Common use of UTI Clause in Contracts

UTI. “off legs”, Not eating and drinking/dehydration (Step Up);  Post fall (Step Up or Step Down);  Post-acute medical, orthopaedic or surgical episode (Step Down);  Patients considering/being considered for long-term care;  Patients awaiting further assessment (e.g. CHC MDT, completion of Social care assessment, further assessment/input from therapists). This service will be provided in line with all the latest guidance and standards pertaining to intermediate care services. These include the following –  High Quality Care for all; Delivering Care Closer to Home: Meeting the Challenge; Our Health, Our Care, Our Say – A New Direction for Community Services (DoH, 2008)  National Audit of Intermediate Care (2012)  National Audit of Intermediate Care (2013)  Intermediate Care – Halfway Home  Updated Guidance for the NHS and Local Authorities, (DoH, 2009)  Reablement: a cost effective route to better outcomes (scie, 2011) The delivery chain Please provide evidence of a coherent delivery chain, naming the commissioners and providers involved The expectation is that it will be possible to commission the entire service from one provider with beds appropriately situated, supported by the re-shaped Integrated Transitional Care team. A procurement exercise will be necessary to seek one provider to deliver this service in its entirety, across the 3 localities (Preston, South Ribble, and Chorley).It will also stimulate the Health and Social care economy to work in partnership with an independent provider and the third sector The key deliverables for implementation are: Deliverable Responsibility Delivery of the new model Integrated Transitional Care Team GPs Providers of health and care services  Identify what populations will most benefit from integrated Greater Preston CCG commissioning and provision  determine the outcomes for these populations  Identify the budgets that will be contributed and the whole Chorley and South Ribble CCG care payment that will be made for each person requiring care  Performance management and governance arrangements Lancashire County Council NHS England (in partnership where necessary)  Local area coordination with the Voluntary Community and Greater Preston CCG Faith Sector. Chorley & South Ribble CCG Lancashire County Council  Co-design the care models that will Lancashire Care Trust deliver these outcomes  Transition resources into these models Lancashire Teaching Hospital to deliver outcomes  Ensure governance and organisational public, private and voluntary and arrangements are in place to manage community sector groups these resources  Agree the process for managing risks and savings achieved through improving outcomes  Establish information flows to support delivery  Ensure effective alignment of responsibilities and accountability across all the organisations concerned. The evidence base Please reference the evidence base which you have drawn on - to support the selection and design of this scheme - to drive assumptions about impact and outcomes We have taken into account UK evidence, the local context and academic research when developing this scheme. UK evidence In totality we are experiencing similar challenges to health and social care systems throughout the country: ● Local public health statistics indicate that the over 65‟s age group is expected to increase by approximately 10% over the next 5 years. ● The over 65 years age group made up 19% of attendances at Lancashire Teaching Hospitals Emergency department during 2012/13; a rise of approximately 0.9% per year over the past 4yrs. ● Local intelligence suggests that the over 65 years age group will have an increased demand for substantive social care services of approximately 4000 people between 2013 and 2018, with the biggest projected increase for domiciliary based services as opposed to residential care. ● Increasing regulation in health and social care is increasing quality but also reducing freedom to act atypically – this means having to do more with less; ● The general ethos of both health and social care services is shifting from treatment - to prevention and promoting independence and self-care. We have also drawn on key guidance in prioritising and developing this scheme:  Our plans are in line with the strong emphasis on health maintenance and prevention in the DoH document „NHS 2010 – 2015: from good to great. Preventative, people-centred, productive‟.  The National Audit Commission briefing “Reablement: a cost-effective route to better outcomes” (Social Care institute for excellence, 2011) declares there is “good evidence that reablement removes or reduces the need for ongoing conventional home care” and that it “improves outcomes for people who use services”.  The National Audit for Intermediate Care 2012 placed strong focus on the positive patient impact of focused home based rehabilitation, delivered at the earliest opportunity  The results of the recently produced National Audit for Intermediate Care 2013 indicate that „the current provision of intermediate care remains around half of that which is required to avoid inappropriate admissions and provide adequate post-acute care for older people‟. Local context Due to the fragmentation of the current system in Greater Preston and Chorley & South Ribble, National benchmarking data indicates that intervention time for both bed and community based Intermediate Care services is generally higher than the national average. Intermediate Care Usage National Local Variance Average occupancy rates in residential rehab 85% 80% 5% Average Length of Stay in residential rehab bed 26.9 34.1 7.2 Average Length of domiciliary rehabilitation services 28.5 34.8 6.3 Average Length of domiciliary reablement services 32.4 42 9.6 Average Length of crisis care 5.7 4.41 1.29 Intermediate Care Costs National Local VarianceAverage cost per patient in ICT bed/res rehab £5,218 £3,737 £1,481 Average cost per hospital bed day (rehab) £169 £195 £26 Average cost per patient - home based services £1,134 £402 £732 Average cost per patient - reablement services £1,850 £2,000 £150 Average cost per patient – crisis care £1,019 £402 £617 A reasonable interpretation might be that: ● The balance of intermediate care beds and home based intermediate care is inconsistent with the national picture; ● Patients who do receive home based care are retained within the system for too long; ● There is significant scope for improving access, throughput and thus value for money in the local Intermediate care system. Lancashire Teaching Hospitals is considered to be an outlier in relation to Delayed Transfers of Care (DToC) having „lost‟ 6325 bed days in 12/13 to patients who were deemed medically well enough to leave the acute setting but were unable to be discharged for a variety of reasons. Establishment National NW Comparator Group Top Quartil e Local (12/13) Variance (Comparator) Variance (Top Quartile) Patients admitted to 690.3 772.4 716.3 574.8 876.8 160.5 302 long-term care (≥65 yrs.) per 100,000 population Our local health economy is also an outlier both regionally and Nationally in relation to the number of patients admitted to long-term care with 161 patients more (per 100,000 population) being admitted to long-term care than a comparator health economy (187 more per 100,000 population than the national average). Investment requirements Please enter the amount of funding required for this scheme in Part 2, Tab 3. HWB Expenditure Plan The investment requirements are as follows Urgent Care Budgets S 256 £'000 NHS £'000 Total £'000 Step Up/Step Down 1,814 4,579 6,393 Impact of scheme Please enter details of outcomes anticipated in Part 2, Tab 4. HWB Benefits Plan lease provide any further information about anticipated outcomes that is not captured in headline metrics below This scheme is expected to have a positive impact on the following BCF metrics: Metrics Emergency admissions  Admissions to residential and nursing care  Effectiveness of reablement  Delayed transfers of care  Patient experience: Proportion of people feeling support  to manage their LTC The quantified impact on reduction in non-elective admissions is calculated as 1,126. A reduction of 10 permanent residential admissions by 2015/16.  The medium-term aim would be to reduce admissions to long-term care by 12% to bring the local health economy in line with the North West average.  The long-term aim would be to reduce admissions to long-term care by 21% to bring us in line with the national average.  However, the aspiration and ambition would be to reduce admissions to long- term care by 34% to bring us in line with the Top Quartile. Other benefits will be:  Improved outcomes and experience for patients and carers as the service becomes seamless and provides greater flexibility in managing the transition through bed based and home based services;  Realisation of savings across the Health Economy from improved integration and efficiency in intermediate care services;  Provision of services which are more aligned with current local and national strategies  Maximising the use of community care, including robust admission criteria and exit strategies for all patients to ensure resources (bed based service in particular) are used appropriately.  Reduction of Delayed Transfers of Care  Providing care (both clinical and therapy) closer to home for individuals, in a non-acute environment, preferably their own home.

UTI. “off legs”, Not eating and drinking/dehydration (Step Up);  • Post fall (Step Up or Step Down);  • Post-acute medical, orthopaedic or surgical episode (Step Down);  • Patients considering/being considered for long-term care;  • Patients awaiting further assessment (e.g. CHC MDT, completion of Social care assessment, further assessment/input from therapists). This service will be provided in line with all the latest guidance and standards pertaining to intermediate care services. These include the following –  • High Quality Care for all; Delivering Care Closer to Home: Meeting the Challenge; Our Health, Our Care, Our Say – A New Direction for Community Services (DoH, 2008)  • National Audit of Intermediate Care (2012)  • National Audit of Intermediate Care (2013)  • Intermediate Care – Halfway Home  • Updated Guidance for the NHS and Local Authorities, (DoH, 2009)  • Reablement: a cost effective route to better outcomes (scie, 2011) The delivery chain Please provide evidence of a coherent delivery chain, naming the commissioners and providers involved The expectation is that it will be possible to commission the entire service from one provider with beds appropriately situated, supported by the re-shaped Integrated Transitional Care team. A procurement exercise will be necessary to seek one provider to deliver this service in its entirety, across the 3 localities (Preston, South Ribble, and Chorley).It will also stimulate the Health and Social care economy to work in partnership with an independent provider and the third sector The key deliverables for implementation are: Deliverable Responsibility Delivery of the new model Integrated Transitional Care Team GPs Providers roviders of health and care services  • Identify what populations will most benefit from integrated Greater Preston CCG commissioning and provision  • determine the outcomes for these populations  • Identify the budgets that will be contributed and the whole Chorley and South Ribble CCG care payment that will be made for each person requiring care  • Performance management and governance arrangements Greater Preston CCG Chorley and Soutl Ribble CCG Lancashire County Council NHS England (in partnership where necessary)  • Local area coordination with the Voluntary Community and Faith Sector. Greater Preston CCG Faith Sector. Chorley & South Ribble CCG Lancashire County Council  • Co-design the care models that will Lancashire Care Trust deliver these outcomes  • Transition resources into these models Lancashire Teaching Hospital to deliver outcomes  • Ensure governance and organisational Lancashire Care Trust Lancashire Teaching Hospital public, private and voluntary and arrangements are in place to manage community sector groups these resources  • Agree the process for managing risks and savings achieved through improving outcomes  • Establish information flows to support delivery  • Ensure effective alignment of responsibilities and accountability across all the organisations concerned. The evidence base Please reference the evidence base which you have drawn on - to support the selection and design of this scheme - to drive assumptions about impact and outcomes We have taken into account UK evidence, the local context and academic research when developing this scheme. UK evidence In totality we are experiencing similar challenges to health and social care systems throughout the country: ● Local public health statistics indicate that the over 65‟s 65’s age group is expected to increase by approximately 10% over the next 5 years. ● The over 65 years age group made up 19% of attendances at Lancashire Teaching Hospitals Emergency department during 2012/13; a rise of approximately 0.9% per year over the past 4yrs. ● Local intelligence suggests that the over 65 years age group will have an increased demand for substantive social care services of approximately 4000 people between 2013 and 2018, with the biggest projected increase for domiciliary based services as opposed to residential care. ● Increasing regulation in health and social care is increasing quality but also reducing freedom to act atypically – this means having to do more with less; ● The general ethos of both health and social care services is shifting from treatment - to prevention and promoting independence and self-care. We have also drawn on key guidance in prioritising and developing this scheme:  • Our plans are in line with the strong emphasis on health maintenance and prevention in the DoH document „‘NHS 2010 – 2015: from good to great. Preventative, people-centred, productive‟.  productive’. • The National Audit Commission briefing “Reablement: a cost-effective route to better outcomes” (Social Care institute for excellence, 2011) declares there is “good evidence that reablement removes or reduces the need for ongoing conventional home care” and that it “improves outcomes for people who use services”.  • The National Audit for Intermediate Care 2012 placed strong focus on the positive patient impact of focused home based rehabilitation, delivered at the earliest opportunity  • The results of the recently produced National Audit for Intermediate Care 2013 indicate that „‘the current provision of intermediate care remains around half of that which is required to avoid inappropriate admissions and provide adequate post-acute care for older people‟. people’. Local context Due to the fragmentation of the current system in Greater Preston and Chorley & South Ribble, National benchmarking data indicates that intervention time for both bed and community based Intermediate Care services is generally higher than the national average. Intermediate Care Usage National Local Variance Average occupancy rates in residential rehab 85% 80% 5% Average Length of Stay in residential rehab bed 26.9 34.1 7.2 Average Length of domiciliary rehabilitation services 28.5 34.8 6.3 Average Length of domiciliary reablement services 32.4 42 9.6 Average Length of crisis care 5.7 4.41 1.29 Intermediate Care Costs National Local VarianceAverage cost per patient in ICT bed/res rehab £5,218 £3,737 £1,481 Average cost per hospital bed day (rehab) £169 £195 £26 Average cost per patient - home based services £1,134 £402 £732 Average cost per patient - reablement services £1,850 £2,000 £150 Average cost per patient – crisis care £1,019 £402 £617 A reasonable interpretation might be that: ● The balance of intermediate care beds and home based intermediate care is inconsistent with the national picture; ● Patients who do receive home based care are retained within the system for too long; ● There is significant scope for improving access, throughput and thus value for money in the local Intermediate care system. Lancashire Teaching Hospitals is considered to be an outlier in relation to Delayed Transfers of Care (DToC) having „lost‟ ‘lost’ 6325 bed days in 12/13 to patients who were deemed medically well enough to leave the acute setting but were unable to be discharged for a variety of reasons. Establishment National NW Comparator Group Top Quartil e Quartile Local (12/13) Variance (Comparator) Variance (Top Quartile) Patients admitted to 690.3 772.4 716.3 574.8 876.8 160.5 302 long-term care (≥65 yrs.) per 690.3 772.4 716.3 574.8 876.8 160.5 302 100,000 population Our local health economy is also an outlier both regionally and Nationally in relation to the number of patients admitted to long-term care with 161 patients more (per 100,000 population) being admitted to long-term care than a comparator health economy (187 more per 100,000 population than the national average). Investment requirements Please enter the amount of funding required for this scheme in Part 2, Tab 3. HWB Expenditure Plan The investment requirements are as follows Urgent Care Budgets S 256 £'000 NHS £'000 Total £'000 Step Up/Step Down 1,814 4,579 Total £'000 6,393 Impact of scheme Please enter details of outcomes anticipated in Part 2, Tab 4. HWB Benefits Plan lease provide any further information about anticipated outcomes that is not captured in headline metrics below This scheme is expected to have a positive impact on the following BCF metrics: Metrics Emergency admissions  ☑ Admissions to residential and nursing care  ☑ Effectiveness of reablement  ☑ Delayed transfers of care  Patient ☑ atient experience: Proportion of people feeling support  to manage their LTC ☑ The quantified impact on reduction in non-elective admissions is calculated as 1,126. A reduction of 10 permanent residential admissions by 2015/16.  • The medium-term aim would be to reduce admissions to long-term care by 12% to bring the local health economy in line with the North West average.  • The long-term aim would be to reduce admissions to long-term care by 21% to bring us in line with the national average.  • However, the aspiration and ambition would be to reduce admissions to long- term care by 34% to bring us in line with the Top Quartile. Other benefits will be:  • Improved outcomes and experience for patients and carers as the service becomes seamless and provides greater flexibility in managing the transition through bed based and home based services;  • Realisation of savings across the Health Economy from improved integration and efficiency in intermediate care services;  • Provision of services which are more aligned with current local and national strategies  • Maximising the use of community care, including robust admission criteria and exit strategies for all patients to ensure resources (bed based service in particular) are used appropriately.  • Reduction of Delayed Transfers of Care  • Providing care (both clinical and therapy) closer to home for individuals, in a non-acute environment, preferably their own home.

UTI. “off legs”, Not eating and drinking/dehydration (Step Up);  Post fall (Step Up or Step Down);  Post-acute medical, orthopaedic or surgical episode (Step Down);  Patients considering/being considered for long-term care;  Patients awaiting further assessment (e.g. CHC MDT, completion of Social care assessment, further assessment/input from therapists). This service will be provided in line with all the latest guidance and standards pertaining to intermediate care services. These include the following –  High Quality Care for all; Delivering Care Closer to Home: Meeting the Challenge; Our Health, Our Care, Our Say – A New Direction for Community Services (DoH, 2008)  National Audit of Intermediate Care (2012)  National Audit of Intermediate Care (2013)  Intermediate Care – Halfway Home  Updated Guidance for the NHS and Local Authorities, (DoH, 2009)  Reablement: a cost effective route to better outcomes (scie, 2011) The delivery chain Please provide evidence of a coherent delivery chain, naming the commissioners and providers involved The expectation is that it will be possible to commission the entire service from one provider with beds appropriately situated, supported by the re-shaped Integrated Transitional Care team. A procurement exercise will be necessary to seek one provider to deliver this service in its entirety, across the 3 localities (Preston, South Ribble, and Chorley).It will also stimulate the Health and Social care economy to work in partnership with an independent provider and the third sector The key deliverables for implementation are: Deliverable Responsibility Delivery of the new model Integrated Transitional Care Team GPs Providers roviders of health and care services  Identify what populations will most benefit from integrated Greater Preston CCG commissioning and provision  determine the outcomes for these populations  Identify the budgets that will be contributed and the whole Chorley and South Ribble CCG care payment that will be made for each person requiring care  Performance management and governance arrangements Greater Preston CCG Chorley and Soutl Ribble CCG Lancashire County Council NHS England (in partnership where necessary)  Local area coordination with the Voluntary Community and Faith Sector. Greater Preston CCG Faith Sector. Chorley & South Ribble CCG Lancashire County Council  Co-design the care models that will Lancashire Care Trust deliver these outcomes  Transition resources into these models Lancashire Teaching Hospital to deliver outcomes  Ensure governance and organisational Lancashire Care Trust Lancashire Teaching Hospital public, private and voluntary and arrangements are in place to manage community sector groups these resources  Agree the process for managing risks and savings achieved through improving outcomes  Establish information flows to support delivery  Ensure effective alignment of responsibilities and accountability across all the organisations concerned. The evidence base Please reference the evidence base which you have drawn on - to support the selection and design of this scheme - to drive assumptions about impact and outcomes We have taken into account UK evidence, the local context and academic research when developing this scheme. UK evidence In totality we are experiencing similar challenges to health and social care systems throughout the country: ● Local public health statistics indicate that the over 65‟s age group is expected to increase by approximately 10% over the next 5 years. ● The over 65 years age group made up 19% of attendances at Lancashire Teaching Hospitals Emergency department during 2012/13; a rise of approximately 0.9% per year over the past 4yrs. ● Local intelligence suggests that the over 65 years age group will have an increased demand for substantive social care services of approximately 4000 people between 2013 and 2018, with the biggest projected increase for domiciliary based services as opposed to residential care. ● Increasing regulation in health and social care is increasing quality but also reducing freedom to act atypically – this means having to do more with less; ● The general ethos of both health and social care services is shifting from treatment - to prevention and promoting independence and self-care. We have also drawn on key guidance in prioritising and developing this scheme:  Our plans are in line with the strong emphasis on health maintenance and prevention in the DoH document „NHS 2010 – 2015: from good to great. Preventative, people-centred, productive‟.  The National Audit Commission briefing “Reablement: a cost-effective route to better outcomes” (Social Care institute for excellence, 2011) declares there is “good evidence that reablement removes or reduces the need for ongoing conventional home care” and that it “improves outcomes for people who use services”.  The National Audit for Intermediate Care 2012 placed strong focus on the positive patient impact of focused home based rehabilitation, delivered at the earliest opportunity  The results of the recently produced National Audit for Intermediate Care 2013 indicate that „the current provision of intermediate care remains around half of that which is required to avoid inappropriate admissions and provide adequate post-acute care for older people‟. Local context Due to the fragmentation of the current system in Greater Preston and Chorley & South Ribble, National benchmarking data indicates that intervention time for both bed and community based Intermediate Care services is generally higher than the national average. Intermediate Care Usage National Local Variance Average occupancy rates in residential rehab 85% 80% 5% Average Length of Stay in residential rehab bed 26.9 34.1 7.2 Average Length of domiciliary rehabilitation services 28.5 34.8 6.3 Average Length of domiciliary reablement services 32.4 42 9.6 Average Length of crisis care 5.7 4.41 1.29 Intermediate Care Costs National Local VarianceAverage cost per patient in ICT bed/res rehab £5,218 £3,737 £1,481 Average cost per hospital bed day (rehab) £169 £195 £26 Average cost per patient - home based services £1,134 £402 £732 Average cost per patient - reablement services £1,850 £2,000 £150 Average cost per patient – crisis care £1,019 £402 £617 A reasonable interpretation might be that: ● The balance of intermediate care beds and home based intermediate care is inconsistent with the national picture; ● Patients who do receive home based care are retained within the system for too long; ● There is significant scope for improving access, throughput and thus value for money in the local Intermediate care system. Lancashire Teaching Hospitals is considered to be an outlier in relation to Delayed Transfers of Care (DToC) having „lost‟ 6325 bed days in 12/13 to patients who were deemed medically well enough to leave the acute setting but were unable to be discharged for a variety of reasons. Establishment National NW Comparator Group Top Quartil e Quartile Local (12/13) Variance (Comparator) Variance (Top Quartile) Patients admitted to 690.3 772.4 716.3 574.8 876.8 160.5 302 long-term care (≥65 yrs.) per 100,000 population Our local health economy is also an outlier both regionally and Nationally in relation to the number of patients admitted to long-term care with 161 patients more (per 100,000 population) being admitted to long-term care than a comparator health economy (187 more per 100,000 population than the national average). Investment requirements Please enter the amount of funding required for this scheme in Part 2, Tab 3. HWB Expenditure Plan The investment requirements are as follows Urgent Care Budgets S 256 £'000 NHS £'000 Total £'000 Step Up/Step Down 1,814 4,579 Total £'000 6,393 Impact of scheme Please enter details of outcomes anticipated in Part 2, Tab 4. HWB Benefits Plan lease provide any further information about anticipated outcomes that is not captured in headline metrics below This scheme is expected to have a positive impact on the following BCF metrics: Metrics Emergency admissions  Admissions to residential and nursing care  Effectiveness of reablement  Delayed transfers of care  Patient atient experience: Proportion of people feeling support  to manage their LTC  The quantified impact on reduction in non-elective admissions is calculated as 1,126. A reduction of 10 permanent residential admissions by 2015/16.  The medium-term aim would be to reduce admissions to long-term care by 12% to bring the local health economy in line with the North West average.  The long-term aim would be to reduce admissions to long-term care by 21% to bring us in line with the national average.  However, the aspiration and ambition would be to reduce admissions to long- term care by 34% to bring us in line with the Top Quartile. Other benefits will be:  Improved outcomes and experience for patients and carers as the service becomes seamless and provides greater flexibility in managing the transition through bed based and home based services;  Realisation of savings across the Health Economy from improved integration and efficiency in intermediate care services;  Provision of services which are more aligned with current local and national strategies  Maximising the use of community care, including robust admission criteria and exit strategies for all patients to ensure resources (bed based service in particular) are used appropriately.  Reduction of Delayed Transfers of Care  Providing care (both clinical and therapy) closer to home for individuals, in a non-acute environment, preferably their own home.

UTI. “off legs”, Not eating and drinking/dehydration (Step Up);  • Post fall (Step Up or Step Down);  • Post-acute medical, orthopaedic or surgical episode (Step Down);  • Patients considering/being considered for long-term care;  • Patients awaiting further assessment (e.g. CHC MDT, completion of Social care assessment, further assessment/input from therapists). This service will be provided in line with all the latest guidance and standards pertaining to intermediate care services. These include the following –  • High Quality Care for all; Delivering Care Closer to Home: Meeting the Challenge; Our Health, Our Care, Our Say – A New Direction for Community Services (DoH, 2008)  • National Audit of Intermediate Care (2012)  • National Audit of Intermediate Care (2013)  • Intermediate Care – Halfway Home  • Updated Guidance for the NHS and Local Authorities, (DoH, 2009)  • Reablement: a cost effective route to better outcomes (scie, 2011) The delivery chain Please provide evidence of a coherent delivery chain, naming the commissioners and providers involved The expectation is that it will be possible to commission the entire service from one provider with beds appropriately situated, supported by the re-shaped Integrated Transitional Care team. A procurement exercise will be necessary to seek one provider to deliver this service in its entirety, across the 3 localities (Preston, South Ribble, and Chorley).It will also stimulate the Health and Social care economy to work in partnership with an independent provider and the third sector The key deliverables for implementation are: Deliverable Responsibility Delivery of the new model Integrated Transitional Care Team GPs Providers roviders of health and care services  • Identify what populations will most benefit from integrated Greater Preston CCG commissioning and provision  • determine the outcomes for these populations  • Identify the budgets that will be contributed and the whole Chorley and South Ribble CCG care payment that will be made for each person requiring care  • Performance management and governance arrangements Greater Preston CCG Chorley and Soutl Ribble CCG Lancashire County Council NHS England (in partnership where necessary)  • Local area coordination with the Voluntary Community and Faith Sector. Greater Preston CCG Faith Sector. Chorley & South Ribble CCG Lancashire County Council  • Co-design the care models that will Lancashire Care Trust deliver these outcomes  • Transition resources into these models Lancashire Teaching Hospital to deliver outcomes  • Ensure governance and organisational Lancashire Care Trust Lancashire Teaching Hospital public, private and voluntary and arrangements are in place to manage community sector groups these resources  • Agree the process for managing risks and savings achieved through improving outcomes  • Establish information flows to support delivery  • Ensure effective alignment of responsibilities and accountability across all the organisations concerned. The evidence base Please reference the evidence base which you have drawn on - to support the selection and design of this scheme - to drive assumptions about impact and outcomes We have taken into account UK evidence, the local context and academic research when developing this scheme. UK evidence In totality we are experiencing similar challenges to health and social care systems throughout the country: ● Local public health statistics indicate that the over 65‟s age group is expected to increase by approximately 10% over the next 5 years. ● The over 65 years age group made up 19% of attendances at Lancashire Teaching Hospitals Emergency department during 2012/13; a rise of approximately 0.9% per year over the past 4yrs. ● Local intelligence suggests that the over 65 years age group will have an increased demand for substantive social care services of approximately 4000 people between 2013 and 2018, with the biggest projected increase for domiciliary based services as opposed to residential care. ● Increasing regulation in health and social care is increasing quality but also reducing freedom to act atypically – this means having to do more with less; ● The general ethos of both health and social care services is shifting from treatment - to prevention and promoting independence and self-care. We have also drawn on key guidance in prioritising and developing this scheme:  • Our plans are in line with the strong emphasis on health maintenance and prevention in the DoH document „NHS 2010 – 2015: from good to great. Preventative, people-centred, productive‟.  • The National Audit Commission briefing “Reablement: a cost-effective route to better outcomes” (Social Care institute for excellence, 2011) declares there is “good evidence that reablement removes or reduces the need for ongoing conventional home care” and that it “improves outcomes for people who use services”.  • The National Audit for Intermediate Care 2012 placed strong focus on the positive patient impact of focused home based rehabilitation, delivered at the earliest opportunity  • The results of the recently produced National Audit for Intermediate Care 2013 indicate that „the current provision of intermediate care remains around half of that which is required to avoid inappropriate admissions and provide adequate post-acute care for older people‟. Local context Due to the fragmentation of the current system in Greater Preston and Chorley & South Ribble, National benchmarking data indicates that intervention time for both bed and community based Intermediate Care services is generally higher than the national average. Intermediate Care Usage National Local Variance Average occupancy rates in residential rehab 85% 80% 5% Average Length of Stay in residential rehab bed 26.9 34.1 7.2 Average Length of domiciliary rehabilitation services 28.5 34.8 6.3 Average Length of domiciliary reablement services 32.4 42 9.6 Average Length of crisis care 5.7 4.41 1.29 Intermediate Care Costs National Local VarianceAverage cost per patient in ICT bed/res rehab £5,218 £3,737 £1,481 Average cost per hospital bed day (rehab) £169 £195 £26 Average cost per patient - home based services £1,134 £402 £732 Average cost per patient - reablement services £1,850 £2,000 £150 Average cost per patient – crisis care £1,019 £402 £617 A reasonable interpretation might be that: ● The balance of intermediate care beds and home based intermediate care is inconsistent with the national picture; ● Patients who do receive home based care are retained within the system for too long; ● There is significant scope for improving access, throughput and thus value for money in the local Intermediate care system. Lancashire Teaching Hospitals is considered to be an outlier in relation to Delayed Transfers of Care (DToC) having „lost‟ 6325 bed days in 12/13 to patients who were deemed medically well enough to leave the acute setting but were unable to be discharged for a variety of reasons. Establishment National NW Comparator Group Top Quartil e Quartile Local (12/13) Variance (Comparator) Variance (Top Quartile) Patients admitted to 690.3 772.4 716.3 574.8 876.8 160.5 302 long-term care (≥65 yrs.) per 100,000 population Our local health economy is also an outlier both regionally and Nationally in relation to the number of patients admitted to long-term care with 161 patients more (per 100,000 population) being admitted to long-term care than a comparator health economy (187 more per 100,000 population than the national average). Investment requirements Please enter the amount of funding required for this scheme in Part 2, Tab 3. HWB Expenditure Plan The investment requirements are as follows Urgent Care Budgets S 256 £'000 NHS £'000 Total £'000 Step Up/Step Down 1,814 4,579 Total £'000 6,393 Impact of scheme Please enter details of outcomes anticipated in Part 2, Tab 4. HWB Benefits Plan lease provide any further information about anticipated outcomes that is not captured in headline metrics below This scheme is expected to have a positive impact on the following BCF metrics: Metrics Emergency admissions  ☑ Admissions to residential and nursing care  ☑ Effectiveness of reablement  ☑ Delayed transfers of care  Patient ☑ atient experience: Proportion of people feeling support  to manage their LTC ☑ The quantified impact on reduction in non-elective admissions is calculated as 1,126. A reduction of 10 permanent residential admissions by 2015/16.  • The medium-term aim would be to reduce admissions to long-term care by 12% to bring the local health economy in line with the North West average.  • The long-term aim would be to reduce admissions to long-term care by 21% to bring us in line with the national average.  • However, the aspiration and ambition would be to reduce admissions to long- term care by 34% to bring us in line with the Top Quartile. Other benefits will be:  • Improved outcomes and experience for patients and carers as the service becomes seamless and provides greater flexibility in managing the transition through bed based and home based services;  • Realisation of savings across the Health Economy from improved integration and efficiency in intermediate care services;  • Provision of services which are more aligned with current local and national strategies  • Maximising the use of community care, including robust admission criteria and exit strategies for all patients to ensure resources (bed based service in particular) are used appropriately.  • Reduction of Delayed Transfers of Care  • Providing care (both clinical and therapy) closer to home for individuals, in a non-acute environment, preferably their own home.