Please note, there are two parts to the Better Care Fund planning template. Part 2 is in Excel and contains metrics and finance.

Transcription

1 Updated March 2016 Better Care Fund planning template Part 1 Please note, there are two parts to the Better Care Fund planning template. Part 2 is in Excel and contains metrics and finance. Contents 1 Plan Details... 2 A Summary of Plan... 2 B Authorisation and signoff... 3 C Related documentation The Local Vision An evidence base supporting the case for change A coordinated and integrated plan of action for delivering change National Conditions A Plans to be jointly agreed B Maintain provision of social care services C Agreement for the delivery of 7-day services across health and social care to prevent unnecessary non-elective (physical and mental health) admissions to acute settings and to facilitate transfer to alternative care settings when clinically appropriate 15 D Better data sharing between health and social care, based on the NHS number.. 16 E Ensure a joint approach to assessments and care planning and ensure that, where funding is used for integrated packages of care, there will be an accountable professional F Agreement on the consequential impact of the changes on the providers that are predicted to be substantially affected by the plans G Agreement to invest in NHS commissioned out of hospital services, which may include a wide range of services including social care H Agreement on local action plan to reduce delayed transfers of care (DTOC) Financial risk sharing and contingency Better Care Fund Plan 2016/17 for Nottinghamshire March 2016 Page 1 of 24

2 1 Plan Details A Summary of Plan Local Authority Clinical Commissioning Groups District and Borough Councils Boundary Differences agreed at Health and Wellbeing Board: submitted: Minimum required value of BCF pooled budget: 2016/17 Total agreed value of pooled budget: 2016/17 Nottinghamshire County Council Bassetlaw CCG Mansfield and Ashfield CCG Newark and Sherwood CCG Nottingham North and East CCG Nottingham West CCG Rushcliffe CCG Ashfield District Council Bassetlaw District Council Broxtowe Borough Council Gedling Borough Council Mansfield District Council Newark and Sherwood District Council Rushcliffe Borough Council There is a 2.7% population difference between the Local Authority and CCG boundaries. This small figure is not expected to impact significantly on delivery of this Better Care Fund (BCF) plan. XXX XXX 56,105,611 56,191,611 Better Care Fund Plan 2016/17 for Nottinghamshire March 2016 Page 2 of 24

3 B Authorisation and signoff Signed on behalf of the Clinical Commissioning Group Signed on behalf of the Clinical Commissioning Group Signed on behalf of the Clinical Commissioning Group Signed on behalf of the Clinical Commissioning Group Signed on behalf of the Clinical Commissioning Group Signed on behalf of the Clinical Commissioning Group Signed on behalf of Nottinghamshire Council Signed on behalf of Ashfield District Council Better Care Fund Plan 2016/17 for Nottinghamshire March 2016 Page 3 of 24

4 Signed on behalf of Bassetlaw District Council Signed on behalf of Broxtowe Borough Council Signed on behalf of Gedling Borough Council Signed on behalf of Mansfield District Council Signed on behalf of Newark and Sherwood District Council Signed on behalf of Rushcliffe Borough Council Signed on behalf of the Health and Wellbeing Board Chair of Health and Wellbeing Board Better Care Fund Plan 2016/17 for Nottinghamshire March 2016 Page 4 of 24

5 C Related documentation Document or information title 01 Our strategy for Health and Wellbeing in Nottinghamshire Nottinghamshire BCF Logic Model 03 Planned BCF Schemes and Themes 04 Vanguard value generation: South Nottinghamshire Urgent and Emergency Care Network, Mid Nottinghamshire Better + Together and Rushcliffe 05 BCF Metrics - M performance report summary 06 BCF Scheme Implementation Plans Annex 1 detailed scheme description forms 08 Nottinghamshire BCF Audit Report 2014/15 09 Nottinghamshire BCF Audit report January Nottinghamshire BCF Risk Log 11 Report from joint HWB workshop 12 Appendix to report from joint HWB workshop 13 Integrated Commissioning Carers Strategy and Action Plan NHS Improving Quality Seven Day Services: 10 point Implementation Checklist 15 7 Day Services Mapping and Aspirations 16 No Health without Mental Health, Nottinghamshire s Mental Health Framework for Action (Final October 2014) 17 Nottinghamshire Suicide Prevention Framework for Action Nottinghamshire Local Action Plan for Delayed Transfers of Care 2 The Local Vision for health and social care services The Nottinghamshire Health and Wellbeing Board (HWB) continues to work towards its four key ambitions of: - For everyone to have a good start in life - For people to live well, making healthier choices and living healthier lives - That people cope well and that they are supported to improve their own health and wellbeing and maintain independence - To get everyone to work together This fourth ambition underpins all of the Board s work to improve efficiency, maximise value for money, and provide joined up services and care pathways. Our overall vision is that, through working together, we will enable people living in Nottinghamshire to live longer, be healthier, and have a better quality of life, especially in the communities with the poorest health. This is a shared vision, and steps have already been taken across Nottinghamshire to transition towards this person-centred model of health and social care. What matters most to local people, commissioners, and providers are the improvements we make together for the benefit of patients and service users by optimising choice, where possible. The final strategy was agreed by the HWB in March 2014, and supporting delivery plan in September The strategy is attached in document 01. The BCF schemes continue to prioritise short- to medium-term actions to build capacity in the health and social care system, and respond to patient and carer feedback to improve the quality and effectiveness of services. focusing on supporting patients post-acute illness (reablement, maintenance, and independence), mental health services, Better Care Fund Plan 2016/17 for Nottinghamshire March 2016 Page 5 of 24

6 care home and specialist accommodation for older people, care for the elderly in the community, and the urgent care system, we aim to re-design intermediate care offered in the patient s own home to be more flexible, and consequently reduce the number of acute and mental health patient beds. Our BCF schemes are designed around the person, not the condition, and aim to address the multiple needs of individuals through better joined up work, communication, and integration. In this way, the BCF is a key component to delivering not just the health commissioners integration plans, but also the overall Health and Wellbeing Strategy. We have accordingly structured all BCF schemes into six overarching themes: 1. 7 Day Service Provision and Access 2. Supporting Integration 3. Transforming Patient Satisfaction 4. Protecting Social Care Services 5. Accelerating Discharge 6. Infrastructure, Enablers, and Other Developments A logic model for the Nottinghamshire BCF programme can be found in the attached document 02.An outline of the specific schemes being implemented under each of the six main BCF themes, along with timescales for delivery, can be found in the attached document 03. We held an extended board meeting with partners to review our BCF plan using the Better Care Support Team self-assessment tool in January We had good engagement in the event and have identified a number of successes and areas for action during 2016/17. Successes include: Domain 1. Leading and managing a successful Better Care Implementation o HWB engagement is good. o Relationships between commissioners improved and has led to the development of other initiatives. o Information sharing across units of planning to spread best practice within Nottinghamshire and scale up initiatives. o Strong governance in place which received substantial assurance from internal audit. o Patient engagement and evaluation of services embedded in commissioning. o Better understanding of stakeholder work areas, e.g. housing and health this is leading to more collaboration, for example in Mid Nottinghamshire one of the district councils housing team is in-reaching to the hospital to facilitate discharge. o Links in place between BCF and relevant workstreams, such as work led by System Resilience Groups. Domain 2. Delivering excellent on-the-ground care around the person o Work progressing on linked datasets. o The Joint Strategic Needs Assessment (JSNA) includes the local assets and commissioning gaps. o Both formal and informal processes in place for engaging citizens in service development and the development of transformation plans. For example, carers are engaged through carers groups throughout Nottinghamshire on service developments, and a smaller number of carers are members of a Better Care Fund Plan 2016/17 for Nottinghamshire March 2016 Page 6 of 24

7 Carers Implementation Group along with health and care commissioners to develop and transform services. Domain 3. Develop underpinning, integrated datasets and information systems o Good progress on this domain. o Good stakeholder engagement and clinical buy in. o Processes and systems in place for sharing information for direct care. o Technical solutions commissioned as part of the Principia Partners in Health MCP Vanguard. Domain 4. Aligning systems and sharing risks and benefits o Work in development and Mid Nottinghamshire Better +Together Vanguard leading nationally on this area. o Risk stratification tools embedded in practice with a test site including social care data to ascertain the added value. o Providers are engaged at a local level. For example, the Integrated Care Board in North Nottinghamshire has tasked providers with working together to develop a system wide outcome focussed falls pathway for 16/17. Domain 5. Measuring Success o Evaluation frameworks in place at a service level for the majority of services, however this could be more comprehensive. Domain 6. Developing organisations to enable effective health and social care working relationships o Positive relationships are in place and the vision is coherent, for example, in November 2015 the HWB hosted a workforce event jointly with the Nottingham City HWB to better understand our workforce needs. o Protocols and processes are in place between front-line teams to enable them to work proactively across organisational boundaries, for example, our multidisciplinary primary care teams are formed of primary care, community care, social care and voluntary sector colleagues who are able to share information and expertise across organisations for the benefit of our citizens. Areas for us to progress in 2016/17 include: Further develop relationships with providers and district councils to ensure that information is understood and filters through these organisations. Patient / service user / carer representation at a programme board level Healthwatch are part of the HWB, and units of planning have embedded patient / service user perspectives in commissioning. However, at a Nottinghamshire BCF Programme Board we do not have representation. Build on the JSNA to include mapping of assets. Further progress needed on procurement processes to enable smaller providers to engage fully in the developing market. It was recognised that as we scale up initiatives, this increases the risk of excluding providers. Engage all district councils in data sharing protocols. Work to evaluate outcomes at a programme / pathway level is needed with reference to the impacts on health and care commissioners and providers. Having reviewed schemes as part of the evaluation process, there will be no material changes to schemes / services within the BCF plan. However we have refocused some schemes in light of emerging priorities and changes within our planning footprint, for example, since BCF planning Nottinghamshire has been awarded Vanguard status in a Better Care Fund Plan 2016/17 for Nottinghamshire March 2016 Page 7 of 24

8 number of areas (Mid Nottinghamshire Better Together PACS, Principia Partners in Health MCP, Greater Nottingham Urgent and Emergency Care, East Midlands Radiology Consortium, Primary Care Homes in Nottingham North East and Bassetlaw CCGs) and we have considered this in forming our BCF plan. There are no material changes to our BCF schemes; some schemes have been rephrased due to developments. Our aspiration is to build on the knowledge and experience gained from BCF to develop our Sustainability and Transformation Plans (STP). We believe that it is in the best interests of the health and care economy to retain a Nottinghamshire approach to the STP, and that this would ensure that we can build on the positive work to date, such as our HWB and BCF plan which have been successfully operating across Nottinghamshire. Nottinghamshire comes under two separate NHS England regional areas; South and Mid Nottinghamshire are part of Midlands and East, and Bassetlaw is part of North of England. NHS England following local discussions have determined that South and Mid will be part of the same planning area, and it is recognised that Bassetlaw will face to Nottinghamshire as well as maintaining its links with South Yorkshire. 3 An evidence base supporting the case for change As outlined in the first section, we have made strong progress against our 2015/16 BCF plan with risk stratification embedded and good practice being shared across Nottinghamshire. The Nottinghamshire JSNA continues to inform key strategic plans, including the Health and Wellbeing Strategy. The JSNA Steering Group is responsible for directing the JSNA process for Nottinghamshire on behalf of the HWB. The JSNA in Nottinghamshire comprises life course sections: Children and Young People, Adults, Older People and Cross-cutting themes. Within these there are 56 individual topic chapters. The current JSNA topic chapters will be reviewed in 2016/17 to ensure that they are achieving the agreed objectives, reflect current priority issues, identify and address gaps, align with commissioning arrangements and approaches and have clear ownership across all the topic chapters. Our case for change remains consistent with our 2015/16 BCF plan. We recognise that the current health and social care system in Nottinghamshire is unsustainable without transformational change. Our health and social care economy is facing a very clear set of challenges. Some of these are universal to commissioners and providers throughout England, and urgently need innovators to develop solutions. Others are specific to Nottinghamshire, and take into account our local communities and organisations. Our most pressing challenges are: - An aging population, with more people needing more care. Over the next 20 years from 2016, the number of people residing in Nottinghamshire aged will increase from a range of 28% and 38% between each districts/boroughs. The overall Administrative County average is estimated to have increased by 35% for this age group. For the age group of 85+, it is expected that there will be an increase over the next 20 years by 28,210 individuals based within the Administrative County. This equates to 1,411 people per year for this particular age cohort. - A rising birth rate, placing increasing demand upon services. - Increasing numbers of young people with learning disabilities reaching adulthood: 128 in 2013/14 at a cost of 3.6m to the County Council. - Ongoing and increasing demand for acute hospital beds to deal with urgent care admissions, exacerbated in winter. Better Care Fund Plan 2016/17 for Nottinghamshire March 2016 Page 8 of 24

9 - Rising citizen expectations around the quality and location of care. - Financial constraints as healthcare sees only small budget increases, while social care sees significant decreases. - Saving requirements for adult social care of approximately 80-90m over the next three years, requiring a fundamental review of the social care offering. - Challenging fixed points in the system, such as the PFI arrangements at King s Mill Hospital. Additional information is available in document 04, which shows the wide array of work being undertaken to support our Vanguard programmes, and document 05 showing a summary of performance against BCF metrics 2014/15 and 2015/16 to date. Across Nottinghamshire we continue to adopt risk stratification delivered by Nottingham's ehealthscope project and based on the Devon CPM (Care Plan Management) solution in Mid and South Nottinghamshire, which uses information about admissions, outpatient attendances and A&E attendances to calculate the risk of future admissions, a locallydeveloped approach in partnership with the South Yorkshire and Bassetlaw Commissioning Support Unit in North Nottinghamshire. This information is then joined to care management information that GPs add information onto about the use of community services such as COPD matrons, heart failure matrons, and Crisis Intervention Services. This information is used in multidisciplinary team (MDT) meetings to make management decisions about who should be the care co-ordinator and which services should be offered to patients. MDTs concentrate on patients with a risk greater than 50% of admission, as this group has the greatest evidence for benefit (though the teams can view patients with lower risk). As outlined in BCF plans in 2015/16 we have an overarching model of care built around the principles of Support to Thrive, Choose to Admit, Transfer to Assess, and End of Life Care that we use to drive our county-wide and locality-based interventions. This approach is being taken to move towards more co-ordinated care for adults, including older people. Layered on this are locality-specific approaches designed to respond to local system pressures, and based on rigorous analytical modelling. 4 A coordinated and integrated plan of action for delivering change Our detailed BCF implementation plans can be found in the attached document 06 alongside updated Annex 1 forms document 07. These set out the timing and phasing for Better Care Fund Plan 2016/17 for Nottinghamshire March 2016 Page 9 of 24

10 all individual schemes, as well as the associated milestones and activity changes anticipated. Schemes contained within the plan include: Ref no. Scheme Locality A. Seven Day Working South Nottinghamshire B. Delayed Transfers of Care South Nottinghamshire C. Reducing non-elective admissions South Nottinghamshire D. Support to social care South Nottinghamshire E. Enabling South Nottinghamshire F. Proactive care (community based) Mid-Nottinghamshire G. Patient and carer support Mid-Nottinghamshire H. Better Together Implementation Support Mid-Nottinghamshire I. 7 day access to services North Nottinghamshire J. Mental Health Liaison North Nottinghamshire K. Discharge / Assessment incl. Intermediate Care North Nottinghamshire L. Respite services North Nottinghamshire M. Improving Care Home quality North Nottinghamshire N. Telehealth Countywide O. Support for carers Countywide P. Protecting social care Countywide Q. Disabled Facilities Grant Countywide R. Care Act Implementation Countywide Governance and accountability arrangements remain in place as outlined in our BCF 2015/16 plan with the HWB being ultimately responsible for maintaining oversight of the health and social care system. The countywide BCF Programme Board continues to oversee development and delivery of the plan, with monitoring undertaken by the BCF Finance, Planning and Performance subgroup. The supporting governance structure of the HWB is as follows: Better Care Fund Plan 2016/17 for Nottinghamshire March 2016 Page 10 of 24

11 Operationally, each locality already has an established board or group to oversee the development and implementation of integrated care plans and schemes within the BCF: the Integrated Care Board in North Nottinghamshire, the Alliance Board in Mid Nottinghamshire, and the South Nottinghamshire Integrated Health and Social Care Board. A dedicated BCF Programme Manager has also been appointed, and has dual accountability to the Local Authority and CCGs. This post is hosted by the Mid- Nottinghamshire CCGs. Our countywide BCF governance structure is shown on the following page: Better Care Fund Plan 2016/17 for Nottinghamshire March 2016 Page 11 of 24

12 Housing colleagues and providers have been involved in the development and agreement of the BCF 2016/17 plan. District Council colleagues from our seven districts have been involved in the development and implementation of the BCF with representation on the HWB, BCF Programme Board, and Finance, Planning and Performance subgroup. We have a lead Chief Executive and a lead Officer on behalf of these organisations. Key health providers are similarly engaged with representation on the BCF Programme Board and Finance, Planning and Performance subgroup, along with representation on Transformation Boards in the three Units of Planning. Since 2014 we have undertaken two audits of the BCF programme, with a further two planned to report in Q2 2016/17. Copies of the audit reports are attached as documents 08 and 09. In summary for both audits we received significant / substantial assurance concerning processes for our BCF pooled fund and governance arrangements: In 2014/15 the focus of our review has been on the effectiveness of emerging controls being put in place to support the management of the BCF pooled fund from 1 April Significant Assurance has been provided that the CCGs, working in partnership with Nottinghamshire County Council, are putting in place appropriate governance arrangements in relation to the BCF. Nevertheless, we have made a small number of recommendations to assist the CCGs in ensuring the effectiveness of the arrangements is maximised. 360 Assurance, April 2015 Better Care Fund Plan 2016/17 for Nottinghamshire March 2016 Page 12 of 24

13 We have audited the governance, performance monitoring and reporting arrangements in respect of the Government s Better Care Fund (BCF) to enable better integration of health and social care, fewer emergency admissions to hospital and more people living independently. In our opinion the level of assurance we can provide is: - Limited assurance Reasonable Assurance SUBSTANTIAL ASSURANCE Risk levels are low Nottinghamshire County Council Internal Audit, January 2016 As an overarching principle, accountability for performance, mitigation of risks, and any remedial action is managed wherever possible at Unit of Planning level and is monitored and overseen through the aforementioned BCF governance process. The Nottinghamshire BCF risk log can be found in the attached document 10. The Finance Planning and Performance subgroup regularly review and update the risk log. The BCF Programme Board review on a quarterly basis and escalate high risks to the HWB quarterly as part of performance reporting. 5 BCF National Conditions NATIONAL CONDITIONS A Plans to be jointly agreed As outlined above, housing colleagues and health providers have been involved in the development and agreement of the BCF 2016/17 plan. District Council colleagues from our seven districts have been involved in the development and implementation of the BCF with representation on the HWB, BCF Programme Board, and Finance, Planning and Performance subgroup. We have a lead Chief Executive and a lead Officer on behalf of these organisations. Key health providers are similarly engaged with representation on the BCF Programme Board and Finance Planning and Performance subgroup, and Transformation Boards within the Units of Planning. Our BCF plan is set within the context of longer term plans for the integration of health and care and work is underway to support STP planning building on the success of our BCF programme and work of the HWB. For example, a joint workshop was hosted by Nottinghamshire and Nottingham City HWBs to explore possible local solutions to known workforce issues. The workshop was designed to give participants the opportunity to share experiences and discuss local strategies to address workforce issues, such as 7 day working, use of agency staff, integrating workforce, skills and retention, new models of care, and implications of the living wage. Documents 11 and 12 contain a summary of the findings and outline the next steps locally. Better Care Fund Plan 2016/17 for Nottinghamshire March 2016 Page 13 of 24

14 B Maintain provision of social care services Our definition of protecting adult social care services remains consistent with our BCF 2015/16 plans with the BCF allocation for protecting social care services being targeted at the following: - Enabling the Local Authority to meet increasing demand arising from demographic changes with an aging population, and as a result of medical advances as people with complex health and social care needs are supported to live longer - Helping maintain essential social care services - Working with health and social care providers to ensure there is a robust and diverse market of care services to meet increasing demand - Supporting and investing further in preventative services which help people to remain independent - Helping meet cost pressures arising from the Care Act Supporting innovative ways of delivering health and social care services to help realise efficiencies and savings The services that will be funded from the BCF allocation include: Community-based care services for frail elderly people Social Work and Occupational Therapy assessment and care management staff Long-term nursing care placements Supported living Community-based care services for younger adults with complex health care needs Short term and targeted housing-related support services As detailed in the list of schemes contained in Part 2 of this plan, each of the three localities has explicitly allocated the mandatory funds for the specific purpose of protecting social care services, Care Act implementation and support to carers (summarised in the below tables) in a manner consistent with 2015/16 planning. This commitment is made in addition to other BCF schemes that will also be providing additional support to social care, both directly and indirectly. Locality Protecting Social Care Services 2014/ / /17 North Nottinghamshire 2,277,000 2,277,000 2,342,000 Mid-Nottinghamshire 6,245,000 6,245,000 6,423,000 South Nottinghamshire 7,645,000 7,645,000 7,680,000 County-wide Total 16,167,000 16,167,000 16,445,000 Locality Care Act Implementation 2014/ / /17 North Nottinghamshire 0 294, ,000 Mid-Nottinghamshire 0 863, ,000 South Nottinghamshire 0 788, ,000 County-wide Total 0 1,945,000 1,987,000 Better Care Fund Plan 2016/17 for Nottinghamshire March 2016 Page 14 of 24

15 Support to Carers county-wide initiatives Locality 2014/ / /17 County-wide Total 1,225,000 1,225,000 1,223,000 To complement the information available in the updated Annex 1 forms, document 07, a copy of Nottinghamshire Carers Strategy is attached as document 13. C Agreement for the delivery of 7-day services across health and social care to prevent unnecessary non-elective (physical and mental health) admissions to acute settings and to facilitate transfer to alternative care settings when clinically appropriate Nottinghamshire remains committed to providing 7 day services within the Joint Health and Wellbeing Strategy, and its local planning groups. 7 day services to support hospital discharge and avoid admissions to both hospital and care homes are particularly key to supporting the strategic principles. One related initiative to support our vision for 7 day services has been the involvement of primary care in discharge planning following an emergency admission. Nottinghamshire currently has a number of 7 day services already in place, such as Rapid Response Teams and Intermediate Care Teams, and a number of developments to services are outlined in the BCF plan. The continuation and/or expansion of existing services are crucial to delivering the change required. Plans have been developed during 2015/16 to ensure progress toward 7 day services in key areas of delivery. In July 2015 the BCF Programme Board reviewed its progress on BCF plans using the NHS Improving Quality Seven Day Services: 10 point Implementation Checklist in the attached document 14 and were assured that good progress was being made. In relation to clinical standard 9: Services are developing to give primary and community care staff improved access to senior clinical expertise. For example, in Mid Nottinghamshire Call for Care, a care navigator service for health professionals is in the early stages of implementation. As outlined in more detail in relation to National Condition 4 (Section 5D), Connected Nottinghamshire has a dedicated workstream focussing on full role out of integrated care records (with informed consent) for direct care and the necessary information sharing protocols are in place. Multi-disciplinary primary care teams are in place across Nottinghamshire. These teams are informed when patients are discharged from hospital and case managed as appropriate. Transport services are available 7 days a week across the county. Local NHS contracts with providers contain Service Development and Improvement Plan detailing actions to progress seven day services. Services will be focussed on preventing admissions and for those that are admitted, stepping down to other services as soon as possible, for example, the Better Together Urgent and Proactive work-streams in Mid Nottinghamshire are currently being mobilised to ensure that patients receive an integrated assessment that is available 7 days a week. The services will aim to support patients in or returning to their usual place of residence wherever possible, with bedded alternatives available where this is not appropriate. Better Care Fund Plan 2016/17 for Nottinghamshire March 2016 Page 15 of 24

16 A copy of our updated BCF plan 2015/16 seven day services delivery plan is attached document 15. D Better data sharing between health and social care, based on the NHS number A countywide programme Connected Nottinghamshire is leading on information systems integration. This includes work on integrated datasets, Information Governance, underpinning infrastructure and standards. The work is progressing well with engagement across all partners and supporting the integration of services by enabling the sharing of key information. As part of the overall planning for BCF and STP, Connected Nottinghamshire are facilitating the development of the Nottinghamshire Digital Roadmap which will set out the plan for Planning for the Nottinghamshire Digital Roadmap commenced at our November 2015 Health and Care IT Summit, which involved members from all Connected Nottinghamshire partners including citizens and patients. Connected Nottinghamshire members have submitted the Digital Footprint and are progressing the development of the Roadmap for submission later this year. The Nottinghamshire Digital Roadmap will be aligned to BCF and STP plans with HWB approval. This document will outline the programme vision, governance arrangements and accountabilities. It will be made available from March 2016 and will supersede the existing Connected Nottinghamshire Blueprint. The content will include: Access to information systems Integrated Digital Care Records Plans for exchange of data Plans for workflow (tasks/referral/s2&5) Integration tools such as MIG and the Care Portal Citizen access to records Mobile workforce Information Governance arrangements Benefits and evaluation/exploitation All project boards have citizen representation, and through existing engagement forums we ensure that citizens and patients play an active part in the design of solutions. To engage the wider population we have developed a set of leaflets and posters, which are utilised across partners, and explain how information is being used. Alongside this, website privacy notices have been updated to incorporate these messages. We plan to develop a comprehensive communications plan to support the Digital Roadmap. Connected Nottinghamshire is concluding Tranche 1 of implementation. Tranche 1 has laid the foundations for future integration requirements (technical enablement and information governance principles development). Excellent progress has been made in populating systems with the NHS number. Agreement of the use of the NHS number has been in place for some time. With modern systems in place, the timeliness of NHS Number matching is primarily at the point of contact via PDS linked PMI trace. Recent research puts tracing/use of NHS number at 98% in the main providers, with the Ambulance Service matching approx. 60% of Better Care Fund Plan 2016/17 for Nottinghamshire March 2016 Page 16 of 24

17 GP Hospital Social Care Community Mental health Specialised palliative electronic records within 24 hours. Matching and recording of NHS Number across social care systems is in place and on-going via direct entry or batch tracing of NHS number via PDS. Key systems have been modified to support the storage and use of the key identifier. Using the MACS Service, social care system data has been submitted from the local authorities and matched to NHS Numbers, which are then data quality checked and uploaded. Progress to date is 85% of current caseload records matched. All procurements now have a set of requirements addressing the requirements for Open APIs. Recent procurements have addressed this specifically and now basing development of these APIs on the NHS England API standards document. Our position at Quarter /16 is as follows: Progress towards installation of Open APIs to enable information to be shared with other organisations Progress status Projected 'golive' date (dd/mm/yy) Installed (not live) Installed (not live) 01/10/17 01/10/17 Installed (not live) Unavailable In development In development Connected Nottinghamshire has oversight of the Nottinghamshire Health and Social Care Records Information Group. This GP, Caldicott Guardian led group is leading the way in relation to IG requirements and ensuring Nottinghamshire has good information sharing for direct care and risk stratification. In addition to this and in line with Caldicott 2 recommendations and best practice, pseudonymised or annonymised information is used sharing for reporting. A Nottinghamshire Data Sharing Protocol is already in place across all partners and due for review in summer Sharing to date has been using existing messaging capability and shared access to multiple systems. This has been supplemented with the use of the Medical Interoperability Gateway (MIG) and is now moving into the key phases of MIG2 and implementation of the Care Portal. The table below sets out the forthcoming key milestones, along with expected and required dates. The overall plan is reported by the Connected Nottinghamshire Programme Director and monitored by the Connected Nottinghamshire Board. The milestones are inter-organisational some require crossorganisational delivery. Milestone MIG2 sharing of additional datasets across Health and Care live Electronic workflow (S2,3 & 5) phase one live Nottinghamshire Care Portal 1. Phase one (estimated February 2016-November 2016) October 2016 October 2016 January 2016 Better Care Fund Plan 2016/17 for Nottinghamshire March 2016 Page 17 of 24

18 Milestone a. NUH, SFHFT, NHCFT connectivity (through trust integration engine connected between Highway, Rhapsody and Ensemble respectively). b. Commercial arrangements in place for phase one providers c. IG arrangements in place d. MIG connectivity into CareCentric e. CareCentric viewer available for Care Co-ordinators and Call for Care f. GP direct connect phase one - pilot (12 practices?) g. Structured messaging in place for ITK transit (edischarge and letters) h. EPaCCS transition i. Governance arrangements in place j. Benefits framework in place 2. Phase two (estimated January 2016-October 2017) a. Nottinghamshire County Council connectivity (via TotalMobile connect interface?) b. Nottm City Council (connection via Liquid Logic) October 2017 As part of the overall delivery and assurance framework, benefits of the Connected Nottinghamshire programme are reported into Connected Nottinghamshire. The Programme Director provides regular updates to the Better Care fund Implementation Board and the HWB. Better Care Fund Plan 2016/17 for Nottinghamshire March 2016 Page 18 of 24

19 The figure below shows the overall benefits framework used for management and tracking of benefits of the programme. Connected Nottinghamshire also manages the risks and issues associated with this work. Locally we are making good progress and risks for NHS number, Open APIs and data sharing are low with Privacy Impact Assessments being undertaken for all projects: There is a risk Mitigation Residual Risk Rating that NHS number is not matched NHS numbers are provided at the Low on a live basis between health and social care point of referral with mechanisms in place for requesting this that the national GP SOC API is Mechanisms in place to share Low not available locally that there are inconsistencies across Nottinghamshire is the use of secondary uses of data data through the MIG and portal Vanguard support will be in place from April 2016 to progress E Ensure a joint approach to assessments and care planning and ensure that, where funding is used for integrated packages of care, there will be an accountable professional There is an identified case management approach across the County with risk stratification tools being used to identify those people most at risk of a hospital admission as outlined in our BCF 2015/16 plan. All areas use a MDT approach, the specific details vary by Unit of Planning e.g. multi-disciplinary, multi-agency teams are established; Care Low Better Care Fund Plan 2016/17 for Nottinghamshire March 2016 Page 19 of 24

20 Delivery Groups in South Nottinghamshire, Local Integrated Care Teams in Mid Nottinghamshire, and Integrated Neighbourhood Teams in North Nottinghamshire. As outlined in Section 3, risk stratification tools are used in the management of multidisciplinary care teams for direct care. There are two NHS England approved risk stratification tools in use across our 6 CCGs. Our risk stratification algorithms uses a threshold of the top 5% (numerically) of patients with a score generated from the last 2 years of SUS data (i.e. a subset of our total resident / registered population who have interacted with secondary care in the past 2 years). Practices use the information to manage their active caseloads across the whole care team and prioritise the at risk patients. Practices typically focus on those with a score of 40-50% and above, lowering that threshold as time and resources permit. Work is also underway to introduce Social care data to this modelling. Self-management support is available to individuals within both the standard disease management, and primary prevention categories representing approximately 95% of the population. Within wider transformation plans, mental health and dementia are priorities. There are already a number of integrated teams in place both within and outside of the BCF schemes. For example, outside of BCF plans there is a Nottinghamshire wide Intensive Recovery Intervention Service (IRIS) in place. IRIS is a 12 week intermediate care service delivered by a multidisciplinary care team (available 7 days a week) for older Better Care Fund Plan 2016/17 for Nottinghamshire March 2016 Page 20 of 24

21 people with mental health problems and/or dementia to facilitate hospital discharge and/or prevent hospital or care home admissions. Within our BCF plan, there is funding for the Compass Workers carers service which is complementary to IRIS. The Compass Workers are peer support workers who have personal experience of being a carer. Compass Workers provider support to people of any age caring for someone with moderate to severe dementia who lives at home and is under the care of a Community Mental Health Team (CMHT) or IRIS for up to 12 sessions. We are developing this service in 2016/17 to expand the capacity of the service and include support to those not registered with the CMHT. Copies of our mental health strategy No Health without Mental Health, Nottinghamshire s Mental Health Framework for Action (Final October 2014) and suicide prevention strategy Nottinghamshire Suicide Prevention Framework for Action are attached as documents 16 and 17. F Agreement on the consequential impact of the changes on the providers that are predicted to be substantially affected by the plans As outlined in Section 4, our BCF Programme Board and transformation board continue to include representation from providers including our acute, community, ambulance and mental health trusts, and regularly reports to and is led by the HWB. Relationships across Nottinghamshire are continuing to strengthen as new models of care are adopted, for example, Mid Nottinghamshire are developing an alliance as part of the PAC vanguard, Rushcliffe are developing an MCP vanguard, and North Nottinghamshire are developing an Accountable Care Partnership. The County Council commissions a range of community-based care and support services from independent sector providers to support people to live independently in their own homes. The Council has contracts with over 400 care and support providers for a range of services including domiciliary care, supported living for people with learning disabilities, physical disabilities and/or mental health needs, and community equipment services, including minor adaptations. Many of these services are commissioned jointly with the CCGs. Providers and wider stakeholders continue to be engaged to discuss strategic commissioning intentions through engagement events and contract negotiations. These discussions have also involved their role in avoiding unnecessary admissions to hospital, facilitating timely discharge, and sharing pertinent information with health and social care professionals. The Local Authority is working with providers and colleagues from CCGs and the CQC to drive quality standards in care homes and for homecare providers. Providers have in place their own risk management and action plans to respond to change in activity. Within local transformation boards, and where appropriate, steering groups for strategic priorities have membership from the community and voluntary sector. For instance, in Mid Nottinghamshire representatives of the Community and Voluntary Services in each locality sit on the CCGs Stakeholder Reference Group in Newark and Sherwood and the Citizens Reference Panel at Mansfield and Ashfield. Our vision of integrated care is important, but it is how outcomes are met and experienced by the citizen that really matters. Nottinghamshire s plan for integrated care has therefore been designed with the needs of the citizen at its core. Accordingly, we Better Care Fund Plan 2016/17 for Nottinghamshire March 2016 Page 21 of 24

22 have deliberately implemented all engagement activity at locality level, based on prior experiences on how to best achieve deep and impactful engagement. Healthwatch are also represented on our HWB, as well as the South Nottinghamshire Transformation Board. G Agreement to invest in NHS commissioned out of hospital services, which may include a wide range of services including social care Investment in NHS commissioned out of hospital services, including social care equates to approximately 27.5 million in our BCF plan (over 5 times the amount previously allocated to Pay for Performance). The crux of our BCF plan since 2014 has been to focus on out of hospital services to support the shift in activity, facilitate system flow and prevent avoidable admissions to hospital and care homes. Our plans have a particular focus on integrated care teams to facilitate discharge and support citizens in the community, intermediate care and reablement services, including transfer to assess, and support for carers. Our level of investment against the minimum allocations can be seen in the table below. Investment in NHS commissioned out of hospital Locality services 2016/17 allocation 2016/17 investment North Nottinghamshire 2,147,000 3,547,000 Mid-Nottinghamshire 5,852,000 10,336,000 South Nottinghamshire 6,390,000 11,152,000 County-wide Total 14,389,000 25,035,000 Our BCF Programme Board has considered a risk sharing arrangement for out of hospital services and concluded that it is not required at this time due to our strong working relationships and risk share agreement within our pooled fund agreement. As in our risk sharing agreement, risk will be managed at a Unit of Planning level. H Agreement on local action plan to reduce delayed transfers of care (DTOC) Delayed Transfers of Care are managed through each planning units System Resilience Group (SRG) and monitored by the BCF Finance, Planning and Performance subgroup. The Finance, Planning and Performance subgroup have members from the three SRGs and have developed a locally agreed target which has been built up from targets contained within the six CCG operational plans due to the differing requirements of the BCF and CCG operational plan targets. Both at a local level and through the BCF governance structures acute and community trusts have been engaged in the monitoring and development of DTOC targets. Our BCF Programme Board has considered a risk sharing arrangement for DTOCs and concluded that it is not required at this time due to our strong working relationships and need for local management at a Unit of Planning level. Document 18 contains a situation analysis, overview of progress against the 8 high impact interventions and capacity review against NICE Guidance (Transition between Better Care Fund Plan 2016/17 for Nottinghamshire March 2016 Page 22 of 24

23 inpatient hospital settings and community or care home settings for adults with social care needs (NICE social care guideline NG27, December 2015)). 6 Financial risk sharing and contingency As previously set out in our BCF 2015/16 plan, Nottinghamshire is a complex health and care economy, comprising six CCGs working as three units of planning, a two-tier local government structure consisting of a County Council and seven District Councils, three major acute Trusts which relate primarily to the three units of planning, and a myriad of health and care providers across all sectors. The HWB have been actively engaged in supporting and driving the BCF plan for Nottinghamshire, and consider the risk sharing approach to be appropriate for the complex environment described. The 2015/16 BCF plan has established a financial risk sharing mechanism that has operated successfully in the first year of the pooled fund. This risk sharing mechanism is in addition to existing risk sharing mechanisms that currently exist across the CCGs in Nottinghamshire for expenditure that sits outside of the BCF pooled fund services. For 2016/17 the established BCF pooled fund risk sharing mechanisms will remain largely as per the 2015/16 arrangements. The mechanism recognises that the initial level of risk sharing is at an individual organisation or Unit of Planning level, utilising established contingencies in existence outside of the core BCF pool to mitigate risks in the first instance. Expenditure on Protecting Social Care Services, Disabled Facilities Grants, Social Care Capital and Care Act Implementation is explicitly assumed to remain within the allocation and thus deemed to be expenditure that is not risk shared. Should risks exceed those that can be managed at a Unit of Planning level, an escalation route to the Programme Board is in place. The Board will consider various options to mitigate the overspend / risk. These include an appraisal of actions that can be implemented to contain expenditure, viring underspends from other Unit of Planning or Council funds from the BCF pool and how any risk or overspend will be apportioned across organisations. Our county-wide BCF governance arrangements have created a forum for discussing local and shared risks impacting upon integration transformation. These discussions enable shared learning and dissemination of best practice in terms of effectiveness of required interventions, and approaches to managing and mitigating delivery risks. While addressing local health and social care needs, the Transformation Boards in each of the three Units of Planning take a similarly robust approach to identifying, monitoring, reporting, and mitigating risks within individual schemes. The BCF Finance, Planning and Performance subgroup reporting ensures a clear line of sight across Unit of Planning mitigations and use of contingency and significant matters will be escalated up to the BCF Programme Board. CCGs continue to managed activity variances, and have a number of process and governance structures in place to identify these early and mitigate. CCGs hold both contingency and specific risk reserves based on calculated risk at plan stage, so these resources will be utilised should investment be needed for any mitigation or corrective action. Better Care Fund Plan 2016/17 for Nottinghamshire March 2016 Page 23 of 24

24 Mechanisms also exist and are built into provider contracts to manage and minimise the impact of any variation to the system. Furthermore, the whole focus of the schemes in the BCF plan is geared towards admissions avoidance, and the implementation of these (and therefore the investment) will be done in a planned and managed to way to allow flexibility to transfer resource should there be slippage within the schemes. In addition, it is important to note that the BCF schemes focus on admissions avoidance have been developed across the health and social care community with full engagement. Therefore, each scheme has its own set of potential risks identified, mitigations, and contingency. At this level, this means accountability is clear and each organisation is clear on the risks to them and their planned response. Better Care Fund Plan 2016/17 for Nottinghamshire March 2016 Page 24 of 24