Better Care Fund 2016/17

• Recap and reflection on 2015/16• Understanding the problem• What did the people of sheffield say• A single city vision• Engaging the whole system• Key areas of work for 2016/17• Questions / feedback

Contents

• 2015/16 BCF £270m– One of the largest in England (min commitment is £40m)

– National influence– 2015/16 learning

• Its difficult work.• Barriers – statutory / organisational / cultural /

professional / populations served etc.• Providers didn't feel part of this process.• But … all stakeholders across the City are up for this.

Recap and reflection on 2015/16

Understanding the needs of our 580k population

The gap in life expectancy between the most and least deprived men in Sheffield is 9.8 years and 6.9 years for women – no change for 10 years!

25-30% of people admitted to hospital have a mental health condition which in many cases isn't treated..

The causes in life expectancy between least and most deprived in sheffield: Men - Cancer 32.1%, Circulatory disease 27.3%, Respiratory Disease 13.5%, Women – Cancer 35.6%, Respiratory Disease 21.5%, Circulatory disease 19.5%,

People wait too long for emergency and elective care – outside of national standards.

The CCG allocation uplift for 2016/17 was 2.2% National average 3.4% - 0.8% in real terms

The assessed combined efficiency challenge across the health and social care system taking into account demand pressures, tariff efficiency, trust stretch CIP targets, other loss of income is £96m, leaving a net efficiency challenge of £75m.

Sheffield City Council required to find £50m savings this year. £50m delivered last year.

We know we have a financial problem

We know what contributes to our poor outcomes in health inequalities

We know where are services do not provide support and care at the standards people expect.

The care they do receive does not deliver the outcomes other health systems enjoy.

The gap in healthy life expectancy is a gap of 22 years for men and for women a gap of 22.5 years between the most and least deprived

What do the people of Sheffield say?I find it hard to find my way around all the variety of services – or even to know if what I need is actually provided by someone

I have little control over the care I do or don’t receive

My psychological needs are not met as part of care for my physical needs

Services often aren’t available at night or weekends like they are during the week

Why don’t services plan in advance – surely they should know if I get unwell I’ll struggle to cope but don’t necessarily want or need to go into hospital

Why can’t I just have one care plan?

If things go wrong it’s difficult to

receive the care I might need quickly

enough

We have to constantly repeat information from one person to another

Single Sheffield City View

Focus on health and wellbeing inequalities

Financial sustainability for the system

Integration and integrated care

pathways

Alteration of contracting

mechanisms across system

Collaboration with partners

Workforce, technology,

etc. development

There is consensus across the city from all key parties that there are six principles to deliver by 2020

Engaging the whole system

- Fewer meetings- Local Clinicians leading delivery- Working for the whole systems benefit- Commissioner led Service Transformation structure- we set pace and scale- Patient Centred solutions- New rigour of delivery- Organisationally agnostic

… to deliver!

A detailed action plan

Theme1.    People Keeping Well/Ongoing Care2.    Servicing neighbourhoods3.    Developing primary care4.    Urgent and reactive care5.    Effective care/planned care6.   Mental health7.    IT/Information Governance8.    Estates9.    Workforce/OD10. Research and evaluation

Actions

1.    Reduce numbers and cost of high activity of people with whole-life conditions

2.    Agree a single assessment process/reduce assessment3.    Where appropriate redeploy staff duplicated through development of a single team to then deliver a faster assessment at six weeks reducing their level of support required4.    Transforming Care Action Plan5.    Implementation of the second phase of People Keeping Well6.    Voluntary sector to standardise social prescribing offer across all practices7.    Fire service extension of home visits8.    Trial of expanded scope of health check visits to include sight tests and exercise routines etc.

• People Keeping Well– Local Advice and Information– Risk stratification– Community Assets / Activities– Life Navigators– Wellness planning

Key areas of work for 2016/17

• Active Support and Recovery– Provide packages of care to enable patients to stay at

home– Establish GPs working in groups to release more time

to proactively plan care for complex patients– Agree escalation plans with patients to mean they are

able to better prevent escalation of their condition– Improve the coordination of post acute discharge

support.

Key areas of work for 2016/17

• Ongoing Care– Deliver an integrated process of assessment of

ongoing care need across health and social care– Simplify the administration of care packages which

will enable a culture change and more joint assessments

– Develop a new assessment process which supports patients in hospital and allows discharge based on health need.

Future models of care

• We want feedback.

• We need to be ambitious

• Does what is proposed do what is required?

Questions