Briefing Note / Middlesbrough Health and Wellbeing Board
Date / 14 December 2016
Title / Better Care Fund - Q2 Progress Reportand Integration Update
Responsible Officer / Kathryn Warnock – South Tees Integration Programme Manager
Purpose of Item / To provide Middlesbrough Health and Wellbeing Board with a summary of:
  • Better Care Fund progress for quarter 2 -2016/17
  • Progress on other integration projects including:
  • Strategic Commissioning
  • Joint Health and Wellbeing Board Session update
  • Integrating Continuing Health Care
  • Integration In Action

Better Care Fund

  1. Middlesbrough and Redcar & Cleveland’s Better Care Fund Planwereformallyapproved in July 2016.
  1. In June 2016, both Middlesbrough Council and Redcar and Cleveland Council entered into section 75 agreements with South Tees Clinical Commissioning Group to govern the Better Care Fund Pooled budget.
  1. Reporting on progress against Middlesbrough and Redcar & Cleveland’s BCF plans is required on a quarterly basis. Quarter 2 monitoring was submitted to NHS England 25 November 2016, the completed template is attached at Appendix 1.
  1. The performance reports attached at appendices2 and 3 provide a high level summary on each of the BCF schemes. Key points to note are

Single Point of Access / Implementation date for the SPA has been further delayed due to delays in the procurement of the telephony and IT equipment.
A revised delivery plan has been developed with an anticipated ‘go-live’ date of 30 January 2017 – this is based on the assumption that there are no issues arising from the testing process.
All internal refurbishments have now been completed and furniture is in situ. Formal consultation with staff is complete with no major concerns raised. The Information Sharing Agreement has been finalised and IT equipment is now being delivered and configured to suit the needs of the SPA. Testing of the systems (including the new telephony system) will begin early January.
The further delay in the implementation of the SPA reduces the ability of the SPA to start to have impact on non-elective activity this winter.
The SPA will host staff from the 2 Local Authorities, STFT and TEWV and it will provide access to:
  • social care access teams
  • social care reablement including Integrated Occupational Therapy
  • social care and nursing rapid response
  • community nursing and matrons
  • integrated community therapists,
  • hospital discharge to community SPOR
  • TEWV mental health nurse.
Call handlers/first point of contact staff will undertake the initial screening via a number of methods i.e. telephone, e-mail, written and via electronic referral systems. As well as initial call handlers/first point of contact staff there will also be registered social workers, nursing staff, OTs and PTs that will be able to provide clinical triage and assessments where appropriate.
In addition to the multi-agency SPA team there will also be co-located teams
2x Local Authority Access Teams,
Middlesbrough Integrated Occupational Therapy team (IOT’s) –
STFT Integrated Community Therapy team.
Staff and Stakeholder engagement has taken place with
Trade Unions, Clinical Council meetings and GP practice manager meetings to update them on SPA and the new community nursing referral processes.
Work on the stocktake of 7 day services is continuing, this will include plotting a few patient journeys to see where the gaps are. This will assist with making referrals once the SPA is up and running.
Support to Care Homes / The South Tees BCF Support to Care Home Project has a number of strands to reduce hospital admissions and improve resilience of the care homes.
The schemes have been developed with the relevant staff/colleagues from all south tees partner organisations including care home providers.
Consultation and engagement include a support to care home steering group, attendance at the two LA Care Home Forums and regular updates/feedback to the Clinical Council of Members (GP’s).
Progress to date includes:
Strand 1
a) Pilot led by South Tees Trust – 12 care homes identified with high admissions. Rapid response nurse attends if anyone at risk of being admitted.
b) 12 month pilot business case awaiting approval to provide EHCP’s to cover all South Tees Care Homes as first response for anyone at risk of being admitted which includes education and training with care home staff on site.
c) A working group is exploring the possibility of a pilot to align GP practices to care homes.
d) Pro-active nursing to do routine/advance care plans etc. still to be developed.
Strand 2
12 month proposal has been approved to spend to provide additional meds training and support (based on Hartlepool model) to all South Tees Care Homes. Estimated timescale is January 2017.
Strand 3
18 month proposals have been approved to provide additional nutrition training and support to all care homes – Public health to provide in Middlesbrough and South Tees Dietetics team to provide in Redcar & Cleveland. Includes speech and language input. Start January 2017 and continue 2017/18.
Strand 4
7 month Falls Pilot – joint initiative between the STFT Falls Team and 2 Telecare providers in Middlesbrough and Redcar & Cleveland. Care homes targeted with the highest number of resident falls resulting in hospital admission. Resident assessments carried out by OT and fitting and monitoring of telecare equipment. Includes education and training for staff including post fall training.
Strand 5
Approval for Specialist Palliative Care Nurse to work in care homes to undertake end of life training to gold standard framework including exploring verification of death training in nursing homes. Recruitment is underway to start January 2017 for 18 months.
Strand 6
Establish links to mental health including delirium pathway.
Strand 7
To set up a working group to look at current training available for care home staff to identify gaps and see if can improve communication/coordination. Group to include LA staff including workforce development and contracts and commissioning and care home representatives.
Strand 8
Task and finish group was established to look at discharge processes including reviewing and revising assessment procedure for residents being discharged to a care home. Patient passport has been developed and currently being piloted in number of care homes before rolling out to all care homes. Passport was based on Sunderland model and adapted for South Tees. Pilot till December 2016 with roll out January 2017.
Strand 9
Infection Control Nurse – Specification to be developed and implementation expected 2017.
Telehealth– exploring potential to pilot in care homes and extra care provision based on NEWS Digital Model used in Sunderland.
Seating Pilot
Pilot consisting of 2 OT’s providing seating assessments to all residents in 5 Middlesbrough care homes. BCF funding to assist care homes purchase recommended seating. Homes identified based on CQC ratings. The aim is to identify potential postural problems early. Also supports hospital discharges so care homes can provide suitable equipment to meet resident needs. Identification of residents who may benefit from rehab with intent to return home if 24 hour care is no longer required.
Frailty Unit – James Cook – ETTF bid
Through a single point of access the Primary Care Frailty Unit (PCFU) will be able to deliver a seamless integrated approach to managing the Frail and Elderly patient that presents at the acute hospital.This will be aided by the use of the MIG and Summary Care Record Advanced Information, allowing GPs and Secondary Care consultants to view patient’s records. the aim of the service is to reduce hospital admissions as patients will be able to be seen and treated in the unit on arrival.For those patients that may need further assessment, a complex or specialist package of care there will be a unit on the 1st floor providing a step up short stay facility. This would be a GP led bed provision with geriatric Consultant outreach.
The scheme will deliver a number of services that will reduce unplanned admissions including:
  • Frail and Elderly Primary care service
  • Patient triage
  • GP in A&E service
  • Step up GP facility
The service will be responsible for the coordination of other community teams input in to packages of care.This will also be included in the discharge to asses in future years.
We are starting a pilot for this in January 2017.
Community Assessment Unit
The development of a Community Assessment Unit that could assess and treat a number of sub-acute conditions in the community setting will complement the CCG’s emerging Urgent Care strategy with the aim of reducing Acute hospital attendance and pressures on Urgent Care.
This is a new initiative that could be developed utilising existing workforce and within existing estate.
GP Urgent Care Scheme / A revised GP Urgent Care scheme has been implemented from November 2016.
The scheme incentivises practices to do everything possible to reduce unplanned admissions and A+E attendances and thereby shift activity from urgent care at A+E and the hospital into primary care. This will reduce pressure on the urgent care system through the improvement in the quality of primary medical care services. Practices will be required to develop initiatives and actions plans which will be closely monitored.
Continuing Health Care Integration / An Integrating Continuing Health Care (CHC) Design and Implementation Group has been established to progress the recommendations identified by the recent independent CHC review and approved by the CCG’s Executive and Local Authority Management Teams. The priorities for the team include co-locating CHC teams, creating a pooled budget to avoid delays from possible disputes and exploring how we can more effectively commission the packages of care which incur significant costs.

Non Elective Admissions

  1. The first 6 months of 2016/17 has seen a significant increase in emergency activity within South Tees FT.
  1. Activity is currently forecasted to be around £4.1 million over plan.
  1. The BCF Policy Framework establishes that £1 billion of the CCG contribution to the Fund will be ring fenced to deliver investment or equivalent savings to the NHS, whilst supporting local integration aims. Local areas should agree how they will use their share of the £1 billion to fund NHS commissioned out-of-hospital services, that demonstrably lead to off-setting reductions in other NHS costs against the 2014-15 baseline. This could include a wide range of services, to be determined locally.
  1. However, where the local partners recognise a significant degree of risk associated with the delivery of their 2016-17 BCF plan, we expect them to consider using a local risk sharing agreement, given that ‘the same pound cannot be spent twice’ – on emergency admissions and on NHS-commissioned out-of-hospital activity at the same time. The key point is that BCF investment does not cause a CCG to over extend itself in financial terms and hence put the financial balance of the health economy at risk.
  1. Middlesbrough and Redcar & Cleveland’s Better Care Pooled Funds for 2016/17, included a ‘risk share’ agreement of circa £2million across both plans. This was the value of the planned reduction in emergency activity.
  1. Given the increase in emergency activity across South Tees this risk share element of the pooled funds is unable to be spent on out of hospital activity – as the same pound cannot be spent twice. Plans have been drawn up to support the increase in activity through a combination of reserves and in year re-budgeting.
  1. In addition there are further financial pressures within the CCG, after accounting for the risk share element of the BCF, pressures in either of the partners can be supported by any underspend within the pool. A further approx. £675k has been identified from the two BCF pooled funds from uncommitted schemes or from in year slippage which can also be used to mitigate the pressures within the CCG, on a non-recurrent basis
  1. Existing BCF schemes and project continue to be fully supported.

Integration In Action

  1. A proposal was presented to the Chief Officers on 27th October which identified projects that can be worked on now to alleviate financial and demand pressures and help organisations work closer together.
  1. All organisations recognise that the scale of the problem is too large for one organisation to solve on their own. Therefore working together can ensure that we better use the joint resources available to meet the health and care needs of the population of South Tees’s health needs as well as helping to reduce the financial burden on organisations by shifting resource to where it’s needed - the £South Tees
  1. It was agreed that the Chiefs would focus on 4 projects from now until 31 March 2017 which will aim to alleviate the financial and demand pressures this winter and help organisations move closer together.
  1. The four projects are:
  • Keeping People Healthy - How does the system work together to avoid future demand and plan for the longer term - Led by Edward Kunonga
  • Admission Avoidance - What are the actions the whole system can take, once people are ill, to prevent a hospital admission - Led by Jim O’Connell
  • Discharge Home -How can the whole system work together to ensure that once a patient is admitted to hospital that they are discharged home without delay - Led by Patrick Rice
  • Out of Hospital Care –How does the system work in partnership with people, pre and post chronic conditions, so we can support them to manage their condition at home - Led by Craig Blair
  1. Project Leads are currently scoping out the projects and identifying key deliverables further updates will be presented to the next meeting of the Board.

Strategic Alignment for Commissioning Transformation

  1. The CCG hosted an event in September to explore innovative contracting models and how they are used in new models of care.
  1. Integration developments have largely been dominated by the implementation and delivery of the BCF and its associated projects and schemes which go some way in driving integration however it is recognised that the creative use of the contracting process is a critical factor in making new models of care and integrated workhappen. Without bold, robust contracting the theoretical benefits of more efficient, better-integrated and higher quality care systems will not be realised.
  1. The commissioning organisations within the IEG has acknowledged the potential to streamline commissioning and reduce duplication in order to influence future contracting models by signing up to a set of commissioning principles and begun to develop a memorandum of understanding.

Joint Health and Well Being Board Session

  1. A joint Health and Wellbeing Board session was held, 26 September. The purpose of the session was to consider where there were opportunities to work collectively across South Tees and identify potential issues where it makes sense for the two boards to come together and tackle an issue jointly.
  1. The session was facilitated by Professor David Hunter and considered:
  • the national drivers for integrating Health and Social Care,
  • what is happening locally around integration
  • the shared issues and problems across South Tees
  • opportunities to align Health and Wellbeing Board work programmes and work jointly
  • agreeing priorities to take forward
  1. The session was well attended, by representatives from both Health and Wellbeing Boards.
  1. The two Health and Wellbeing Boards welcomed to the opportunity to meet together and clearly recognised the need to work in a more joined up way if we are able to start to tackle the issues and challenges both Boards face.
  1. It was agreed that there is merit in the 2 Health and Wellbeing Boards working closer together. In the first instance the group agreed to prioritise prevention (with a particular focus on exercise).
  1. Edward Kunonga, Director of Public Health, has been identified as the lead officer to take this work forward as part of the Integration In Action - Keeping People Healthy project. A progress report will be included in Edward Kunonga’s report to this Board.

Working with Housing Providers

  1. A workshop took place on Monday 19th September to look at ways of working with housing (Thirteen and Coast and Country) to identify integrated solutions. An outcome was to look at how many Delayed Transfers of Care days were due to patients waiting for minor adaptations to their house and if this was a significant number to look at investing in a joint additional ‘rapid response handyperson’.

Customer Journey

  1. The Customer Journey project is progressing. This involves detailed interviews with patients aged over 75 who have been discharged following a stay in James Cook University Hospital to track their experiences and highlight any areas where pathways could be improved. A final report is expected in the New Year.

Report prepared by:

Kathryn Warnock – South Tees Integration Programme Manager

Tel: 01642 263041

E mail:

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