Calderdale Health and Wellbeing (HWB) Board met on 30th October.

It heard that there are no grounds for believing that the new social care scheme, known as Better Care, will keep patients out of hospital.  But it went ahead and approved the transfer of £4m this year from the hard-pressed hospital to Calderdale Council’s Adult Social Care directorate. And £15m next year.

The HWB Board also approved Calderdale Council’s and Calderdale Clinical Commissioning Group’s joint plan for spending this money.

The Calderdale Clinical Commissioning Group (CCG) Chair Dr Brooks complained,

“It has been a challenge regarding moving funds from the NHS to a shared health and social care fund. Particularly with moving funds from the acute hospital into the community with the aim of reducing acute admissions.”

NHS England says local authorities must use this BCF money to pay for “adult social care services…which also has [sic] a health benefit.” [Section 256 funding transfer to sc letter, 19/6/2013]

The Council and CCG will jointly co-commission these adult social care services, with the aim that they will cut emergency hospital admissions.

The Better Care Fund is a way of propping up the Council’s social care services after brutal funding cuts have left adult social care services in England facing a £4.3bn “black hole” in funding by the end of the decade.

The lack of social care, as funding has been cut, has led to more frail elderly and chronically ill patients going to hospital and then staying there longer than they need, because there are no social care services to take care of them on leaving hospital.

BCF spending is high risk because there’s no real evidence it will work to reduce acute hospital admissions

Elaine James from Calderdale Council’s Adult Health and Social Care directorate said that BCF spending is high risk because there is no real evidence that it will work.

She explained that there are no real grounds for believing that taking NHS money from the hospital and giving it to Calderdale Council, in order for the Council and the CCG to spend it on adult social care, is going to reduce acute hospital admissions.

As a result, BCF spending will be subject to a line by line audit.

Paul Butcher, the Council’s Public Health head honcho, said,

“It’s crucial to identify evidence about the reduction of emergency admissions – there is sparse national evidence on this.”

Sharing confidential patient data to identify the costs of caring for children and adults at risk and people with long term conditions

Evidence about whether or not the BCF works will be collected through sharing patients’ NHS data with social care organisations. Ms James said,

“This will integrate all known information about children and adults at risk and people with long term conditions.

“This will make it possible to identify the costs of these people and allow the assessment of the effectiveness of health and social care spending…

“A research committee is to be set up between Calderdale Council and the Clinical Commissioning Group to allow evidence-based commissioning.”

Collecting and analysing this patient data will generate evidence about whether or not the BCF reduces acute hospital admissions, and also go much further than that in guiding commissioning decisions.

Dr Brook piped up,

“We might need to do new work and collect new data rather than just recycle existing data that uses old metrics. There may be considerable expense in collecting new data but we need to do this.”

The CCG representative chimed in,

“It will be a challenge to identify and pinpoint reduction in emergency admissions as a result of the BCF.”

This was the cue for Dr Brooks to drive his point home,

“Reliance on hospital data isn’t going to answer the question. We need new out-of-hospital data to measure what’s happening at that end to keep patients out of emergency hospital admission.”

Big data protection issues associated with plan to share patients’ identifiable, confidential medical data outside the NHS

Under the Better Care Plan, both NHS organisations and social care companies will have access to patients’ confidential medical data associated with a “unique identifier”  – their NHS number.

This confidential patient data will be identifiable – ie it will be possible to trace who the person is that the data relates to.

One condition of NHS England’s approval of Calderdale’s Better Care Fund plan is that patients’ confidential data has to be really secure and the Department of Health has to approve the system for collecting, sharing and storing it.

This involves the Council applying to the Secretary of State for Health for Regulation 251 approval.

A plan to share confidential patient data across NHS and social care organisations in the MIdlands fell apart over concerns about the impossibility of informed patient consent for such wide sharing of their data.

Where the money will go

The £4m for 2014/15 is to be spent on:

• a self-care hub for patients with long term illnesses
• contract with voluntary organisations for peer support, dementia advisor post and dementia awareness, to support early Dementia diagnosis and advanced planning
• registered home care to provide adult social care for people with moderate social care needs
• social work assessment service over 7 days/week to provide back up for hospital, community services and intermediate care
• funding for AHSC directorate to prepare for implications of Care Act from 2015
• residential transitional beds so people can be discharged from hospital without having to wait for housing issues or community care issues to be sorted
• intermediate care social work
• reablement and coordinated support at home
• voluntary sector stroke coordinator & support for stroke recovery
• end of life social work
• IT to support patient data sharing between NHS and social care

Most of Calderdale’s social care services are already privatised, so this looks likely put NHS money into profit-making social care companies, siphoning money off from patient care.

Ms James reported that the NHS England Commissioning Board has approved “with support”  Calderdale’s Better Care Fund plan, as well as Kirklees and Wakefield’s too. As a result, Ms James said,

“The Calderdale and Kirklees area is now in a strong position going forward in terms of the acute trust.”

After the meeting, Ms James clarified that,

“Calderdale and Greater Huddersfield CCGs work together through a single Urgent Care Partnership Board.  Both the Better Care Programme and the Urgent Care Partnership aim to reduce avoidable admissions and reduce delayed transfer of care.

My comments at the meeting of the Health and Wellbeing Board related to the ability of Calderdale Council to work in partnership with Kirklees Council and the two Clinical Commissioning Groups to align the planning for Better Care Fund schemes where possible, with schemes commissioned by the Urgent Care Partnership.”

Calderdale Council Scrutiny Panel, Cabinet and Council need to approve these proposals

Ms James said that the NHS “Better Care Fund” money could now be transferred from the Hospitals Trust to Calderdale Council and asked the HWB Board to approve this.

She said that Calderdale Council Adults Social Care Directorate and Calderdale CCG want to move towards co-commissioning, on the basis of pooling Better Care Funds between the Council and the CCG.

This would be run by a working group that would report to the HWB Board.

Cllr Tim Swift asked about BCF governance arrangements. He said,

“Elaine’s verbal report goes well beyond the written report. These details need to go to the Adults Health and Social Care Scrutiny Panel and to Cabinet. I’m not sure that the Health and Wellbeing Board has delegated powers to commit the local authority to this.”

He also asked about the BCF Project Group’s membership and role.

Ms James replied that the BCF Project Group will come back to the HWB Board for an update once the scheme moves from the BCF assurance process to the management process.

Someone asked,

“What if the projected spend doesn’t meet the planned outcomes?”

Ms James said that Calderdale CCG is taking legal advice about how the BCF will operate.

Cllr Baines agreed with Cllr Swift that they will need Council approval for the BCF report – by both Cabinet and full Council.

The Chair Cllr Battye proposed that the HWB Board accept today’s report, subject to legal confirmation within the Council.

A recent Nuffield Trust briefing (NHS hospitals under pressure: trends in acute activity up to 2022) said that plans to replace acute and emergency hospital services by care in the community (which is what is proposed in Calderdale and Huddersfield as well as across the rest of England) are not likely to work, given the evidence that

“To date, attempts to reduce the numbers of people admitted to hospital through better preventative care in their communities have not been very successful on a large scale” ( p2)

and

“Current policy is aimed at cutting the number of emergency admissions by providing more, better services outside hospital that can either prevent the need for hospital admission or offer the same care but in different settings. This is a common theme in initiatives for more integrated services, including the government’s Better Care Fund. But there is little evidence that this can be achieved.(Bardsley and others, 2013).” (p11)