1. Better Care Fund (BCF) Update Dr Sharon Hadley GP lead for Unplanned Care 11 th June 2015 1

2. Better Care Fund (BCF) New initiative announced in June 2013 The NHS and Social Care will share £3.8bn in 2015/16 Every CCG + LA has to jointly agree a spending plan for integrated care New initiative announced in June 2013 The NHS and Social Care will share £3.8bn in 2015/16 Every CCG + LA has to jointly agree a spending plan for integrated care “A lack of joined up care is one of the biggest frustrations for patients, service users and carers. Getting it right will make a huge difference to quality, safety and people’s experience of care.” (Jeremy Taylor, CEO National Voices) “A lack of joined up care is one of the biggest frustrations for patients, service users and carers. Getting it right will make a huge difference to quality, safety and people’s experience of care.” (Jeremy Taylor, CEO National Voices) 2

3. Agreed Spend 3

4. Local Challenges 4 High levels of Emergency AdmissionsTarget reduction is 656 emergency admissions for 15/16 (3.5%) High levels of residential placementsTarget reduction is 23 residential placements for 15/16 High levels of complex care packagesTarget reduction is 39 complex care packages BCF funds committed to existing servicesNo new funding Achieving truly integrated teams/servicesNew ways of contracting services for true integration Data sharingConsent & inter-operability

5. BCF for Southend 1.Community Recovery Pathway 2.Primary Care Hub 3.Redesigning Social Services 4.End of Life Services 5.Prevention & Engagement 5

6. Community Recovery Pathway - 1 First Contact, admission avoidance/prevention, urgent response -Review of SPOR and SBC Access Team format and function. -Potential to pool resource and co-locate to improve effectiveness -Review access to crisis response for admission avoidance -Review discharge process and protocols -Review MDTs in Primary Care 6

7. Community Recovery Pathway - 2 Reablement, Intermediate Care beds, Step up/down beds, Short term placements -Review current reablement capacity and contract terms/performance -Review current bed capacity (intermediate care, step up/down) and contract terms/performance -Develop the market to find new providers, promote innovation and new ways of working. -Consider re-commissioning of reablement and bed based services 7

8. Community Recovery Pathway – 3 Long term community support -Frail elderly & Long term conditions focus -Maximise independence by supporting people in the community wherever possible -Bring together health & social care functions -Reduce fragmentation and duplication -Scope options for care co-ordination -Closely aligned to Multi disciplinary teams & Primary Care Hub 8

9. Primary Care Hub Provide proactive health and social care and support, to avoid health crises and improve person/family/carer experience -GP practices are the entry point into the health system, accounting for 80% of patient contact. -Patients will only go into hospital when they need specialist care and there is no alternative available in the community -Appropriate services are available and accessible to the local population – right care, right place, right time. -7 day services where possible -Personalisation, care planning & support to self manage -Partnership working with all stakeholders 9

10. End of Life Redesign services to increase the number of people supported to remain in their home and community setting who achieve their preferred place of care during the final stages of their lives. -Increase patient numbers on EOL register -Review current service provision -Redesign new model of care/pathways -Reduce the number of emergency admissions for patients during end of life phase - Increased compliance with patients preferred place of care -Personalisation, ensure the person and those important to them are involved in planning and care. 10

11. Redesign of Social Services Redesign of social care services, contributing to admission avoidance and timely hospital discharge -Review & redesign of social work model -Review of current contractual arrangements with care homes -Contribute to reduction in complex care placements and residential care placements 11

12. Prevention & Engagement Offering effective solutions for lifestyle related health behaviours -Led by Public Health -Lifestyle hub for assessment and treatment or onward referral for intervention -Patient activation measures, 8 practices signed up to pilot encouraging self care -Social prescribing -Falls prevention and postural stability 12