Derbyshire County Council has been working with local partners to develop and deliver a clear plan for use of the improved Better Care Fund. The approach is helping to maintain capacity across both social work and the independent sector, and supporting system flow and hospital discharges. This example of how local areas are working to implement overall system change forms part of our managing transfers of care resource.
The total number of bed days delayed across Derbyshire reduced in the first two quarters of 2017/18 and this encouraging performance is continuing. Just as importantly partners remain focused on their long-term ambitions of supporting more people to live at home independently.
In his Spring Budget of 2017 the Chancellor announced additional grant funding, called the improved Better Care Fund (iBCF), of £2 billion to social care in England over three years, with £1 billion available in 2017/18.
Conditions for use of the iBCF funding were specified in a grant determination letter issued by the then Department for Communities and Local Government (DCLG) in April 2017, with an expectation that the additional monies would be used to fund one or more of the following:
- meeting adult social care needs
- reducing pressures on the NHS (including supporting transfers of care from hospital)
- ensuring the local social care provider market is supported.
These conditions have remained, although there has subsequently been an increased emphasis on addressing delayed transfers of care (DTOC). All iBCF plans need to clearly set out how the funding is supporting local need and improving performance, especially where DTOC performance is challenging.
In Derbyshire, iBCF funding for 2017/18 accounts for 1.2% of the total spend across health and care.
Derbyshire is a diverse county, with both sparsely populated rural areas and built-up urban areas, and local partners were facing a number of issues. Recruitment and retention were problematic, and there were challenges with non-acute and mental health DTOC. At the same time, savings targets for adult social care needed to be achieved, and planning for 2018 onwards was difficult due to future funding uncertainty.
As in so many other complex situations, the solution in Derbyshire could not be achieved through a single action or project. Instead, health and local government partners agreed:
- a comprehensive plan of interdependent activity, setting out what success would look like, and showing clear links to wider Sustainability and Transformation Partnership (STP) plan priorities and broader system working
- a clear rationale for the use of iBCF funding against all three of the national conditions
- to fund increased capacity to address immediate challenges, supplemented by investment in initiatives to support longer-term sustainability.
Meeting adult social care demand
More than £5m has been invested in maintaining capacity in the social care workforce, thus avoiding a potential reduction of 60 full-time equivalent posts. This not only fulfils a local commitment to maintain the numbers of assessments and reviews that can be undertaken, but also ensures there are enough social work staff to continue working within the acute system.
In addition, staffing capacity within the council’s in-house provider function has been enhanced to help its home care service element focus on short-term provision. Funding has also been allocated to the development and implementation of a new case management system which will work better across social care and the NHS.
Reducing NHS pressure (including DTOC)
Funding to enhance capacity is being used to secure additional social workers to support community hospitals with a mixed team of social workers, occupational therapists and community care workers across the county.
Recognising that a reduction in hospital admissions will also have a positive impact on NHS pressures, and long-term sustainability, investment has been made in preventative services including development of a falls pathways and support related to welfare rights, and additional funding for the equipment service will support the roll-out of safer single handling practices.
Supporting the local care market
The focus here has largely been on addressing the impacts of the introduction of the National Living Wage, but fees to independent care sector providers have also been increased with the expectation of improvements in quality, patient flow and patient experience. Examples include funding for staff training costs, hospital admittance retainer rates, improved home care travel rates and the introduction of the ‘Red Bag’ initiative for managing better transfers between care homes and hospitals.
Addressing delayed transfers of care – supporting system flow and hospital discharges
To support shared system-wide understanding of the need for investment in social work functions and the impact this will have on addressing delayed discharges, each area of spend has an accompanying explanation of why the system is funding this and the impact it is expected to achieve.
County-wide examples include:
- additional social work posts across the county’s community hospitals – to provide a consistent link for people transferring from acute to non-acute settings or to their community, leading to reductions in length of stay for people in non-acute settings
- additional social work, occupational therapy and community care practitioners – to reduce unnecessary hospital admissions and increase post-discharge support, creating the potential for more people to be supported to live at home
- a county-wide home-from-hospital service provided by British Red Cross – addressing a previous inequity of provision from a service that was grant-funded in only some areas of the county. It provides support on discharge, including help with transport, prescriptions, basic provision in the home and signposting to other support
- additional domiciliary service organisers – to support the strategic shift of the Council’s in-house provider service towards short-term provision for home-care, providing a consistent seven-day response.
In some parts of the county, targeted approaches are being used, so that a single half-time or full-time post can help to support the delivery of a more consistent and equitable response across the diverse county. These include:
- 0.5 full-time equivalent senior practitioner occupational therapist – to embed agreed principles and practice for safer single handling across the North Dales area, in line with county-wide developments
- an additional mental health service manager to ensure that new prevention approaches can be embedded within the mental health service in the north of the county.
Wider system working
The iBCF plans align to the broader framework for the Better Care Fund and STP priorities. Together, these seek to ensure that:
- initiatives are in place that enable people to take more control of their lives in their normal place of residence
- services look after and focus on people in their community, rather than being offered in a way that suits organisations and revolves around buildings
- initiatives are in place that support flow through the system, where possible preventing unnecessary readmissions or permanent admissions to care settings
- specialist services are organised to ensure that everyone is enabled to secure their rights, independence, choice and inclusion, including those at risk of high-cost care
- supporting mechanisms are in place such as data sharing and information governance arrangements, and programme management capacity;
Wider system working adds value to iBCF-funded work, including for example:
- ongoing initiatives with district and borough councils to develop accommodation solutions for homeless people and those with mental health conditions to reduce associated non-elective admissions and DTOCs
- monthly review meetings of non-acute delays between adult social care, Derbyshire Community Health Services NHS Trust, and continuing healthcare have helped reduce length and numbers of DTOCs.
Measuring progress and sharing learning
Quarterly reporting on iBCF highlighted the following progress:
- the number of referrals and assessments undertaken by adult social care during the second quarter of 2017/18 are broadly similar to those for the same period in 2016/17. This is in line with expectations to maintain the same level of service provision through protection of social care by reducing budget savings (approximately 17,000 assessments will be undertaken in 2017-18, compared to 16,700 in 2016-17. Without iBCF funding this would have dropped to 14,000 assessments)
- the rate of admission to residential and nursing care settings continues to reduce in line with BCF plans, while hours of home care provided by the independent care sector have increased during the first quarter of 2017/18 from the last quarter of 2016/17
- the total number of bed days delayed across Derbyshire has reduced in the first and second quarters of 2017/18 when compared to 2016/17 levels. This encouraging performance has continued into the start of quarter three with the health and social care system in Derbyshire reporting the lowest DTOCs of any shire county in October and November 2017.
For further information contact:
Group Manager – Better Care Fund
Derbyshire County Council