Liverpool CCG Demand Management Plan for 2016 / 2017

Size: px

Start display at page:

Download "Liverpool CCG Demand Management Plan for 2016 / 2017"

Emory Kennedy
6 years ago
Views:

Liverpool CCG Demand Management Plan for 2016 / 2017 Investing the retained funds relating to the Non-Elective Marginal rate rule and emergency readmissions within 30 days 1.

1 Liverpool CCG Demand Management Plan for 2016 / 2017 Investing the retained funds relating to the Non-Elective Marginal rate rule and emergency readmissions within 30 days 1. Purpose of document This demand management plan for 2016 / 2017 details how Liverpool CCG (LCCG) has used Marginal Rate Emergency Tariff (MRET) and 30 day readmission monies (retained under the marginal tariff arrangements) and LCCG funding for urgent care system resilience in 2015 / 2016 and will continue to use in 2016 / 2017 (unless advised by NHSE). 2. Amount invested as a result of the Marginal Rate Emergency Tariff (MRET) in 2015 / 2016 In 2015 / 2016 NHS England Planning Guidance indicated that 30% of the value of the increase in emergency admissions over those seen in 2008 / 2009 marginal rate baseline figure should be withheld by commissioners and used to fund schemes that support delivery of safe and timely urgent care. LCCG sees urgent care as one of its top priorities and (as such) has added to this marginal rate retained tariff with significant additional (LCCG funded) investment in a comprehensive range of urgent care schemes designed to improve care, provide care outside of hospital where safe and feasible, and to improve timeliness of services. Despite the reduction in the marginal rate from 70% to 30% in 2015/2016, LCCG has maintained existing recurrent investments by increasing its funding contribution to new schemes in 2015 / In addition to the Marginal Rate Emergenncy Tariff (MRET) is the 30 day readmission rule which was introduced in 2011 / 2012 in response to a significant increase in the number of emergency readmissions over the previous decade. The rule provides an incentive for hospitals to reduce avoidable unplanned emergency readmissions within 30 days of discharge. Hospitals may reduce the number of avoidable emergency readmissions by investing in, for example, better discharge planning, more collaborative working and better coordination of clinical intervention with community and social care providers. Page 1

2 For planning purposes, LCCG has agreed as part of the NHS standard contract a notional value for MRET and emergency readmissions to be retained from Royal Liverpool University Hospital Trust (RLBUHT). Although there are other provider trusts within Liverpool (listed below); due to the value of NEL admissions activity and the baseline value agreed as part of 2015 / 2016 contract, there is no notional value of MRET or emergency readmissions reductions within the other provider contracts. The other provider trusts in Liverpool are: Alder Hey Children s NHS Foundation Trust (AHCH) Liverpool Women s Hospital Foundation Trust (LWH) Liverpool Heart and Chest Foundation Trust (LHCH) Mersey Care NHS Trust Spire Liverpool Liverpool Community Health Trust (LCH) The planned value of MRET in 2015 / 2016 in RLBUHT contract is 519,914 and emergency readmissions adjustment of 597,617 total 1,117,531. The exact value of MRET will be determined by the level of emergency activity undertaken in assumed to quarter 1 of 2016 / Details of evidence used in considering investment proposals for 2016 / 2017 In developing the investment proposals and interventions outlined below, LCCG has made use of a wide range of diagnostics and best practice guides including: Benchmarking of standardised admission ratios to understand how Liverpool compares to other cities Locality-specific analysis to see where best practice within Liverpool can be rolled out more widely and to identify variation that can be tackled Use of Kings Fund and other national body guidance documents on the most effective urgent care interventions Ongoing work of Emergency Care Improvement Programme Reviews of previous investments in Liverpool and by neighbouring CCGs to identify what worked and can be built upon, and what did not work Page 2

3 4. Details of targeted initiatives for managing demand in emergency admissions in 2014 / 2015 to 2015 / 2016 For the purposes of clarity, the key schemes invested in as part of LCCG s commitment to supporting urgent care system resilience in Liverpool in the past two years are outlined below: Provider Scheme 2014/ / 2016 Capacity provided NWAS/UC24 NHS ,104 Funding contributed towards the north west procured NHS 111 contract Liverpool City Council - Better Care Fund Liverpool GP Practices Dom. Care packages from acute wards Additional Capacity in Primary Care commissioned Blackpool CCG. From period April 2015 December 2015, 41,219 calls for Liverpool CCG were handled 1,418 1, packages of dom care supported since December 2015-January Average weekly cost 60k. 2,031 2,362 Additional 4,968 appointments per week. Since November 2015 to end of January 2016 there have been 245,084 additional appointments in primary care. UC24 GP at the Royal A&E ,096 appointments Department commissioned for 2015/16 UC24 GP at Alder Hey ,119 appointments commissioned for 2015/16 NWAS/UC24 Pathfinder/acute visiting scheme Between period April January 2016, a total of NWAS Frequent callers paramedic to provide interventions to those frequent callers LCC Public Health Mersey Care Street Cars MH 2,346 contacts made % call reduction from July 2014 July Examine your options Winter advertising campaigns Reduction in the numbers of practioner working detentions under S136 MHA alongside police to over a twelve month period, help reduce the with April 2013 March 2014 number of S136 (366) and April 2014 to detentions under the March 2015 (291) is a 21% Mental Health Act reduction in total. Page 3

4 (MHA), and divert the place of safety away from A & E. Total 5,327 6,501 The value of schemes outlined above outweighs the value of funds available to LCCG from MRET and emergency readmissions. LCCG has provided funding to support system resilience in Liverpool and the wider North Mersey SRG footprint in addition to the MRET and 30 readmission income to the value of 5.384m ( 6.501m costs of schemes less 1.117m RLBUHT MRET and 30 day readmission) in 2015/ Demand Management Plan 2016 / 2017 This demand management plan for 2016 / 2017 was presented to stakeholders at the North Mersey SRG meeting on 5 th February Contracts for 2016 / 2017 are due to be signed by 31 st March The amount available for MRET and 30 day emergency readmissions will be confirmed once contracts have been agreed, however, the schemes listed in section 4 above will continue into 2016 / 2017 at the proposed funding levels: Provider Scheme 2014/ / /17 NWAS/UC24 NHS ,104 1,104 Liverpool City Dom. Care packages from 1,418 1,418 1,418* Council - Better acute wards Care Fund Liverpool GP Additional Capacity in 2,031 2,362 2,362 Practices Primary Care UC24 GP at the Royal A&E Department UC24 GP at Alder Hey NWAS/UC24 Pathfinder/acute visiting scheme NWAS Frequent callers * LCC Public Health Examine your options * Mersey Care Street Cars * Total 5,327 6,501 6,501 * Actual level of investment to be confirmed for 2016 / 2017 Page 4

5 Other schemes currently for consideration in 2016 / 2017 are: Admission avoidance Improvement to NHS 111 and Out Of Hours services Reduction in short stay emergency admissions Rehabilitation and reablement Improvements to Complex Discharge Older People s Community Services Preventative schemes in elective care pathways Care Home Interventional schemes Telehealth Extended primary care Current schemes are regularly monitored by LCCG in terms of demand and impact on the wider system. In line with Monitor and NHS England s proposals for the 2016 / 2017 National Tariff Payment System 1, draft 2016 / 2017 guidance for commissioners on the marginal rate emergency rule and 30-day readmission rule LCCG will report progress of curent schemes through at the end of the financial year in LCCG accounts along with the final value of funds retained due to the marginal rate rule in each contract they commission. 1 Draft 2016/17 guidance for commissioners on the marginal rate emergency rule and 30-day readmission rule R_and_30-day_readmissions.pdf Page 5

Guidance on blended payment for emergency care. A joint publication by NHS England and NHS Improvement

Guidance on blended payment for emergency care A joint publication by NHS England and NHS Improvement January 2019 Guidance on blended payment for emergency care A joint publication by NHS England and