Many NHS and council leaders will assess the effectiveness of the government’s £3.8bn plan to integrate health and social care with performance measures on dementia, falls and long-term conditions.
This is the chief finding from an HSJ analysis of 60 draft better care fund submissions, many of which were obtained via the Freedom of Information Act.
Our analysis found that many areas had picked similar metrics as a “proxy” measure for integration.
The most popular locally selected Better Care Fund metrics were:
- Estimated diagnosis rate for people with dementia;
- Proportion of people feeling supported to manage their (long term) condition; and
- Injuries due to falls in people aged 65 and over.
One in three of the submissions we analysed listed one of the above three measures.
Variations on these included a measure of hospital admissions rates due to falls and a pledge by one health and wellbeing board to cut the number of falls by 4 per cent over two years.
King’s Fund senior fellow Richard Humphries described the falls metric as a “proxy”, intended to demonstrate a system which intervened to prevent hospital admissions among its most vulnerable patients.
The popularity of dementia diagnosis will be controversial, as there is little clinical treatment available for dementia patients.
However Mr Humphries said increasing the rate of diagnosis was valuable because it allows carers, families and local commissioners to better plan support services.
David Pearson, president of the Association of Directors of Adult Social Services, said the selections were “encouraging”.
“Overall these are the sorts of measures that touch the people who might need integrated health and social care support,” he added.
HSJ analysis has also shown that many places emphasise improving conditions for carers.
“Carer-reported quality of life” was the most common of these identified. Similar metrics picked by health and wellbeing boards included “unpaid carers prepared and supported to care for longer”, and “number of carers receiving a carers specific service”.
However many areas failed to pinpoint a suitable metric in time for the draft submissions in February. Shropshire did not expect to have a measure agreed until September.
Devon’s draft Better Care Fund plan said: “Given the late distribution of the guidance, the Christmas break and the timing of the health and wellbeing board there has been insufficient opportunity to consider this within the broader health and social care community.”
A minority of integration plans feature process measures, rather than ones that directly relate to outcomes for patients. Commissioners in Bath and North East Somerset planned to measure the “implementation of weekly multidisciplinary team meetings”.
Meanwhile Bracknell’s chosen metric was the “number of people supported by a multi agency approach”, and Milton Keynes has chosen to measure the proportion of patients receiving telehealth.
Performance measures and the Better Care Fund
As part of the Department of Health’s Better Care Fund initiative, all areas will be judged against five national measures, including delayed discharges and avoidable emergency admissions.
However they are also all required to nominate a local measure to track the impact of their Better Care Fund initiatives.
The metrics will form the basis of the performance related element of the Better Care Fund. The DH, NHS England and the Local Government Association will bring in external “support” for areas which do not demonstrate improved performance.