In preparation for the full Better Care Fund, which will come into effect in 2015/16, £200 million will be transferred from the NHS to social care in 2014/15, in addition to the £900 million transfer already planned. This pooled budget must be used to support adult social care services that have a health benefit, based on agreement between local authorities and CCGs, which are signed off by both parties and the local health and wellbeing boards.
Approach for ‘Spending to Save’
1. A sound understanding of the key local challenges and the underlying issues that need to be addressed
2. Evidence-based approaches interpreted and used accordingly (see list below)
3. Balancing evidence-based decision-making with a willingness to innovate and try out different approaches.
- ? Primary prevention
- ? Self-care
- ? Managing ambulatory care-sensitive conditions
- ? Risk stratification or predictive modelling
- ? Falls prevention
- ? Care co-ordination
- ? Case management
- ? Intermediate care, re-ablement and rehabilitation
- ? Managing emergency activity, discharge planning and post-discharge support
- ? Medicines management
- ? Mental and physical health needs
- ? Improving management o f end-of-life care
- ? Delivering integrated care eg House of Care model
Plans for spending from the Better Care Fund must detail how they will provide:
• protection for social care services
• seven-day services in health and social care to support patients being discharged and prevent unnecessary admissions at weekends
• better data sharing between health and social care, based on the NHS number
• a joint approach to assessments and care planning and, where funding is used for integrated packages of care, an accountable professional
• agreement on the consequential impact of changes in the acute sector, with an analysis, provider- by-provider, of what the impact will be in their local area alongside public and patient and service user engagement in this planning, and plans for political buy-in.
The national metrics for how well the Better Care Fund is being used to develop integrated care will be admissions to residential and care homes
- effectiveness of re-ablement
- delayed transfers of care
- avoidable emergency admissions
- patient / service user experience.
These measures will be important in allocating the £1 billion of the Fund that is related to performance against outcomes, though there is some scope to use locally developed measures.
Understanding the sources of need and demand
• Nationally, our population is growing, ageing and becoming more diverse (The King’s Fund 2013). Over the next 20 years the number of people aged over 85 is expected to increase by 106 per cent.
• In the next 20 years, the number of people with some diseases is expected to double
• By 2018, the number of people with three or more long-term conditions is expected to rise to 2.9 million; in 2008 this figure stood at 1.9 million
Reference: Making Best Use of the Better Care Fund : Kings Fund January 2014