers

Locality Support to Carers – county-wide initiatives

2014/15 2015/16 2016/17 2017/18 2018/19

Total £1,225,000 £1,225,000 £1,223,000 £1,227,689 £1,232,187

A copy of Nottinghamshire Carers Strategy is attached as document 09.

C Agreement to invest in NHS commissioned out of hospital services, which may include a wide range of services including social care Investment in NHS commissioned out of hospital services, including social care equates to approximately £27.5 million in our BCF plan. The crux of our BCF plan since 2014 has been to focus on out of hospital services to support the shift in activity, facilitate system flow and prevent avoidable admissions to hospital and care homes. Our plans have a particular focus on integrated care teams to facilitate discharge and support citizens in the community, intermediate care and reablement services, including transfer to assess, and support for carers. Our level of investment against the minimum allocations can be seen in the table below.

15. Investment in out of hospital services

Locality

Investment in NHS commissioned out of hospital services

2016/17 minimum

2016/17 2017/18

minimum 2017/18

2018/19 minimum

2018/19

North £2,147,766 £3,547,000 £2,185,193 £2,226,712

Mid £5,851,876 £10,336,000 £5,956,625 £6,069,801

South £6,389,141 £11,152,000 £6,503,307 £6,627,074

Total £14,387,784 £25,035,000 £14,645,325 £14,923,586

Our BCF Steering Group has considered a risk sharing arrangement for out of hospital services and concluded that it is not required at this time due to our strong working relationships and risk share agreement within our pooled fund agreement. As in our risk sharing agreement, risk and contingency will be managed at a Unit of Planning level as set out in Section 5.

5 Financial risk sharing and contingency As previously set out in our BCF 2015/16 plan, Nottinghamshire is a complex health and care economy, comprising six CCGs working as three units of planning, a two-tier local government structure consisting of a County Council and seven District Councils, three major acute Trusts which relate primarily to the three units of planning, and a myriad of health and care providers across all sectors. The HWB have been actively engaged in supporting and driving the BCF plan for Nottinghamshire, and consider the risk sharing approach to be appropriate for the complex environment described.


The 2015/16 BCF plan has established a financial risk sharing mechanism that has operated successfully in the first and second year of the pooled fund. This risk sharing mechanism is in addition to existing risk sharing mechanisms that currently exist across the CCGs in Nottinghamshire for expenditure that sits outside of the BCF pooled fund services. For 2017/18 the established BCF pooled fund risk sharing mechanisms will remain largely as per the previous arrangements. The mechanism recognises that the initial level of risk sharing is at an individual organisation or Unit of Planning level, utilising established contingencies in existence outside of the core BCF pool to mitigate risks in the first instance. Expenditure on Protecting Social Care Services, Disabled Facilities Grants, Social Care Capital and Enabling Care Act statutory responsibilities and meeting demand implications are explicitly assumed to remain within the allocation and thus deemed to be expenditure that is not risk shared. Should risks exceed those that can be managed at a Unit of Planning level, an escalation route to the Steering Group is in place. The Board will consider various options to mitigate the overspend / risk. These include an appraisal of actions that can be implemented to contain expenditure, viring underspends from other Unit of Planning or Council funds from the BCF pool and how any risk or overspend will be apportioned across organisations. Our county-wide BCF governance arrangements have created a forum for discussing local and shared risks impacting upon integration transformation. These discussions enable shared learning and dissemination of best practice in terms of effectiveness of required interventions, and approaches to managing and mitigating delivery risks. While addressing local health and social care needs, the Transformation Boards in each of the three Units of Planning take a similarly robust approach to identifying, monitoring, reporting, and mitigating risks within individual schemes. Once STP governance arrangements are confirmed, a review of the BCF governance arrangements will take place. The BCF Finance, Planning and Performance subgroup reporting ensures a clear line of sight across Unit of Planning mitigations and use of contingency and significant matters will be escalated up to the BCF Steering Group. CCGs continue to managed activity variances, and have a number of process and governance structures in place to identify these early and mitigate. CCGs hold both contingency and specific risk reserves based on calculated risk at plan stage, so these resources will be utilised should investment be needed for any mitigation or corrective action. Mechanisms also exist and are built into provider contracts to manage and minimise the impact of any variation to the system. Furthermore, the focus of the schemes in the BCF plan is geared towards admissions avoidance of inappropriate hospital and care home admissions, improving discharge from hospital, and supporting people to remain at home. The implementation of these schemes (and therefore the investment) will be done in a planned and managed to way to allow flexibility to transfer resource should there be slippage within the schemes. In addition, it is important to note that the BCF schemes focus has been developed across the health and social care community with full engagement. Therefore, each scheme has its own set of potential risks identified, mitigations, and contingency. At this


level, this means accountability is clear and each organisation is clear on the risks to them and their planned response.

6 Metrics Document 10 provides a summary of performance against BCF metrics 2014-16 and actions undertaken. Alongside the four national metrics, citizen experience and a locally developed metric on care home admissions directly from hospital will continue to be monitored in 2017-19.

A Non-elective admissions (NEA) (General and Acute) In 2016/17 NEA plans were aligned to CCG operational plans and no further reduction was proposed for BCF. The same approach is proposed for 2017-19. In 2016 Nottinghamshire has not met its NEA target for quarters 1-3. Figure 1.

B Admissions to residential and care homes Care home admissions are currently on target for 2016/17. The figure below shows the position at the end of month 9. Figure 2.


The 2017-19 targets have been set following our previous methodology; utilising the BCF ready reckoner.

C Effectiveness of reablement Reablement is not on target for 2016/17 as a new data collection methodology was put in place for 2016/17 to incorporate a wider number of service areas with more complex service users. Based on the services included in 2015/16, the indicator is on target (at 91.4% against a target of 91.2%). Figure 3.


The 2017-19 targets have been set following our previous methodology; utilising the BCF ready reckoner.

D Delayed Transfers of Care (DTOC) DTOCs are currently on target for 2016/17. The figure below shows the position at the end of month 9. Figure 4

The 2017-19 targets have been set following our previous methodology; utilising the BCF ready reckoner and aligning to trust and CCG targets.

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