To discuss and consider the Oldham Better Care Fund (BCF) Plan year end return for 2022-23.
Minutes:
Consideration was given to a report and presentation by Claire Hooley, Head of Commissioning and Market Management – Working Age Adults regarding
the Oldham Better Care Fund Plan year end return for 2022-23.
The Better Care Fund (BCF) requires areas to jointly agree to deliver health and social care services supporting improvement in outcomes against the following BCF policy objectives:
· Enable people to stay well, safe and independent for longer
· Provide the right care in the right place at the right time.
In November 2022 the Hospital Discharge Fund was included in the BCF 2022-23allocation.
Oldham’s allocation is as follows:
Funding source |
|
NHS Greater Manchester ICB Contribution |
£20,755,612 |
Disabled Facilities Grant |
£2,343,87 |
Improved Better Care Fund (iBCF) |
£11,187,623 |
Hospital Discharge Fund |
£2,573,295 |
Total |
£37,525,524* |
This amount differs from the original amount submitted in the plan (September 2022) due to the inclusion of the Hospital Discharge Fund.
Conditions of the Grant are as follows:
National Condition 1: a jointly agreed plan between local health and social care commissioners signed off by the HWB.
National Condition 2: NHS contribution to adult social care to be maintained in line with the uplift to CCG minimum contribution.
National Condition 3: invest in NHS commissioned out of hospital services
National condition 4: implementing the BCF policy objectives.
Beyond the 4 national conditions and the funding criteria, localities have flexibility in how the fund is spent but need to agree how the spending will improve performance against the following metrics:
· Avoidable admissions to hospital
· Admissions to residential provision
· Effectiveness of reablement
· Hospital discharges that are to the person’s usual place of residence
The funding of schemes was utilised across HSC to fund a wide range of provision for residents including the following:
The year end return requires the inclusion of two successes and two challenges, and to be aligned to at least one of the logic model enablers, those reported were:
(i) Successes Response Detail
Joint working on the delivery of the integrated contract for residential and nursing homes. |
The focus of the work was to refresh the commissioning and contracting arrangements in place for residential and nursing homes supporting Oldham residents, made possible by HSC partners coming together with clear priorities. Whilst predominantly the arrangements are for in-borough provision, they also cover out of area placements supporting Oldham residents. The approach has provided clarity to internal staff and also external partners such as providers of care. |
Carers |
The Carers team is jointly HSC funded through the BCF and has seen a significant increase in the identification of hidden carers, including individuals who do not identify themselves as carers. As such more information, advice and support has been offered. 2022/23 saw a coproduction refresh on the Carers Strategy with a number of focus groups being held encouraging wide participation from a variety of stakeholders. |
(ii) Challenges Response Detail
Care Home market |
During 2022-23 the care home market has become increasingly fragile nationally, with Oldham not exempt from this. A number of providers have approached commissioners advising about considering to deregister from nursing provision or moving away from general nursing to moving towards specialist provision such as Mental Health. We are seeking to address this by reviewing our care home rates, and in particular nursing fee rates, which will have longer term implications for us from a funding perspective enabling us to meet the needs of the Oldham population. |
Discharge to Assess
|
The 'Discharge to Assess' process places additional pressures on an already stretched social care resource. This can result in reviews not taking place as quickly as the system would wish. It can also place pressures on community health services such as GPs and Therapy teams where people are placed in short term placements away from where they are normally registered. The Oldham health and social care system is currently exploring opportunities for block booking 'Discharge to Assess' beds in one or two locations which may streamline the review and therapy inputs but more resource/support is required in this area.
|
The BCF Plan required four key metrics to be measured and reported on, summarised in the table below
|
|||
Metric |
Planned |
Actual |
Commentary |
Avoidable admissions - Unplanned hospitalisation for chronic ambulatory care sensitive conditions |
1,160 |
Local estimate is 1,113 |
Oldham are on track to achieve this due to the number of avoidable admissions services in place. The Urgent Care Hub managed over 70,000 patients with a 96% success rate of keeping them out of hospital. Community HSC services have also significantly contributed to the achievement with existing and newly developed pathways for patients, including reablement, 2 hour rapid response service, and district nursing care. Extensive work across health and social care has taken place with care homes in order to better manage patients and enable them to stay in their own place of residence. |
Discharge to normal place of residence (from acute setting) |
92.3% |
90.8% for 12 months to Feb-23 |
We have seen a decrease in patients returning to their normal place of residence due to two main factors: 1. the emphasis on D2A has resulted in patients being discharged earlier to a D2A setting in order to best establish their needs without being in an acute hospital bed. These patients often do return to their usual place of residence, but the extra move within their journey has an impact on this metric. 2. the acuity of patients presenting and subsequently being discharged from hospital. Oldham are seeing an increased number of patients who are sicker or more advanced in their illness than in previous years and so their destination once treatment has taken place is often needed to be long-term care and/or hospice care. |
Residential admissions – (Rate of permanent admissions to residential care per 100,000 population (65+)) |
681 |
590 |
Actual rate is better than planned, and this equates to 229 permanent admissions to residential care of people aged 65+ |
Reablement – (Proportion of older people who were still at home 91 days after discharge from hospital into reablement services) |
93.3% |
88% - of 108 people 13 didn't stay at home. |
To meet target an additional 8 people would have needed to stay at home for 91 days. The acuity of people at the point of discharge is significant and this is having an impact on this measure. |
In response to a query regarding the planned and actual expenditure, and the number of packages in paragraph 2.5 of the report, Claire Hooley informed the Board that more detailed information to clarify and update the figures relating to each scheme would be circulated to the Board.
The Board noted that funds would be vired between schemes to cover overspends.
Resolved: That the Better Care Fund return for 2022-23 be signed off in line with national conditions subject to the amendments to clarify and update the figures to the extract from the year end return as shown in paragraph 2.5 of the report.
Supporting documents: