Older People Joint Management Group Finance, Performance and - - PowerPoint PPT Presentation

Older People Joint Management Group

Finance, Performance and Activity Report

For Period April to June 2015/16

Pooled Budgets Older People & Equipment

• 1. Vision
• 2. Priorities
• 3. Spending & activity to meet those priorities
• 4. Performance
• 5. Issues

Pooled Budgets Older People - Vision

We celebrate our ageing population in Oxfordshire; however we acknowledge that the natural effect of ageing means that the likelihood of ill health increases with age. We want all people as they age to lead lives that are healthy and personally and socially fulfilling. Our goal for older people in Oxfordshire is to enable people to live independent and successful lives

Pooled Budgets Older People - Priorities

Priority 1: I can take part in a range of activities and services that help me stay well and be part of a supportive community. Priority 2: I get the care and support I need in the most appropriate way and at the right time. Priority 3: When I am in hospital or longer term care it is because I need to be

• there. While I am there, I receive high quality care and am discharged home

when I am ready. Priority 4: As a carer, I am supported in my caring role. Priority 5: Living with dementia, I and my carers, receive good advice and support early on and I get the right help at the right time to live well. Priority 6: I see health and social care services working well together.

Pooled Budgets OP & Equipment Purchasing Summary

Pooled Budgets OP & Equipment – Finance Summary

Emerging Risks The County Council anticipates increased spend within the Older People’s pool in

• rder to build and maintain system resilience through summer into winter. However,

it is anticipated that this can be met by underspends within other areas of the pool. A virement will be processed to reduce budgets where there is an underspend and to increase the budgets where pressures have been identified.

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Pooled Budgets OP & Equipment – Finance Summary

Emerging Risks continued.

A pressure of £0.389m is reported for the non-emergency patient transport service on an annual budget of £3.3m. This is mainly due to the savings anticipated from changing eligibility criteria proving lower than

• riginally planned.

Changes to eligibility criteria for the patient transport service were introduced towards the end of 2014, and it was anticipated that this would result in the annual number of journeys reducing by around 28,000 in 2015/16 (total number of journeys 110,000 in 2013/14), saving £603k annually. Whilst a reduction in the number of journeys has been achieved, the reduction has not been as steep as anticipated, and there have been increases in the number of high cost bariatric journeys and wheelchair journeys. Revised savings of £248k per year are now forecast, creating a pressure of £355k. The remaining pressure of £34k is due to a small increase in expenditure on smaller (mainly out-of-county) providers. Action is underway between OCCG, South Central Ambulance Service (the main provider of PTS) and OUH to review the increases in higher acuity transport (e.g. wheelchair) and in the smaller reduction in seated transport than anticipated, to ensure that hospital staff are not classifying patients as higher need than required in order to arrange transport for them. The CCG is keeping the expenditure under review and if savings cannot be delivered to offset the pressure during the remaining months of the year, this will be a call

• n the contingency reserve.

This pressure will be met in full by the Clinical Commissioning Group and is excluded from the risk share.

Pooled Budgets Older People – care homes activity

£50.500m annual forecast (compared to 14/15 outturn of £55.129m). Outturn underspend of -£0.004m FNC payments are over 100 more than the same time last year but are decreasing in year. Currently average 12.6 care home admissions per week compared to 11.5 last year. Main growth is in admissions from hospital pathway Average spot price (£597) 4.8% higher than 12 months ago 42 care homes inspected by CQC ) 20 (48%) good – 60% nationally ) 20 (48%) require improvement – 34% nationally ) 2 (5%) inadequate compared t- 7% nationally Budget Forecast Outturn Variance Social Care (net of income) £30.466m £30.609m £0.143m Continuing Health Care £8.239m £8.520m £0.281m Funded Nursing Care £11.799m £11.371m

• £0.428m

) £50.504m £50.500m

• 0.004m

Pooled Budgets Older People – care at home activity

£28.483m annual forecast (compared to 14/15 outturn of £25.642m). Outturn overspend of £0.369m Small drop in client numbers compared to this time last year. Continuing problems with sourcing care Average cost of a package has stabilised in the last 3 months, but is 6% higher than 12 months ago

Budget Forecast Outturn Variance Social Care £24.773m £24.871m £0.098m Continuing Health Care £3.341m £3.612m £0.271m Total £28.114m £28.483m £0.369m

Pooled Budgets Older People – early help

618 receiving Reablement to June 4,100 receiving Alert service 154 receiving Crisis Response (to June) 590 attending health & wellbeing centres 5,542 Items of equipment April to June 641 Nutrition & Dietetics contacts in April 191 receiving hospital at home in April 477 attending EMU in April 83 people attending Diabetics Course in April 1784 Contracts with the care home Support service in April 2881 Attending minor injury units (April) 1727 people funded for day

• pportunities

) A wide range of services are in place to provide early help ) Significantly more people receive these services than receive long term services ) We are currently not able to identify who uses more than one service

Budget February Outturn Variance Expenditure £27.240m £26.940m

• £0.300m

25,561 seen by community information Network

Pooled Budgets Older People – support activities

3,822 social care client assessments 2,189 social care client reviews 731 safeguarding alerts April - June 20,331 district nurse visits in April

Priority 1: I can take part in a range of activities and services that help me stay well and be part of a supportive community

3 key indicators in the better care fund 1. Reduce emergency admissions to hospital - currently 3% more admissions than target 2. Increasing the proportion of people with long term support who are supported at home - currently better than target 1. Reduce the number of permanent admissions to care homes – more admissions than planned, but better than last year 2. Increase the number of people supported by social care through home care in Extra Care Housing Admissions – 107 people currently supported 3. Increase access to reablement from the community – currently half the rate of that expected

Priority 2: I get the care and support I need in the most appropriate way and at the right time.

1. Quality of care New CQC ratings are showing issues about the quality of care 2. Growing number of people waiting for home care due to market pressures

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Priority 3: When I am in hospital or long term care it is because I need to be there. While I am there, I receive high quality care and am discharged home when I am ready

Delayed transfers of care are above target. JMG is responsible for: 1. Care Home delays. Consistently lower than last year 2. Delays into community hospitals higher than last year 3. Home Care delays higher than last year and growing 4. Reablement pathway higher than last year and growing

Priority 4: As a carer I am supported in my caring role

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• Increase the number of carers known

17,000 16,265 16,546 Increase the number of carers receiving an assessment 7,000 6,042 1,162 ytd 4648 Increase the number of carers receiving a service (direct payments) 2,450 2,226 343 ytd 1372

The number of carers known remains high. The apparent fall in carers assessments reflects current under-reporting of joint carer/ cared-for assessments. There are also 166 carers waiting for a separate carers assessment. Carers Services are direct payments. These are no longer given out by GPs, so carers must have an assessment to receive a payment. The threshold for direct payments has been reduced in the last quarter, so more carers will receive a direct payment from 15/6/15 onwards.

Priority 5: Living with dementia, I and my carers, receive good advice and support early on and I get the right help at the right time to live well

) JMG currently only monitors one measure specifically about dementia ) Target is to increase the expected population with dementia with a recorded diagnosis of dementia ) Figures of last year show it to be close to target & showing consistent improvement ) First figures for 2015/16 are expected at the end of July 2015

Priority 6: I see health and social care working well together

Currently we have no specific performance measures but there are a number of key projects including ) the development of the pooled budget ) The delivery of integrated locality teams Proposed measures for next year include the delivery of the Better Care fund national requirements 1. Are the plans still jointly agreed? 2. Are Social Care Services (not spending) being protected? 3. Are the 7 day services to support patients being discharged and prevent unnecessary admission at weekends in place and delivering? 4. In respect of data sharing - confirm that: 1. Is the NHS Number being used as the primary identifier for health and care services? 2. Are you pursuing open APIs (i.e. systems that speak to each other)? 3. Are the appropriate Information Governance controls in place for information sharing in line with Caldicott 2? 5. Is a joint approach to assessments and care planning taking place and where funding is being used for integrated packages of care, is there an accountable professional? 6. Is an agreement on the consequential impact of changes in the acute sector in place?

Issues

Some thoughts on performance

• 1. Relatively small amounts of money support significant amounts of early help
• 2. Despite this early help - there remains increasing demand on the system e.g.

increased emergency admissions to hospital

• 3. Most people placed in care homes are placed from hospital. At present care home

services are meeting demand

• 4. There are issues over the capacity of both long term and short term (e.g.

reablement) care at home services. Fewer people are accessing reablement and the number of people waiting for long term care is growing

• 5. The quality of services as seen in the CQC rating system needs to be continually

monitored

• 6. We are working to set out a framework to share data at a client level across health

and social care, in line with the better care fund, that will enable us to better monitor the money

Decisions

) The Joint Management Group is requested to note the virement to tidy up budgets within the Older People’s pool to reduce budgets where there is an underspend and increase the budgets where pressures have been identified

Pooled Budgets OP & Equipment – Finance Summary

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Pooled Budgets OP & Equipment – Finance Summary

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Pooled Budgets OP & Equipment – Finance Summary

Oxfordshire Clinical Commissioning Group

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