Evaluation of Leicestershire’s Better Care Fund programmeElizabeth Orton, Consultant in Public HealthJanine Dellar, Head of Public Health Intelligence

• Monday 22nd June 2015

Aim of the Better Care fund

Evidence-based improvements to integration of health and care

Increase community capacity

Transfer activity from acute to community

Pooled budget to sustain integration

Better Care Fund

Unified prevention

e.g. Local Area Co-ordination

Integrated proactive response for people with long term care

e.g. case management for >75s

Integrated urgent response (admission avoidance)

e.g. Falls pathway redesign, older persons unit, 7 day GP service, ICRS

Hospital discharge and re-ablement

e.g. integrated reablement

• Reduce the number of permanent admissions

• Increase the number of service users still at home 91 days after discharge

• Reduce the number of delayed transfers of care

• Reduce the number of avoidable admissions

• Reduce the number of emergency admissions due to falls

• Improve Patient experience

Expected outcomes4 Themed areas

Evaluation framework

Outcome evaluation

What are the outcomes for communities and

individuals – LACParticipatory Action

Research, asset mapping

Has an admission or residential care been

avoided?Clinical audit/case note

review

Was it the intervention that made the

difference?Data linkage cohort

analysis

Structure/Process

evaluation

Does the process work as well as it could?

Lean systems analysis and patient satisfaction

Routine Data analysisExample: Integrated crises response service

GP sees patient and refers to

integrated crises response service

Professional contacts LPTs single point of

access

Allocated to specialist nursing

service

If 09:00 to 17:00 this is an existing

service. BCF enhancement is extending this to

night nursing

Is this an improvement for

the patients?

Tracking this through the data

Inputs – LPT SPA Data

Linkage to ambulance data Epidemiology of patients using ICRS

Linkage to A&E data Understanding of full set of activity data for ICRS cohort

Linkage to Inpatient data Patient pathways pre and post ICRS

Inputs – LPT community nursing data

Linkages to outpatients data

Costs of the full patient pathway

Linkages to adult social care data

Future – matched cohort analysis

PSEU

DO

NYM

ISAT

ION

Data FlowsUHL and LPT SUS PbR

Data

Community nursing data

EMAS Ambulance Data

Adult social care data from 3 local authorities

GEM DSCRO

GEM CSU Safe Haven

Rele

ase

to P

I

Information Governance

• Overarching framework for IG– signed by all participating organisations

• Responsibility sits with Senior Information Responsible Officer (SIRO)

• NHS data is flowing under s251 exemptions linked to original NHS act allowing the transmission of pseudonymised data for secondary use

• Councils release data to ASH for pseudonymisation• Only risk is at point of transfer to the ASH• All data that is released to PI is pseudonymised using a

single encryption key

Limitations• How good will our data linkage be (65-80% anticipated on ASC data) • Ambulance data – low for NHS Number• At this time – only data from main acute provider, so cross border flows will

be an issue• No costing of social care data• No primary care data• Diagnoses flagging will be 1st five diagnoses codes in hospital inpatient data• Only three years data• Social care data only has NHS number for patients who are currently active• Care home patients – only identifying clients that are social care funded• No mortality data included at this time

• We need to start somewhere!

Next steps….

• Going out to procurement for LAC evaluation

• Ongoing Lean research with Loughborough University

• Clinical audit proposals being agreed

• Cohort analysis before and after for admission avoidance schemes