Item Number: 8.3. Governing Body Meeting: 7 April Report Author Jane Baxter Head of Commissioning

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1 Item Number: 8.3 Governing Body Meeting: 7 April 2016 Report Sponsor Anthony Fitzgerald Director of Strategy and Delivery Report Author Jane Baxter Head of Commissioning 1. Title of Paper: Better Care Fund Update 2. This Paper is for: Approval Decision Assurance For Discussion Assurance For Information Only 3. CCG Strategic Objectives supported by this paper CCG Strategic Objective 1 Engage and enable local people to be involved in decisions made about the healthcare we commission 2 Commission services to ensure and improve quality and safety of services and improve outcomes 3 Achieve a sustainable Health Economy 4 Deliver our 2 year Operational and 5 year Strategic plan to transform services 5 Strengthen and develop partnerships to collectively deliver our shared strategic objectives 6 The continuous development of a strong, sustainable, successful and accountable Clinical Commissioning Group 4. CCG Values Underpinned in this paper CCG Values 1 Respect and Dignity 2 Commitment to Quality of Care 3 Compassion 4 Improving Lives 5 Working Together for Patients 6 Everyone Counts 5. Does this paper provide evidence of assurance against the Governing Body Assurance Framework? If yes, please insert strategic reference number YES NO Ref: Strategic No

2 If you answered yes above, please indicate which principle risk and outline Principle Principle Risk Outline Risk No 4 1 The governance over the Better Care Fund is insufficient 6. Does this paper mitigate risk included in the CCGs Risk Registers? If Yes, please outline. YES NO Ref: Risk No Outline 7. Executive Summary The attached report describes the Better Care Fund schemes and deliverables throughout 2015/16 and includes an assessment of the initiatives to date. In 2016/17, a number of significant innovations in planning and delivery of integrated services are in place and are expected to increase in both scope and scale. In Harrogate and Rural District this includes the development of the New Care Model as a Vanguard site encompassing community hubs and integrated care delivery, shared care plans and a virtual information hub. 8. Any statutory / regulatory / legal / NHS Constitution implications The CCG has a statutory requirement to submit and report to NHS England. 9. Equality Impact Assessment An Equality Impact Assessment will be undertaken for each scheme. 10. Implications / actions for Public and Patient Engagement Public and patient engagement has been and will continue to be sought via surveys and questionnaires as the schemes are delivered via the New Care Models work in order to assess the success of the changes and react accordingly. 11. Recommendations / action required The Governing Body is asked to note the information provided. 12. Monitoring On a monthly basis the progress of Better Care Fund schemes is monitored by the System Resilience Group including representatives from the CCG, HDFT, NYCC, TEWV and the Voluntary Sector. For further information please contact: Anthony Fitzgerald Director of Strategy and Delivery

3 Better Care Fund Update Introduction The Better Care Fund (BCF) was introduced in June 2013 to facilitate a transformation in integrated health and social care. It creates a local single pooled budget to incentivise the NHS and Local Government to work more closely together, placing the health and wellbeing of individual people at the centre of this work. Clinical Commissioning Groups in collaboration with their Local Authorities continue to deliver the plans to ensure robust systems are in place and to meet the need for a significant shift of resources from acute care to community and social care. North Yorkshire s Approach to the Better Care Fund North Yorkshire s Better Care Fund Plan demonstrated county-wide and local approaches at delivering the integration of care as well as enhancing public health prevention and community resilience. North Yorkshire s Health and Wellbeing Board (HWB) has responsibility for delivery of the commitments in the approved plans. The collective North Yorkshire vision for health and social care services underpinning the Better Care Fund Plan remains unchanged: Care centred on the needs of the individual and their carers, empowering people to take control of their health and independence. The Better Care Fund supports this through 3 priorities agreed by health and social care organisations across the county, which are being addressed by schemes organised into the following themes: Integrated locality services o Community/Intermediate care/reablement/multi-disciplinary case management teams. Prevention and community resilience o Public health/prevention. o Voluntary Sector. High Impact interventions o Mental Health and Dementia. o Care Home Support. Harrogate and Rural District s Governance and Delivery of the Better Care Fund The Harrogate and Rural District (HaRD) System Resilience Group (SRG) is responsible for the delivery and monitoring of the local Better Care Fund schemes in 2015/16. Throughout the year the following schemes were fully implemented and operational: Care Homes A designated GP practice is linked to each Care Home to enable the practice to provide a level of care over and above the current GP contract. The practices provide routine and review visits. Over the last year there has been an improved professional relationship between Care Homes and GPs, better prescribing and monitoring of residents.

4 Positive feedback from GPs and Care Homes. Last year there were 454 deaths of Care Home residents and only 81 (18%) of these were in hospital - 82% deaths were managed entirely by the Care Home and GP. A reduction in Care Home admissions compared to last year by 4%. Care Homes in the area ensure that an ambulance is called only when appropriate. Mental Health support into Care Homes provides education and professional advice to Care Home staff in the care and management of residents (with dementia, delirium and depression) and supports residents prescribed with anti-psychotics. Reduction in Care Home residents on anti-psychotics. Reduction of admissions to older persons inpatient psychiatric ward. Increased number of Care Home residents supported. Mental Health There is a Psychiatric Liaison Scheme in place in the Emergency Department (ED) at Harrogate District Foundation Trust. The Mental Health team provides education and professional advice/support in discharge planning. The service also supports ward staff in care and management of patients with dementia and delirium. Reduction in delay in Mental Health referral and assessment. Increased knowledge for ward staff. A positive impact on mental health re-admissions and a reduction in length of stay for admitted patients. Voluntary Sector Five Voluntary Sector schemes support patients and carers providing tailored support to enable individuals to remain at home. They provide advice and guidance, information and direction. The five schemes include: Carers Support St Michaels Hospice Age UK Knaresborough Age UK North Yorkshire British Red Cross Evaluation of the schemes has shown: Increased number of referrals from primary care to voluntary sector. Increased number of volunteers trained to support people with long term conditions and their carers. Case studies from patients and carers that show evidence of improved lifestyles regarding isolation, guidance on finances, and other support for carers.

5 Intermediate Care A Community Stroke Team at Harrogate District Foundation Trust facilitates an earlier discharge of a cohort of stroke patients from the stroke unit with specialist stroke rehabilitation provided up to 12 weeks post discharge. The service involves patients and carers and offers lifestyle management advice and support. Stroke Service at the Trust meet the 80% stroke unit standard ensuring patients who are diagnosed with stroke spend 90% or more of inpatient stay on stroke unit. There is no waiting list for accessing the team. Average length of stay for stroke patients is 20.8 days, for those patients receiving community stroke team support this is reduced to an average length of stay to 15.9 days. A recent survey conducted demonstrated a high level of patient satisfaction with the service received. Additional FAST response also at Harrogate District Foundation Trust provides a short term support for patients (up to 6 weeks) preventing admissions and support after a hospital stay. An increase in referrals into the FAST team. An increase in the number of visits made by the team. Estimated impact: o Providing capacity to assess an additional 45 new patients per month. o Support approximately 15 additional patients each month to remain at home. o Average length of stay of 5 days estimated as saving 75 bed days per month. Better Care Fund in 2016/17 The continuation of the Better Care Fund is an enabler to the delivery of the CCG strategic vision, and implementation of the New Care Model. In 2016/17 we will ensure the Better Care Fund schemes will compliment implementation of: Integrated, expanded community-based health, mental health and social care teams, with a focus on person-driven care planning, proactive management and self-care. Expanded and enhanced skills to deliver rapid response in the community, to keep acutely unwell people at home where appropriate. Embedded prevention and early intervention in our community in collaboration with an empowered and active voluntary sector. The impacts will be: Improved quality of care Improved patient/ user experience of care Reduction of health inequalities Services which are clinical and financially sustainable.

6 Harrogate and Rural District CCG will continue to work with partners to deliver our Better Care Fund commitments and that our reporting systems meet the Health and Wellbeing Board s standards. Jane Baxter Head of Commissioning April 2016