Agenda item

This report provides an update on progress with the implementation of the Better Care Fund in Haringey.

The panel considered the report of Marco Inzani, Commissioning Lead for the Better Care Fund (BCF).

Mr Inzani informed the panel that the BCF was a transformational programme for complex system integration. It was explained that the vision for Haringey’s BCF was for people to have more control over the health and social care they received, for it to be centred on their needs, supporting independence and locally provided wherever possible. 

The panel noted that the pooled budget for the Haringey BCF in 2015/16 was £22 million, with £16.4 million from Haringey CCG and £5.6 million from Haringey Council.

Mr Inzani informed the panel that Haringey CCG and Haringey Council had approved plans for the use of the BCF pooled budget. It was noted this would be used to review and deliver up to 20 different services organised into four schemes.

A number of issues were discussed in relation to Scheme 1: Admission Avoidance, including:

-       The Locality Team.  The panel was informed that this service had been implemented as a Test and Learn Pilot with two GP practices (Lawrence House and Morris House). It was noted that patients at risk of an emergency hospital admission would be supported by a multi-disciplinary team to identify health and social care goals that would promote self-care and self-management to improve health and well-being.

-       Falls Prevention. The panel was informed that this service provided a strength and balance exercise programme to help prevent falls in older people.

The panel was informed that Scheme 2: Effective Hospital Discharge included the following services:  Reablement; Step Down; and Home From Hospital. It was noted that these services facilitated discharge from hospital as quickly, safely and effectively as possible.

In terms of Scheme 3: Promoting Independence, the panel was informed that the BCF would help to deliver services that would build community capacity to reduce isolation and improve health and wellbeing. The following services were discussed: Neighbourhood Connects; Palliative Care; Supported Self-Management (Generic); and Supported Self-Management (Diabetes).

Mr Inzani explained that Scheme 4: Integration Enablers would help to deliver services to support the implementation of the first three schemes. The panel considered information relating to Interoperable IT; Workforce Development; Disabled Facilities; and Care Act Responsibilities.

In terms of BCF Governance, it was noted that each BCF Scheme linked to a working group and that the working groups reported to the Operational Group – Adults. The panel was informed that this included membership from: Haringey CCG; Haringey Council; HAVCO; Healthwatch; North Middlesex Hospital Trust; and Whittington Hospital Trust.  Mr Inzani explained that any issues from this group were  escalated to the Health and Care Integration (HACI) Board that reported to the Health and Well-being Board.  The panel was informed that once a quarter all finance and performance was overseen by the Finance and Performance Partnership Board.  It was noted that the HACI Board and the Finance and Performance Partnership Board were the only meetings that were exclusively for senior managers from Haringey Council and Haringey CCG.

During the discussion, reference was made to: how the BCF budget had been assigned; how the main target of a reduction in emergency hospital admissions had been progressing; how outcomes were progressing; how the public had been engaged;  how national conditions were being met; how key milestones were being delivered; how risks had been identified and managed; and how the programme was being governed.

The panel was informed that the BCF was expected to deliver fewer emergency hospital admissions (Non-Elective admissions or NELs) over 2015/16.

Mr Inzani explained that Haringey CCG measured hospital activity on Non-Elective Admissions (NELs) using Secondary Uses Service (SUS) data. It was noted that this was the single, comprehensive repository for healthcare data in England.  The panel was informed that SUS data for Total NELs had  approximately 1000 specialties (e.g. trauma and orthopaedics; neurosurgery; palliative medicine).  It was noted that NHS England recommended using a subset of NELs for the BCF.  This recommended subset excluded a number of specialties including well-babies and oral surgery. It was noted that Haringey CCG and Haringey Council had decided to adopt this definition so it more closely aligned to the BCF programme of work for 2015/16. The panel considered the information on NELs and NEL performance as outlined in sections 5.8 – 5.13 of the report. 

In addition to NELs, it was noted that the Haringey BCF was measured according to the following five outcomes:

-       Permanent admissions of older people to residential and nursing car homes, per 100,000 population.

-       Proportion of older people who were still at home 91 days after discharge from hospital into Reablement/rehabilitation services.

-       Delayed transfers of care (delayed days) from hospital per 100,000 population.

-       Injuries due to falls in older people per 100,000 population.

-       GP Patient Survey: In the last 6 months, has the Service User received enough support from local services (not just health) to manage their long term condition(s)? 

The panel raised concerns in relation to both Care Home Outcomes (30% over target) and Falls Outcome (23 over target). In response to questions, Mr Inzani explained that the factors that contributed to these outcomes were varied and complex. As a result, the panel was informed that a thorough analysis (deep dive) had been undertaken to examine a range of supporting data to determine whether an appropriate response could be explored. 

During the discussion it was noted that several risks had been identified for the delivery of the BCF Plan. The highest risk related to emergency hospital admissions not being reduced. It was explained that this was the main target for the BCF and that the release of the contingency fund was dependent on this performance. Other risks and issues included: Joint working structures; the fact that future budgets and targets for the BCF had not been confirmed by NHS England beyond April 2016; Data quality and sharing; and the fact that the existing culture of the workforce in heath and social care could be a barrier to integration and access of services. 

AGREED:

(a)  That the updates on the Haringey Better Care Fund be noted:

(b)  That  an update on the Haringey Better Care Fund, focusing on Non-Elective admissions and the thorough analysis (deep dive) in relation to Care Home and Falls Outcomes, be prioritised in the panel’s future work programme (for January 2016) and discussed further under item 10 on the agenda – Work Programme Update.