Winter Evaluation 2015/16 Sarah Mitchell, Director Social Care Improvement, Local Government Association June 2016 www.local.gov.uk

Winter 2015/16 9 regional DToC roadshows 3 DToC masterclasses ECIP social care leads working with LGA 8 high impact change model

Change 1 : Early Discharge Planning Change 1 : Early Discharge Planning. In elective care, planning should begin before admission. In emergency/unscheduled care, robust systems need to be in place to develop plans for management and discharge, and to allow an expected dates of discharge to be set within 48 hours. Change 2 : Systems to Monitor Patient Flow. Robust Patient flow models for health and social care, including electronic patient flow systems, enable teams to identify and manage problems (for example, if capacity is not available to meet demand), and to plan services around the individual. Change 3 : Multi-Disciplinary/Multi-Agency Discharge Teams, including the voluntary and community sector. Co-ordinated discharge planning based on joint assessment processes and protocols, and on shared and agreed responsibilities, promotes effective discharge and good outcomes for patients Change 4 : Home First/Discharge to Access. Providing short-term care and reablement in people’s homes or using ‘step-down’ beds to bridge the gap between hospital and home means that people no longer need wait unnecessarily for assessments in hospital. In turn, this reduces delayed discharges and improves patient flow. Change 5 : Seven-Day Service. Successful, joint 24/7 working improves the flow of people through the system and across the interface between health and social care, and means that services are more responsive to people’s needs. Change 6 : Trusted Assessors. Using trusted assessors to carry out a holistic assessment of need avoids duplication and speeds up response times so that people can be discharged in a safe and timely way. Change 7 : Focus on Choice. Early engagement with patients, families and carers is vital. A robust protocol, underpinned by a fair and transparent escalation process, is essential so that people can consider their options, the voluntary sector can be a real help to patients in considering their choices and reaching decisions about their future care. Change 8 : Enhancing Health in Care Homes. Offering people joined-up, co-ordinated health and care services, for example by aligning community nurse teams and GP practices with care homes, can help reduce unnecessary admissions to hospital as well as improve hospital discharge.

What has worked this winter Earlier central government planning starting in September with SoS roundtable DCLG leadership and support has strengthened Local Government voice  Learning from winter 15/16 - blame culture doesn't improve performance - changed behaviour at the centre helped change behaviour locally - different tone to follow up conversations    Recognition that change  takes time - 18 months - starting to see places from last year turn round  Recognition that DToCs are important SLI issue - sector reputation  Recognition that LG doesn't benefit financially from DToCs - human and real cost   

What has worked this winter continued Joined up approach - social care experts in ECIP, working with NHSI/E Discharge Programme Board  Greater understanding of the varied reasons for delayed transfers of care, A&E performance, patient flow - more inquisitive enquiry rather than blame Revised DToC guidance - has it impacted on this year's increase ?  Understanding of LG financial challenge - Dom care crisis is not just about commissioning capability 8 High Impact Change Tool - LAs and joint systems have developed plans and it has structured BCF DToC plans Safer Bundle used by ECIP - systems want more support to embed change Care providers more engaged in system work

Regions London weekly data collection and ADs group shifting performance SE and SW investment in High Impact Tool consultants and bespoke work   WM work with NHSE to develop long term change plan Y and H risk assessment work to identify DToC as major risk and best practice work Eastern and East Midlands weekly data collection and investment in best practice support - the Leicester model SW ADs group coordinating social care improvement  NE consistently good performance

What has not worked so well… SRG leadership remains variable and plans don't connect with BCF plans - need care providers and voluntary sector round the table  Lack of understanding by people outside the system of the financial pressures on LG and CCGs and the lack of change management capacity   Concentration on short term delivery of performance counters successful change - we can do it properly or we can do it quickly - change fatigue  Leadership turnover of DASSs - leaders do not understand DToCs and can't see solutions - need master classes using Quick Guides CHC still being done in hospital - needs to be done at home - risk averse culture Concentrate on simple discharges - voluntary sector  Understanding of the Dom care market - low wage economy with high employment in retail and tourism  Latest thinking and best practice needs spreading but don't lift and shift as it won't work! 

30 LAs with highest delayed days attributable to social care, per 100,000 aged 18+ Region LA Winter rate Winter rank NW Cumbria 1727.1 151 Trafford 1624.5 150 Tameside 1587.7 149 SW Cornwall 1544.1 148 North Somerset 1361.1 147 WM Wolverhampton 1290.1 146 Dorset 1072.5 145 Somerset 1058.5 144 Birmingham 1045.6 143 SE Hampshire 1037.4 142 Solihull 1033.2 141 GL Hackney 972.1 140 Plymouth 956.4 139 YH York 948 138 Staffordshire 875.3 137 Warwickshire 867.7 136 East Sussex 864.6 135 Swindon 854.7 134 Oxfordshire 849.7 133 West Berkshire 810.2 132 Walsall 789.2 131 E Suffolk 779.7 130 Manchester 770.7 129 Bristol 763.6 128 Cheshire East 750.5 127 Dudley 730.5 126 Southampton 721.4 125 Liverpool 699 124 Bury 666.6 123 Brent 661 122

30 LAs with lowest delayed days attributable to social care, per 100,000 aged 18+ Region LA Winter rate Winter rank YH Kirklees 112.8 30 GL Southwark 112.6 29 NE Durham 111.6 28 NW Salford 109 27 E Thurrock 107.1 26 EM Leicestershire 106.3 25 Rotherham 105.5 24 SW Gloucestershire 102.9 23 Bedford 102 22 Nottinghamshire 99.1 21 Newcastle upon Tyne 97.6 20 Central Bedfordshire 89.8 19 Redbridge 89.2 18 Wirral 88.4 17 Havering 88.2 16 Newham 81.5 15 SE Windsor and Maidenhead 78.1 14 Wakefield 75.9 13 Northumberland 73.4 12 Barnsley 47.3 11 North Tyneside 43.7 10 Leicester 39.7 9 Rutland 33 8 Darlington 31.4 7 Slough 8.6 6 Redcar and Cleveland 7.4 5 Bradford 6.1 4 Hartlepool 1 Middlesbrough Stockton-On-Tees

30 worst performing Trusts BARTS HEALTH NHS TRUST NORTH MIDDLESEX UNIVERSITY HOSPITAL NHS TRUST BARKING, HAVERING AND REDBRIDGE UNIVERSITY HOSPITALS NHS TRUST KING'S COLLEGE HOSPITAL NHS FOUNDATION TRUST LEWISHAM AND GREENWICH NHS TRUST UNIVERSITY HOSPITALS OF NORTH MIDLANDS NHS TRUST UNIVERSITY HOSPITALS OF LEICESTER NHS TRUST NOTTINGHAM UNIVERSITY HOSPITALS NHS TRUST EAST AND NORTH HERTFORDSHIRE NHS TRUST HEART OF ENGLAND NHS FOUNDATION TRUST WEST HERTFORDSHIRE HOSPITALS NHS TRUST WALSALL HEALTHCARE NHS TRUST THE PRINCESS ALEXANDRA HOSPITAL NHS TRUST NORFOLK AND NORWICH UNIVERSITY HOSPITALS NHS FOUNDATION TRUST WYE VALLEY NHS TRUST COLCHESTER HOSPITAL UNIVERSITY NHS FOUNDATION TRUST PENNINE ACUTE HOSPITALS NHS TRUST MID YORKSHIRE HOSPITALS NHS TRUST HULL AND EAST YORKSHIRE HOSPITALS NHS TRUST COUNTY DURHAM AND DARLINGTON NHS FOUNDATION TRUST YORK TEACHING HOSPITAL NHS FOUNDATION TRUST BLACKPOOL TEACHING HOSPITALS NHS FOUNDATION TRUST AINTREE UNIVERSITY HOSPITAL NHS FOUNDATION TRUST STOCKPORT NHS FOUNDATION TRUST WARRINGTON AND HALTON HOSPITALS NHS FOUNDATION TRUST UNIVERSITY HOSPITAL OF SOUTH MANCHESTER NHS FOUNDATION TRUST ROYAL LIVERPOOL AND BROADGREEN UNIVERSITY HOSPITALS NHS TRUST SOUTHPORT AND ORMSKIRK HOSPITAL NHS TRUST ST HELENS AND KNOWSLEY HOSPITALS NHS TRUST WIRRAL UNIVERSITY TEACHING HOSPITAL NHS FOUNDATION TRUST

30 best performing Trusts WESTERN SUSSEX HOSPITALS NHS FOUNDATION TRUST FRIMLEY HEALTH NHS FOUNDATION TRUST ROYAL DEVON AND EXETER NHS FOUNDATION TRUST SURREY AND SUSSEX HEALTHCARE NHS TRUST ROYAL BERKSHIRE NHS FOUNDATION TRUST SHEFFIELD CHILDREN'S NHS FOUNDATION TRUST AIREDALE NHS FOUNDATION TRUST LUTON AND DUNSTABLE UNIVERSITY HOSPITAL NHS FOUNDATION THE DUDLEY GROUP NHS FOUNDATION TRUST IPSWICH HOSPITAL NHS TRUST SOUTH WARWICKSHIRE NHS FOUNDATION TRUST BEDFORD HOSPITAL NHS TRUST MOORFIELDS EYE HOSPITAL NHS FOUNDATION TRUST HOMERTON UNIVERSITY HOSPITAL NHS FOUNDATION TRUST CHELSEA AND WESTMINSTER HOSPITAL NHS FOUNDATION TRUST SALISBURY NHS FOUNDATION TRUST DORSET COUNTY HOSPITAL NHS FOUNDATION TRUST TAUNTON AND SOMERSET NHS FOUNDATION TRUST YEOVIL DISTRICT HOSPITAL NHS FOUNDATION TRUST THE ROYAL BOURNEMOUTH AND CHRISTCHURCH HOSPITALS NHS FOUNDATION TRUST BUCKINGHAMSHIRE HEALTHCARE NHS TRUST OXFORD UNIVERSITY HOSPITALS NHS FOUNDATION TRUST HARROGATE AND DISTRICT NHS FOUNDATION TRUST WRIGHTINGTON, WIGAN AND LEIGH NHS FOUNDATION TRUST DONCASTER AND BASSETLAW HOSPITALS NHS FOUNDATION TRUST CALDERDALE AND HUDDERSFIELD NHS FOUNDATION TRUST BRADFORD TEACHING HOSPITALS NHS FOUNDATION TRUST NORTHUMBRIA HEALTHCARE NHS FOUNDATION TRUST SOUTH TYNESIDE NHS FOUNDATION TRUST NORTH TEES AND HARTLEPOOL NHS FOUNDATION TRUST

National and regional trends Delayed transfers of care – winter 2015-16 Data up to March 2016 www.local.gov.uk

Delayed days over time, by organisation, England

Delayed days over time by care, and organisation England

Delayed days over time, by reason for delay, England

Delayed days over time, by reason for delay, NHS

Delayed days over time, by reason for delay, social care

Delayed days over time, by reason for delay, both NHS and social care

Delayed days over time, by reason for delay, due to both NHS and social care, plus social care alone

Regional comparisons

Regional picture

Social care delays by reason

Social care delays by reason

Social care delays by reason

Social care delays by reason

Social care delays by reason

Social care delays by reason

Social care delays by reason

Social care delays by reason

Social care delays by reason

Contact details Sarah Mitchell: Director of Social Care Improvement, Local Government Association Email: Sarah.Mitchell@local.gov.uk Website: http://www.local.gov.uk