Agenda item

The Committee considered a report of the Director of Health and Care Integration which provided an overview of the progress to refresh and submit the Leicestershire Better Care Fund (BCF) plan including an update on the refreshed spending plan and outcome metrics for 2016/17 as at 17th March 2016. A copy of the report marked ‘Agenda Item 8’ is filed with these minutes.

In introducing the report the Director of Health and Care Integration provided the details of the emergency admissions avoidance schemes in place which were as follows:

•        7 day services in Primary Care run by East and West Leicestershire CCGs.

•        The falls service.

•        An older persons unit at Loughborough Hospital assessing those in need of urgent diagnostics and support with their Care Plan.

•        Integrated Crisis response providing 72 hours care in a patient’s own home.

•       A new scheme for 2016/17 at Glenfield Hospital designed to avoid admissions for cardiac and respiratory problems.

Arising from discussion the Committee was advised as follows:-

(i)     There was a requirement to include a measurement of patient and service user satisfaction within the Better Care Fund.  Locally, the GP survey question regarding whether patients were satisfied with the support they received to manage long term conditions was used for this purpose.  It was noted that the survey was sent to a random selection of patients each year and was administered nationally on behalf of CCGs, so it was sometimes difficult to measure year on year improvements and whether these had been actively influenced by local changes, using this survey.  The Director of Health and Care Integration undertook to inform the Committee of local response rates to the most recent questionnaire and would seek this information from each CCG.  It was noted that, in order to improve patient satisfaction in supporting people with long term conditions, community based case management had been introduced.

(ii)    Clarification was provided regarding the terminology used in the Metrics in connection with assessing the amount of admissions. It was noted that Metric 4 referred to the total number of emergency admissions whereas Metric 6 was a subset of that and referred specifically to admissions related to injuries due to falls. The definition of an ‘Avoided Admission’ was discussed and the Director of Health and Care Integration explained that in each of the schemes data was recorded against a clinical definition to examine if the activities carried out within the alternative pathway prevented an admission to hospital particularly in the 14 day period after an incident/accident occurred. However, it was recognised that this was an inexact concept to assess and clinical judgements would have to be made on what constituted an avoided admission. To support this work there was a clinical definition of an avoided admission for each scheme. Independent Evaluation including Clinical Audit was carried out to assess how the schemes were operating against the assumptions and gather evidence to inform future practice and commissioning arrangements. Members welcomed the robust attempt made through the Better Care Fund Plan to measure and evaluate the effectiveness of initiatives.

(iii)    The Better Care Fund Plan did not include all schemes to reduce readmissions to hospital; further work in this area was being led by the Urgent Care Board and Vanguard initiatives. However, it was intended that the learning from the Better Care Fund work to date would be incorporated into future urgent care delivery models.

RESOLVED:

(a)    That the progress made to refresh and submit the Leicestershire Better Care Fund (BCF) plan be noted;

(b)    That officers be requested to inform the Committee of the response rate for the GP patient survey;

(c)    That officers be requested to consider how the Better Care Fund Plan can support a reduction in the readmission rate for the University Hospitals of Leicester.