Better Care Fund: Target setting for Delayed Transfers of Care Rutland situation
Delayed Transfers of Care (DToC) have been rising for some time Hospital delays constantly on the news Puts pressure on the acute sector reduces bed capacity for healthcare Social care attributable DToCs are a growing part of the picture 4,000 3,500 3,000 2,500 2,000 1,500 1,000 NHS Social Care 500 0 Apr-14 May-14 Jun-14 Jul-14 Aug-14 Sep-14 Oct-14 Nov-14 Dec-14 Jan-15 Feb-15 Mar-15 Apr-15 May-15 Jun-15 Jul-15 Aug-15 Sep-15 Oct-15 Nov-15 Dec-15 Jan-16 Feb-16 Mar-16 Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Average DTOC per day Both
Better Care Fund programmes are tackling DToCs An aim of Better Care Fund programmes since 2015 Good results in Rutland between 2014-15 and 2016-17 Social care delays down 85% NHS delays down 26% Overall delays down 32% Success of innovative integrated working and tackling root causes But, that hasn t been the case everywhere
Driving faster improvement Two-pronged national effort to support improvement via hospital sector and Better Care programmes High Impact Change Model introduced last year for BCF Maturity model identifying aspects to improve Led to successful Rutland 2016-17 DToC Action Plan Model mandated this year Rutland s 2017-19 BCF plan has a follow-on DToC Action Plan BUT issue continued nationally: Feb 2017 = 6,600 DToCs per day (Feb 2016 = 5,500) This means 6,600 beds unavailable for care Tougher national approach
The overall national target is expressed 2 ways Overall hospital target Measured in lost bed capacity Overall target for HWB areas Measured in delayed patients National hospital target To ensure that 3.5% or less of available hospital bed capacity is lost to discharge delays on any given day. National population target To keep the number of people delayed in hospital to 9.4 delays or fewer per 100,000 adults per day
July: National expectation targets set for BCF programmes A DoH spreadsheet set out, for each HWB area in England, a level of DTOCs that they had to commit to achieve by November 2017 Everyone sharing the load: Poorly performing areas requirement to reduce DTOCs dramatically in many areas Well performing areas requirement to sustain good rates or improve *New: Targets also broken down by sector responsibility for 50% of the reduction by NHS partners, 50% of the reduction by social care partners Targets set relative to performance in February 2017
So what s the problem? 180 160 140 120 100 80 60 40 20 0 Apr-15 May-15 Jun-15 Rutland DToCs by attribution - to the NHS, social care or jointly attributable (actual days) Jul-15 Aug-15 Sep-15 Oct-15 Nov-15 Dec-15 Jan-16 Feb-16 Mar-16 Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17 May-17 Jun-17 Jul-17 2. Zero jointly attributable delays and negligible social care delays not a realistic benchmark Both SC and NHS SC Total NHS Total 1. February 2017 was exceptionally good for Rutland sustaining this performance level is not credible
Rutland s counter-proposal 180 160 140 120 100 80 60 40 20 0 Apr-15 May-15 Jun-15 Rutland DToCs by attribution - the NHS, social care or jointly attributable (actual days) Jul-15 Aug-15 Sep-15 Oct-15 Nov-15 Dec-15 Jan-16 Feb-16 Mar-16 Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17 May-17 Jun-17 Jul-17 2. As part of the adjustment, allow for a slightly higher level of social care and jointly attributable delays Both SC and NHS SC Total NHS Total Total target 1. Use the Q4 2016-17 average as our flat line target more representative of recent performance NB: Method used by CCGs
The targets in perspective 12 10 DToCs per 100,000 adults per day 9.4 10.25 8 7.1 6 4 4 5.6 2 0 Rutland Expectation Rutland Counter proposal Rutland performance Apr- Jul National average target Rutland 2016-17 average
The expectation and proposed targets relative to previous performance annual DToC totals 1800 1662 1600 2014-15 1400 1200 1260 1133 2015-16 1000 936 863 973 2016-17 800 600 400 200 0 624 524 416 442 346 144 62 53 50 56 26 48 50 0 NHS Social Care Joint Total Q4 baselined target - 2017-18 Expectation target - 2017-18
What the proposed targets mean in terms of Rutland people delayed Per day, target would rise from 1.2 people delayed to 1.7 Per 31-day month, target would rise from 37.5 nights of delay to 53 nights In reality, even the more generous target is easily exceeded: July 2017: 22 nights of delay at Peterborough on target Except There were 51 nights of delay at Kettering that only came to light in July s national DTOC statistics
Overall position against expectation and counter-proposal by end July Joint Social Care and NHS 16.7 17.0 Social care & joint delays: On track for counter-proposal, but expectation exceeded Rutland expectation Social Care Total 16.7 17.0 NHS delays: Both targets being exceeded Q4 based target NHS 175.2 Actual 230.0 0.0 50.0 100.0 150.0 200.0 250.0
NHS England are not currently supportive of the Rutland proposed targets Q4 based targets and rationale submitted 15 August 2017 BCF narrative programme submitted 11 September 2017 Letter received from NHS England 20 September Notification of potential non approval of Rutland s BCF programme if DToC are not at least as ambitious as the overall HWB target for the reductions of DToC by November 2017 No consideration to date of Rutland s rationale for counterproposal Other authorities in a similar dialogue Leics, Leicester, Northants LGA and ADASS are disputing the expectation approach National BCF assurance group meets to decide programmes 4 October
Catch 22 Could delay BCF programme approval if we don t agree expectation targets, even if unrealistic Could impact on I-BCF funding next year if we don t achieve targets
Health and Wellbeing Board We have responded to reiterate the basis for our proposal and invite specific dialogue with NHS England In the meantime, views are invited from the HWB Options: Agree expectation targets to move forward?!!!!!!!! Even very low DToC rates = failure if not low enough Negative impact on local partnership, governance and performance? NB: Use local reporting to convey the reality of performance? Implies a risk to future I-BCF funding ( 168k next year) What happens in November? Anticipate many areas will not have met the expectations Hold the position and negotiate?!!!! Something else? The risk to current programme continuity and funding is not known Difficult nationally to vary the ask for one area More realistic, responsible, transparent