The Better Care Fund in Kingston 1/3 1. What is the Better Care - - PowerPoint PPT Presentation

1. What is the Better Care Fund (BCF)

• Formerly termed the Integration Transformation Fund (ITF)
• Substantial local pooled budget to be established in 2015/16

to take the integration agenda forward at scale and pace, acting as a significant catalyst for change

• The Fund will be used to drive closer integration and improve
• utcomes for patients, service users and carers.
• The aim is to provide people with right care, in the right place,

at the right time, including through significant expansion of care in community settings. 2. About the Better Care Fund Plan

• A 2 year BCF Plan (incorporating completed national templates)

is required.

• 1st draft by 14th February 2014, final version by 4th April 2014.
• The BCF Plan needs to be signed off by the Health and

Wellbeing Board, including agreement to the level of ambition expressed in the performance measures.

• The HWB will consider whether the Plan is sufficiently

challenging and whether it will deliver tangible benefits for the local population.

3. About the Better Care Fund

• Legally the Fund commences in 2015/16 as a pooled budget under

Section 75 joint governance arrangements between the CCG and Local Authority.

• 2014/15 is regarded as a preparatory year when the planned

transfer of funds from health to adult social care will be increased from £900m to £1.1bn nationally.

• The additional £200m will only be paid to Local Authorities which

have jointly agreed and signed off a 2 year BCF Plan (estimated as £478k of the £2627k in Kingston).

• These funds must be used ‘to support adult social care services …

which also have a health benefit’. Councils should use the additional £200m to prepare for the implementation of pooled budgets in 2015/16 and make early progress against the relevant BCF national conditions and performance measures.

Expected BCF allocations National Kingston £m 14/15 £m 15/16 £000 14/15 £000 15/16 Existing transfer from health to adult social care 1100 1100 2627 2627 Carers’ breaks funding 130 140 CCG reablement funding 300 932 Capital funding (including Disabled Facilities Grant)+ 354 859 Additional transfer from health to adult social care 1900 6183 Totals 1100 3800* 2627 10741

+ = contribution from adult social care budgets. Remainder from CCG allocations in 2015/16

* = aggregate allowing for rounding etc

The Better Care Fund in Kingston 1/3

PC, 3/1/14

4. National Conditions

• All the funds included in the BCF in 2015/16 will be

contingent on meeting the national conditions set out in the spending review settlement in July 2013: a) A plan that is signed off by the Council, its Health and Wellbeing Board and the constituent Clinical Commissioning Groups with demonstrable engagement of providers; b) Protection of social care services evidenced by sustaining eligibility; c) Data sharing between health and social care using the NHS number as a unique identifier; d) 7 day working in social care to enable hospital discharge and reablement; e) Joint assessment arrangements between health and social care to enable a single assessment and a single accountable professional; f) A clear statement of the implications of the proposed use of the BCF for hospital providers that are affected that is signed off by the health and well- being board; and g) A risk assessment of the consequences of failing to achieve proposed changes in activity levels and a plan to mitigate these. 5. Performance Measures

• Initially a limited number of national measures for the BCF have been

identified because of the need to use existing measures to establish baseline performance in 2014/15: a) admissions to residential and nursing homes; b) effectiveness of reablement; c) delayed transfers of care; d) avoidable emergency admissions; and e) patient / service user experience. f) In addition local areas will choose 1 further local indicator for which it must be possible to establish a baseline in 2014/15.

The Better Care Fund in Kingston 2/3

6. Payment-for-performance element

• Nationally £1bn of the £3.8bn in 2015/16 will be linked to achieving
• utcomes, half to be released in April 2015, the balance on October

2015 based on the following:

• Note in 2015/16 failure to deliver BCF performance targets will NOT

result in withholding of the payment for performance. Other requirements / sanctions may be applied e.g. production and agreement of a local recovery plan.

When Payment for performance amount (nationally) Paid for: April 2015 £250m Progress against 4 of the national conditions, section 4 b, d, e, f above £250m Progress against the local metric and 2

• f the national metrics, section 5 c, d, f

above Oct 2015 £500m Further progress against all of the national and local measures

PC, 3/1/14

The Better Care Fund in Kingston 3/3 – Summary of Progress in Kingston

• Initial guidance around Integration Transformation Fund August 2013 (now renamed

Better Care Fund) shared widely and discussed with stakeholders

• Initial Integration workshop held October 2013 – wide participation: statutory,

voluntary, commissioner, provider, patient representatives

• Health and Wellbeing Board leadership role for local integration agenda established
• PPL Consultants retained to assist with development of BCF (experience elsewhere

across London and at National level)

• BCF initial co-design workshop held December 2013, building on October workshop
• BCF guidance and CCG financial allocations 14/15 -15/16 received 20th December

2013 including specification of minimum level of Fund in 2015/16

• Dec workshop informing development of 1st draft BCF Plan, for discussion early

January 2014 and focus for 2nd co-design workshop late January 2014

• Revised draft BCF to Health and Wellbeing Board 4th Feb 2014
• Agreed draft BCF incorporated into CCG draft Operational Plan for submission by 14th

February 2014

NHS Outcomes Framework - 5 Domains

• 1. Prevent people from dying prematurely
• 2. enhancing quality of life
• 3. recover quickly and successfully
• 4. positive experience of care
• 5. safe, protected from avoidable harm

NHS 7 Outcome Ambitions – 5 Years

• 1. Securing additional years of life for the

people of England with treatable mental and physical health conditions.

• 2. Improving the health related quality of life of

the 15 million+ people with one or more long- term condition, including mental health conditions.

• 3. Reducing the amount of time people spend

avoidably in hospital through better and more integrated care in the community, outside of hospital.

• 4. Increasing the proportion of older people

living independently at home following discharge from hospital.

• 5. Increasing the number of people with mental

and physical health conditions having a positive experience of hospital care.

• 6. Increasing the number of people with mental

and physical health conditions having a positive experience of care outside hospital, in general practice and in the community.

• 7. Making significant progress towards

eliminating avoidable deaths in our hospitals caused by problems in care.

CCG Planning: National Requirements - 6 broad ‘Themes’, 24 ‘Fundamental Areas’:

• 1. Outcomes
• 5 NHS Outcomes Framework Domains, 7 NHS Outcome

Ambitions

• Improving health
• Reducing health inequalities
• Parity of esteem
• 2. Patient Services / delivering transformational service

models

• Citizen involvement, patient empowerment
• Wider primary care provided at scale
• A modern model of integrated care
• Access to highest quality urgent and emergency care
• Step-change in productivity of elective care
• Specialised services concentrated in centres of

excellence

• 3. Access
• Convenient for everyone
• NHS Constitution pledges
• 4. Quality
• Francis, Berwick,

Winterbourne View

• Patient safety
• Patient experience
• Compassion in practice
• Staff satisfaction
• 7 day services
• Safeguarding
• 5. Innovation
• Research and innovation
• 6. Delivering Value
• Value for money
• Effectiveness
• Efficiency
• Procurement

47 ‘Key Features’ and a range of Performance Measures associated with above

Vision: High quality care for all, now and for future generations

Strategic Plan 5 Years, SW London level, 1st draft 4/4/14, Final 20/6/14 Operational Plan 2 Years, CCG level, 1st draft 14/2/14, Final 4/4/14 Kingston working towards Joint Operational Plan across CCG, Adult Social Care, Public Health Better Care Fund Plan 2 Years, HWB level, within CCG Operational Plan and timetable Financial Plan 2 Years, CCG level, detailed financial breakdown of each Plan (Strategic, Operational Better Care Fund)

NHS Planning 2014/15 and beyond – summary of national requirements

• The CCG’s Draft Commissioning Intentions for 2014/15 outlined intended and anticipated changes and

developments in a large number of areas – the headings are listed below.

• These are being reviewed and refined in the light of NHS planning guidance and other more recent

publications such as The Annual Public Health Report 2013 which focussed on Older People.

• Where relevant they will be included in Integrated Operational Plans between the CCG, Adult Social

Care and Public Health:

• Children and young people
• Older people and people with long term conditions - includes the Kingston at Home programme
• Mental health
• Unscheduled care - includes emergency and urgent care
• Integrated care – includes the Better Care Fund
• Socially excluded and disadvantaged groups
• Maternity and new-born
• Cancer commissioning
• NHS continuing health care
• End of life care
• Primary care
• People with learning disabilities
• Medicines optimisation
• Quality – includes actions in relation to the Francis Report
• Health promotion and illness prevention
• Other developments in services outside hospital
• Other developments in hospital services
• Specialised services
• London Ambulance Service
• Quality, Innovation, Productivity and Prevention (QIPP) programme

Service areas likely to be addressed in CCG Operational Plans

CCG Outcomes Indicator Set 2014/15