Sheffield Better Care Fund Abbreviations BCF – Better Care Fund NHS SCCG – NHS Sheffield Clinical Commissioning Group SCC – Sheffield City Council ACS –Accountable Care System CYPF – Children’s & Young people Fund PKW – People keeping well PKW SP – People Keeping Well Social Prescribing CSW – Community Support Workers VCS – Voluntary Support Workers BRC – British Red
KPI – Key performance indicators STIT/CICS – Short Term Intervention Team LCS – Locally Commissioned Scheme PAM – Patient Activation EOL – End of Life EPaCCS – Electronic Palliative Care Co-ordination Systems LTC – Long Term Conditions AS&R – Active Support & Recovery STP - Sustainability and Transformation Plan ACP – Accountable Care Partnership CHC – Continuing Health Care STH – Sheffield Teaching Hospital SHSC – Sheffield Health and Social Care EMG – Executive Management Group A&E - Accident and Emergency SPA - Single Point of Access AMU – Acute Medical Unit PDDs – Planned Discharge Dates CEOs – Chief Executive Officials ACO – Accountable Care Organisation VAS – Voluntary Action Sheffield DFG – Disabilities Facilities AHH – Adoptions Housing and Health
• respond quickly to the additional of people in this cohort and support them to remain out of hospital. • make sure that people are discharged home with the appropriate support, minimising their hospital stay and maximising their recovery and level of independence. Theme 3 - Independent Living Solutions The Strategic Objective for this scheme is to develop and promote the provision of independent living solutions in Sheffield so that more people can maintain and their wellbeing and independence. This is mainly through the Community Equipment Service which is funded from the BCF pooled budget. This service provides loans of community equipment and minor adaptations for disabled children and adults across the city. The service was contracted out to the British Red Cross in July 2015, having previously been run by the local NHS provider. Theme 4 - Ongoing Care The overall aim of this is to integrate the assessment, placement and contract management functions related to ongoing care to improve quality, outcomes and process. Theme 5 Adult inpatient Emergency Admissions The overall aim is to undertake activity to reduce demand for admissions and to ensure that the patient stay whilst in hospital is as short and effective as possible. Additionally it allows monitoring of the impact of other BCF activity to reduce demand for hospital emergency admissions. Theme 6 - Mental Health The aim is to deliver a truly integrated commissioning approach which will offer more effective joined up commissioning (and therefore care), leading to better patient outcomes which will, by default, deliver better value for money. Theme 7 - Capital Expenditure The scheme will deliver home adaptations funded from the Disabled Facilities to enable people to remain in their own homes and live independent lives and reduce their need for organised care. Other Capital Grants will be used to deliver better systems to administer ongoing care. Progress to date Sheffield people have told us: “If things go wrong it’s difficult to receive the care I might need quickly enough” “I find it hard to find my way around all the variety of services – or even to know if what I need is actually provided by someone” “We have to constantly repeat information from one person to another” “I have little control over the care I do or don’t receive”
SK Description Imp Prob Risk Score Mitigation Action ID & Target Mitigation Date & Owner RISK – Risk that projects will not fully deliver until robust plans in place and resources for delivery identified CONSEQUENCE – Slippage in project plan milestone 4 3 12 Detailed project plans to be developed to include any resource requirements and milestones Project Leads – July 2017 RISK – Risk that stakeholders do not fully engage in new ways of working CONSEQUENCE – system reverts to previous behaviours 4 4 16 Comms engagement via Neighbourhood news and ongoing liaison with Locality Managers / key stakeholders LMs/LW/KD - ongoing RISK – Risk that programme is not fully aligned with other interdependent projects CONSEQUENCE – Mismatch in aims/expectations 3 3 9 Overarching Better Care Fund PMO approach to align project dependencies SB /LW – monthly update RISK – Risk that the required QIPP is not achieved in year CONSEQUENCE – Financial gap for city has to be met from schemes 4 2 8 QIPP trajectory across financial year agreed with project leads and finance – delivery monitored on a monthly basis
Outcome Metric How will this be Achieved Risks Mitigations Current Performance Increase number of same day discharges from assessment units Increase the % of 0 LOS spells on assessment units A large body of work has been undertaken to identify opportunities in assessment pathways to improve efficiency and in some areas entirely new pathways have been developed. It has been recognised too that the sooner the patient arrives into the assessment units the greater the chance of a same day discharge. Where appropriate and safe, patients are being advised to transport themselves to the assessment units rather than waiting for transport. Winter Pressures will overwhelm supporting services both within the hospital and wider health and social care system. A lack of responsiveness could have a significant impact on the ability of these pathways to function effectively System wide winter resiliency plan Supporting initiatives to support system resiliency as a e.g. Weekly Flow Group meetings and Newton Europe work YTD performance is 45% of spells are now 0 day LOS up from last year (circa 30%)
Outcome Metric How will this be Achieved Risks Mitigations Current Performance Reducing LOS on spells less than 4 days in 5 identified specialities Reduction in the average LOS across the 5 identified specialities Improve patient flow in the identified specialities by rolling out the Excellence in Emergency Care programme: Creating the “Vital Room” community within the STH to improve cross-speciality working Introduction of the SAFER 10 Flow principles onto wards initiatives such as “Give it a Go Week” to encourage new ways of working Winter Pressures will overwhelm supporting services both within the hospital and wider health and social care system. A lack of responsiveness could have a significant impact on the ability of these pathways to function effectively System wide winter resiliency plan Supporting initiatives to support system resiliency as a whole e.g. Weekly Flow Group meetings and Newton Europe work LOS (< 4 Days) has been reduced by 0.4 on average in the 5 identified specialities. Outcome Metric How will this be Achieved Risks Mitigations Current Performance Reducing the number of Delayed Transfers of Care (DTOCs) DTOCs to be reduced to 50 by September 2017 and beyond A cross city taskforce has been assembled and initiatives identified to reduce DTOCs via a number of methods across the system. The initiatives have been grouped into 3 separate workstreams each led by a city organisation executive. This work is being supported by Newton Europe who have a deep level of experience in improving the performance of health and social care system systems Independent Sector capacity during winter Additional funding from Local Authority during winter have currently been reduced to 62 as of the last weekly report (historically in Sheffield this would be over 100 consistently). The expectation is that the target of 50 will be achieved by September 2017
The CCG contribution to the BCF budget is set to provisionally increase in 2018/19 by £4.4m but this is stated before the setting of 2018/19 QIPP requirements will be determined as part of the 2018/19 planning and contracting round commencing in September 2017. Agreement on funding for carers has been in place for some time. There is a Carers Core Service which provides information and advice, including carers assessments. There is also community outreach via People Keeping Well activities, and breaks from caring also delivered via People Keeping Well partnerships. The CCG were party to the development of the Carers Strategy which is implemented by the Council. Care Act duties are partly funded by the CCG contribution to social care which is discussed in more detail under national condition 1. Considerable reablement services are provided both by the Authority and CCG as part of the commissioned out of hospital services within Theme 2 AS&R. Funding agreement for these services has been in place for some time. IBCF Grant As set out in the 2015 spending review and the BCF Policy Framework, Sheffield’s iBCF commits available funding to the three priorities set out below. The plans were were recently approved by SCC Cabinet, outlining the conditions as set out in national guidance, pooling the grant funding into the local BCF, working with the CCG and Providers and providing quarterly reports. The paper can be viewed in the following link. There has been extensive consultation with NHS partner organisations, both CCG and Providers in Sheffield, to ensure that the balance of investment helps the whole health and care system provide better outcomes for local people. The three key priorities are: The need to invest in development, innovation and infrastructure that will address underlying issues, rather than continuing to work within the existing health and care system and its constraints. £5.900m investment earmarked to support this priority over three years. The need to build the sustainability and resilience of the adult social care provider market so that capacity is there to support the whole health and social care system, particularly in times of high demand. £9.813m investment earmarked to support this priority over three years. The need to ensure that adult social care needs can still be met where there is significant financial constraint that might otherwise result in a service reduction. £8.287m investment earmarked to support this priority over three years. The year one delivery has been allocated to individual themes.
Appendix 4 Active Support and Recovery Deliverable Theme of Risk Mitigation Lead Sheffield Place Based plan and STP There is a risk of duplication of effort or absence of synchronisation of activity due to the areas of overlapping with other work streams within the wider Sheffield Transformation Board and STP, and this may lead to undermining maximisation of the scale of opportunity. Development of the Sheffield Transformation Board governance with regular reporting within and across work streams will minimise impact. AS&R work stream lead director and programme manager linked into to share progress, developments and learning. Internal programme There is a risk to programme delivery activity due to activity in the AS&R work stream cutting across change programmes which are internal to CCG and LA e.g. consistency with QIPP agenda, Primary Care and Cases, and this can lead to loss of direction in the internal programmes. Dependencies are mapped to identify cross over and key leads become stakeholders in AS&R with regular communication. & Engagement is a risk of ineffective engagement at multiple levels across Sheffield including within organisations for staff as well as within the programme of AS&R, Neighbourhoods, and including citizens and patients, due to lack of engagement and lack of clarity of vision and lack of key communications with key stakeholders, thus resulting in failing to ensure the programme is not able to achieve the objectives. Robust stakeholder identification and a clear programme of structured communications is implemented. Clear messages are appropriately directed to key audiences ensuring stakeholders maintain necessary levels of influence and knowledge. Programme to utilise the best and most appropriate channels to communicate with stakeholders. Blueprint of AS&R programme There is a risk of significant change in external environment as a result of national, regional and PAN Sheffield policies and commissioners development which could lead to ongoing need for scope change of the programme resulting in lack of clarity of vision and lack of delivery of programme. Clear vision and support with continued engagement with commissioners and providers and Neighbourhoods and one- to- one engagement with providers.