The Better Care Fund Anne-Maria Olphert
Anne-Maria Olphert
Chief Nurse and Director of Quality, Erewash Clinical Commissioning Group (CCG), Derbyshire
national indicators are: ■■ Delayed transfer of care from hospital ■■ Emergency admissions to acute hospital ■■ Effectiveness of re-ablement ■■ Admissions to residential and nursing care ■■ Patient and service-user experience.
Dementia The proposed local indicator at this stage is the estimated diagnosis rate for people with dementia. In October this year we heard the new debate over GPs receiving £55 for every patient they diagnose with dementia. NHS England’s aim is to diagnose two thirds of people with dementia by 2015. It is estimated up to 90 000 patients are living with undiagnosed dementia (BBC News, 2014).
General practice funding According to the BBC News website, GP practices are funded in the following ways: ■■ Just over 50% is a lump sum to cover the cost of essential services, based on patient numbers, size of elderly population, amount of deprivation etc ■■ Practices earn additional funding, about 20%, through a points-based system according to how well they manage common chronic diseases, like asthma and diabetes, as well as patient experience and general organisation of the practice ■■ Payments are also given for optional ‘enhanced services’, such as flu jabs, childhood immunisations and minor surgery. The new £55 payment, which will pay GP surgeries for the extra patients diagnosed with dementia between now and March, falls into this category ■■ In addition, some GP surgeries get extra money for services targeting specific local problems (BBC News, 2014)
Seven days a week Everyone Counts: Planning for Patients 2013/14 (NHS England, 2014a) signalled that the NHS will move towards routine services being available 7 days a week—a development which is essential to delivering a much more patient-focused service and one that offers the opportunity to improve clinical outcomes. There is evidence of significant variation in outcomes for patients admitted to our hospitals at the weekend across the NHS in
1086
England. This variation is seen in mortality rates, patient experience, length of hospital stay and re-admission rates. It is also clear that the lack of many 7-day services has an adverse effect on measurable outcomes in each of the five domains of the NHS Outcomes Framework (Department of Health, 2013): mortality amenable to health care, treatment of long-term conditions, outcomes from acute episodes of care, patient experience, and patient safety. The idea behind the BCF is to address these variations and tackle the inequalities suffered by many patients admitted during the weekend and out of hours.
Reducing emergency admissions A key performance metric for the BCF is the reduction of emergency admissions to hospitals currently set at 3.5% (NHS England, 2014c). Unplanned admissions are the biggest driver of cost in the health service that the BCF can affect. A reduction in total emergency admissions is a clear indicator of the effectiveness of local health and care services in working better together to support people’s health and independence in the community. The ambition of the BCF is that people need to go to hospital as little as possible; and that when they do, they are admitted quickly, treated well, and discharged as quickly and safely as possible to enable them to get on with their lives. There are around 5.3 million emergency admissions each year (NHS England, 2014b). More than half of these are likely to be amenable to avoidance through the type of interventions the BCF is intended to introduce, such as community, primary and social-care services working more effectively together. The financial reality behind the BCF is that government must reduce demand for acute health services or many NHS trusts and foundation trusts will go under (Jordan, 2014). This effective cut in the acute care budget is bound to affect providers as CCGs must pass it on in this year’s and next year’s commissioning rounds. During the next 2 years, the cumulative effect of the BCF on top of the usual 4% efficiency target for providers means that as much as 6% will come out of the provider’s budget to cover the BCF plans (Jordan, 2014). Historically, providers have only been capable of delivering 1–2% efficiency gains each year (Foundation Trust Network, 2014a). A loss
British Journal of Nursing, 2014, Vol 23, No 20
British Journal of Nursing 2014.23:1086-1087.
© 2014 MA Healthcare Ltd
I
n the Spending Review in June 2013 (HM Treasury, 2013) the Government announced what is now the Better Care Fund (BCF) as a means to improve integrated support for people with health and social care needs. One in three children born today are expected to live to 100 (Office for National Statistics, 2013) so demand is only going to increase. We need to make major changes now to create seamless services fit for future generations and to focus more effectively on preventing ill health. The BCF will, in 2015/16, be made up of a £3.8 billion national budget that will come from existing NHS budgets—it is not new money. In 2014/15 there will be an additional £200 million added to the existing NHS budget for transfer to councils for social-care funding. This is the biggest financial incentive for councils and local NHS organisations to jointly plan and deliver services so that integrated care becomes the norm by 2018. It is a joint fund, not a transfer to social care, so it will be a big ask for clinical commissioning groups (CCGs) and local authorities to use the money together to achieve better outcomes for patients and also satisfy local needs and the national conditions attached to the grant. In October, NHS England Chief Executive, Simon Stevens, launched the Five Year Forward View (NHS England et al, 2014); this recommends a proper evaluation of the results of the 2015/16 Better Care Fund is needed before any national decision is made to extend the fund further. Locally commissioners are required to prepare a joint BCF Plan that outlines how integration will be improved to deliver on four key priorities: ■■ Protecting social-care services ■■ Seven-day services to support hospital discharge ■■ Data sharing and use of the NHS number across health and social care ■■ Joint assessment and an accountable lead professional for people at the highest risk. Also, commissioners have to achieve improved performance on five national indicators and one locally determined indicator to secure the performance-related elements of the BCF. The
CLINICAL COMMISSIONING GROUPS
of £2bn in the NHS budget would be the equivalent of the cost of running around seven general hospitals (Foundation Trust Network, 2014b)
Working in partnership The BCF plans must also indicate how the local voluntary and community sector (VCS) are involved in the planning process, prompting greater engagement between the VCS and health and wellbeing boards. This means that local carers’ organisations can contribute to the planning process by providing specialist expertise and an understanding of carers’ needs so that help and support can be provided in the most suitable way. There are two sections in the BCF Plan that relate directly to carers and to local voluntary sector providers: Section 7: National Conditions A (v) states: ‘Please specify the level of resource that will be dedicated to carer-specific support’. Section 8: Engagement B (iii) states: ‘Please state how the following groups of providers have been engaged in the development of the
plan and the extent to which it is aligned with their operational plans: Social care and providers from the voluntary and community sector’. Section 7 is in recognition of the fact that the BCF includes £130m funding for carers’ breaks, as well as funding to implement the new duties in the Care Act, which includes new rights to assessment and support for carers. The VCS, especially local carers’ services, will be able to provide invaluable expertise on how carers’ needs for support can be met most effectively (Carers Trust, 2014). Five BCF plans have been approved (Vize, 2014) ahead of the deadline on the 19 September 2014, covering Nottinghamshire, Sunderland, Greenwich, Reading and Wiltshire. Nottinghamshire aims to cut emergency admissions by 3.7% and save £7.8 million, while Wiltshire anticipates a cut of 3.7% and a saving of £2.1 million. Sunderland’s target for cutting emergency admissions is just 0.8%, but pitches this as part of a longer-term goal of a 15% reduction from 2016 onwards. Reading, whose emergency admissions are already among the lowest in the country, is aiming for 2.8%. BJN
BBC News (2014) GPs to be paid £55 for each dementia diagnosis. http://tinyurl.com/k8tjrqp (accessed 29 October 2014) Carers Trust (2014) New briefing for the Better Care Fund. http://tinyurl.com/mlwtjbk. (accessed 28 October 2014) Department of Health (2013) Guidance. NHS Outcomes Framework 2013 to 2014. http://tinyurl.com/o3mhjof (accessed 28 October 2014) Foundation Trust Network (2014a) The NHS provider view of the Better Care Fund. http://tinyurl.com/ kx3ajfn (accessed 18 October 2014) Foundation Trust Network (2014b) Better Care Fund - member briefing. http://tinyurl.com/lwupbu5 (accessed 28 October 2014) HM Treasury (2013) Spending Round 2013. http:// tinyurl.com/nvyo6ud (accessed 29 October 2013) Jordan J (2014) The impact of the better care fund on CCGs explained. Health Service Journal. 20 February. http://tinyurl.com/q6phu99 (accessed 28 October 2014) NHS England (2014a) Everyone counts: Planning for Patients 2013/14. http://www.england.nhs.uk/ everyonecounts/ (accessed 28 October 2014) NHS England (2014b) The Better Care Fund Supplementary Guidance on the Expectation of a 3.5% Reduction in Emergency Admissions. http://tinyurl. com/on5awyr (accessed 28 October 2014) NHS England, Public Health England, Monitor, Health Education England, Care Quality Commission, NHS Trust Development Authority (2014) Five Year Forward View. http://tinyurl.com/kcjenmc (accessed 28 October 2014)
Office for National Statistics (2013) One third of babies born in 2013 are expected to live to 100. http:// tinyurl.com/pr93vr8 (accessed 29 October 2014) Vize R (2014) Better Care Fund fast-track projects: cautious, innovative and heroically optimistic. the guardian 18 September. http://tinyurl.com/olulpje (accessed 28 October 2014)
© 2014 MA Healthcare Ltd
Quarterly supplement covering all aspects of tissue viability in nursing from prevention with compression techniques to wound care and management
The British Journal of Nursing (BJN) Tissue Viability Supplement aims to promote evidencebased practice and the provision of high quality patient care. We welcome unsolicited articles including literature reviews, care studies and original research in all areas of tissue viability nursing. To contribute to the supplement or to enquire about how to become a peer reviewer in this area, contact us at [email protected] or 0207 501 6702.
1087
British Journal of Nursing, 2014, Vol 23, No 20
British Journal of Nursing 2014.23:1086-1087.
Anne-Maria Olphert
Chief Nurse and Director of Quality, Erewash Clinical Commissioning Group (CCG), Derbyshire
national indicators are: ■■ Delayed transfer of care from hospital ■■ Emergency admissions to acute hospital ■■ Effectiveness of re-ablement ■■ Admissions to residential and nursing care ■■ Patient and service-user experience.
Dementia The proposed local indicator at this stage is the estimated diagnosis rate for people with dementia. In October this year we heard the new debate over GPs receiving £55 for every patient they diagnose with dementia. NHS England’s aim is to diagnose two thirds of people with dementia by 2015. It is estimated up to 90 000 patients are living with undiagnosed dementia (BBC News, 2014).
General practice funding According to the BBC News website, GP practices are funded in the following ways: ■■ Just over 50% is a lump sum to cover the cost of essential services, based on patient numbers, size of elderly population, amount of deprivation etc ■■ Practices earn additional funding, about 20%, through a points-based system according to how well they manage common chronic diseases, like asthma and diabetes, as well as patient experience and general organisation of the practice ■■ Payments are also given for optional ‘enhanced services’, such as flu jabs, childhood immunisations and minor surgery. The new £55 payment, which will pay GP surgeries for the extra patients diagnosed with dementia between now and March, falls into this category ■■ In addition, some GP surgeries get extra money for services targeting specific local problems (BBC News, 2014)
Seven days a week Everyone Counts: Planning for Patients 2013/14 (NHS England, 2014a) signalled that the NHS will move towards routine services being available 7 days a week—a development which is essential to delivering a much more patient-focused service and one that offers the opportunity to improve clinical outcomes. There is evidence of significant variation in outcomes for patients admitted to our hospitals at the weekend across the NHS in
1086
England. This variation is seen in mortality rates, patient experience, length of hospital stay and re-admission rates. It is also clear that the lack of many 7-day services has an adverse effect on measurable outcomes in each of the five domains of the NHS Outcomes Framework (Department of Health, 2013): mortality amenable to health care, treatment of long-term conditions, outcomes from acute episodes of care, patient experience, and patient safety. The idea behind the BCF is to address these variations and tackle the inequalities suffered by many patients admitted during the weekend and out of hours.
Reducing emergency admissions A key performance metric for the BCF is the reduction of emergency admissions to hospitals currently set at 3.5% (NHS England, 2014c). Unplanned admissions are the biggest driver of cost in the health service that the BCF can affect. A reduction in total emergency admissions is a clear indicator of the effectiveness of local health and care services in working better together to support people’s health and independence in the community. The ambition of the BCF is that people need to go to hospital as little as possible; and that when they do, they are admitted quickly, treated well, and discharged as quickly and safely as possible to enable them to get on with their lives. There are around 5.3 million emergency admissions each year (NHS England, 2014b). More than half of these are likely to be amenable to avoidance through the type of interventions the BCF is intended to introduce, such as community, primary and social-care services working more effectively together. The financial reality behind the BCF is that government must reduce demand for acute health services or many NHS trusts and foundation trusts will go under (Jordan, 2014). This effective cut in the acute care budget is bound to affect providers as CCGs must pass it on in this year’s and next year’s commissioning rounds. During the next 2 years, the cumulative effect of the BCF on top of the usual 4% efficiency target for providers means that as much as 6% will come out of the provider’s budget to cover the BCF plans (Jordan, 2014). Historically, providers have only been capable of delivering 1–2% efficiency gains each year (Foundation Trust Network, 2014a). A loss
British Journal of Nursing, 2014, Vol 23, No 20
British Journal of Nursing 2014.23:1086-1087.
© 2014 MA Healthcare Ltd
I
n the Spending Review in June 2013 (HM Treasury, 2013) the Government announced what is now the Better Care Fund (BCF) as a means to improve integrated support for people with health and social care needs. One in three children born today are expected to live to 100 (Office for National Statistics, 2013) so demand is only going to increase. We need to make major changes now to create seamless services fit for future generations and to focus more effectively on preventing ill health. The BCF will, in 2015/16, be made up of a £3.8 billion national budget that will come from existing NHS budgets—it is not new money. In 2014/15 there will be an additional £200 million added to the existing NHS budget for transfer to councils for social-care funding. This is the biggest financial incentive for councils and local NHS organisations to jointly plan and deliver services so that integrated care becomes the norm by 2018. It is a joint fund, not a transfer to social care, so it will be a big ask for clinical commissioning groups (CCGs) and local authorities to use the money together to achieve better outcomes for patients and also satisfy local needs and the national conditions attached to the grant. In October, NHS England Chief Executive, Simon Stevens, launched the Five Year Forward View (NHS England et al, 2014); this recommends a proper evaluation of the results of the 2015/16 Better Care Fund is needed before any national decision is made to extend the fund further. Locally commissioners are required to prepare a joint BCF Plan that outlines how integration will be improved to deliver on four key priorities: ■■ Protecting social-care services ■■ Seven-day services to support hospital discharge ■■ Data sharing and use of the NHS number across health and social care ■■ Joint assessment and an accountable lead professional for people at the highest risk. Also, commissioners have to achieve improved performance on five national indicators and one locally determined indicator to secure the performance-related elements of the BCF. The
CLINICAL COMMISSIONING GROUPS
of £2bn in the NHS budget would be the equivalent of the cost of running around seven general hospitals (Foundation Trust Network, 2014b)
Working in partnership The BCF plans must also indicate how the local voluntary and community sector (VCS) are involved in the planning process, prompting greater engagement between the VCS and health and wellbeing boards. This means that local carers’ organisations can contribute to the planning process by providing specialist expertise and an understanding of carers’ needs so that help and support can be provided in the most suitable way. There are two sections in the BCF Plan that relate directly to carers and to local voluntary sector providers: Section 7: National Conditions A (v) states: ‘Please specify the level of resource that will be dedicated to carer-specific support’. Section 8: Engagement B (iii) states: ‘Please state how the following groups of providers have been engaged in the development of the
plan and the extent to which it is aligned with their operational plans: Social care and providers from the voluntary and community sector’. Section 7 is in recognition of the fact that the BCF includes £130m funding for carers’ breaks, as well as funding to implement the new duties in the Care Act, which includes new rights to assessment and support for carers. The VCS, especially local carers’ services, will be able to provide invaluable expertise on how carers’ needs for support can be met most effectively (Carers Trust, 2014). Five BCF plans have been approved (Vize, 2014) ahead of the deadline on the 19 September 2014, covering Nottinghamshire, Sunderland, Greenwich, Reading and Wiltshire. Nottinghamshire aims to cut emergency admissions by 3.7% and save £7.8 million, while Wiltshire anticipates a cut of 3.7% and a saving of £2.1 million. Sunderland’s target for cutting emergency admissions is just 0.8%, but pitches this as part of a longer-term goal of a 15% reduction from 2016 onwards. Reading, whose emergency admissions are already among the lowest in the country, is aiming for 2.8%. BJN
BBC News (2014) GPs to be paid £55 for each dementia diagnosis. http://tinyurl.com/k8tjrqp (accessed 29 October 2014) Carers Trust (2014) New briefing for the Better Care Fund. http://tinyurl.com/mlwtjbk. (accessed 28 October 2014) Department of Health (2013) Guidance. NHS Outcomes Framework 2013 to 2014. http://tinyurl.com/o3mhjof (accessed 28 October 2014) Foundation Trust Network (2014a) The NHS provider view of the Better Care Fund. http://tinyurl.com/ kx3ajfn (accessed 18 October 2014) Foundation Trust Network (2014b) Better Care Fund - member briefing. http://tinyurl.com/lwupbu5 (accessed 28 October 2014) HM Treasury (2013) Spending Round 2013. http:// tinyurl.com/nvyo6ud (accessed 29 October 2013) Jordan J (2014) The impact of the better care fund on CCGs explained. Health Service Journal. 20 February. http://tinyurl.com/q6phu99 (accessed 28 October 2014) NHS England (2014a) Everyone counts: Planning for Patients 2013/14. http://www.england.nhs.uk/ everyonecounts/ (accessed 28 October 2014) NHS England (2014b) The Better Care Fund Supplementary Guidance on the Expectation of a 3.5% Reduction in Emergency Admissions. http://tinyurl. com/on5awyr (accessed 28 October 2014) NHS England, Public Health England, Monitor, Health Education England, Care Quality Commission, NHS Trust Development Authority (2014) Five Year Forward View. http://tinyurl.com/kcjenmc (accessed 28 October 2014)
Office for National Statistics (2013) One third of babies born in 2013 are expected to live to 100. http:// tinyurl.com/pr93vr8 (accessed 29 October 2014) Vize R (2014) Better Care Fund fast-track projects: cautious, innovative and heroically optimistic. the guardian 18 September. http://tinyurl.com/olulpje (accessed 28 October 2014)
© 2014 MA Healthcare Ltd
Quarterly supplement covering all aspects of tissue viability in nursing from prevention with compression techniques to wound care and management
The British Journal of Nursing (BJN) Tissue Viability Supplement aims to promote evidencebased practice and the provision of high quality patient care. We welcome unsolicited articles including literature reviews, care studies and original research in all areas of tissue viability nursing. To contribute to the supplement or to enquire about how to become a peer reviewer in this area, contact us at [email protected] or 0207 501 6702.
1087
British Journal of Nursing, 2014, Vol 23, No 20
British Journal of Nursing 2014.23:1086-1087.
