On 15 September 2023, NHSE published its Intermediate Care Framework for rehabilitation, reablement and recovery following hospital discharge to provide good practice guidance for integrated care boards. The framework is relevant for step-down intermediate care for those with particular conditions and needs, including but not limited to: people living with frailty, mild cognitive impairment, dementia or delirium, palliative and end-of-life care needs, mental health conditions, learning disabilities, and autism.
To support Integrated Care Systems (ICSs) with the winter pressures for 2023-2024, Care England has produced a best practice framework to aid system leaders’ engagement and collaboration with their local adult social care providers. This document highlights practical and pragmatic steps that will alleviate pressures facing the health and social care sector and should be read in conjunction with the four priority areas in the Intermediate Care Framework. Care England believes that there are five core principles ICSs must meet when working with their adult social care partners. If implemented the relationships built will deliver a more effective integrated system throughout the year. Winter planning will enable local systems to develop appropriate discharge pathways and also reduce (re)admissions.
Principle 1: Utilising the whole adult social care sector through person-centred care to improve demand and capacity planning
Integrated Care Boards (ICBs) should strive to ensure the whole of their local adult social care service is used effectively, rather than focusing on specific policies that target one part of the sector (i.e., residential/nursing care, homecare, supported living, community services etc). This will ensure that care services (residential/nursing care, homecare, supported living, community services etc.) do not become overburdened, and provide contingencies should capacity become limited. Focusing on the individual and their needs will ensure that the correct care services are utilised in the right location.
- Care England has partnered with Autumna to support local authorities and ICBs to deploy an effective solution for accelerated discharge and care commissioning that will enable discharge teams and local authorities to have greater oversight of their local care network. Care England ran a webinar in September 2023 that showcased what Autumna’s solution, Dashboard for Accelerated Discharge (D.A.D) will deliver and how it can support patients. Watch the recording here.
- Work with local representatives (local trade associations) to be better connected to diverse local care networks.
- Care transfer hubs’ multi-disciplinary teams (MDTs) should ensure that they have up-to date contacts for each of their local care providers to enable effective use of all care capacity, providing more choice to the individual.
Principle 2: Ensure that ICB workforce strategies promote integrational working between health and social care partners and address the challenges facing the care workforce
In Care England’s recent report ‘From Inception to Implementation: A Year of Integrated Care Systems – Findings and Discussion,’ workforce challenges were widely discussed by ICS leaders as the key pressure facing social care providers. It was noted that social care staff are moving to the NHS over work terms and conditions. Stemming this migration from social care to health care was cited as being crucial to the wider success of the integrated system.
- Care England urges ICBs to work with their local authorities with the implementation of improvement funds, such as the Market Sustainability and Improvement Fund – Workforce Fund (MSIF – WF) or Improvement Better Care Fund (iBCF) to eliminating pay and benefit disparity between the NHS and social care.
- When formulating care transfer hubs, ICBs should ensure that social care representatives are included within MDTs to enable better capacity planning and improve integrational working between health and care colleagues.
Principle 3: Using technology to support effective care transfer hubs, improve discharge capacity and process, and avoid (re)admission into hospital
The process of hospital discharge can be challenging, resulting in patients being discharged into a service that is not of their choosing or leaving them in hospital beds for significantly longer than required. The latest data from NHS England shows there were over 11,500 patients in hospital who no longer meet the criteria to reside.
- Through Autumna’s automation of the discharge process, discharge teams will be able to match patients to the appropriate capabilities and vacancies of local care services, creating a shortlist of available care providers within 60 minutes. This will remove the need for discharge teams and commissioners to call and email providers, reducing administration, increasing workforce capacity, and making the process of hospital discharge more efficient. Implementing fall prevention technology, or pain assessment tool kits that better support the social care workforce will dramatically reduce the risk of falls in social care settings, thus limiting the number of hospital readmissions as a result.
- Rolling out virtual wards within care homes will help rehabilitate individuals, upskill the workforce’s digital capabilities and support specialist provision including nursing and dementia care.
- Health and social care organisations, including commissioners, must have access to the right data (patient/resident needs, service level data including occupancy and vacancy) to optimise transfer of care programmes. ICBs, local authorities, and care providers need to agree on a set list of metrics that are universal and do not cause duplication or distortion of internal data sets
Principle 4: Refining commissioning practices and relationships
To efficiently use the adult social care sector and all of its services, ICBs must seek to improve commissioning processes for discharge to assess (D2A) beds and block contracts to avoid spot placements.
- Holistic planning of blocked beds will allow care providers to better plan their services as they will have financial foresight of the intended use of their services by the NHS.
- For successful commissioning to commence, commissioners within ICBs need to appropriately engage and work with their adult social care partners. Effective commissioning is built on relationship building. ICBs should seek to establish direct meetings with their care partners to develop commissioning plans and help build trust between health and care partners.
- D2A contracts need to be simplified and standardised to enable greater take-up from care providers. Current contracts are increasingly expecting more from social care providers, which in turn, leads to a decrease in interest in taking up D2A beds.
- ICBs should seek to review their Trusted Assessor agreements and confirm with their local care providers and local authorities the agreed protocols on who carries out assessments, what competencies are required, and what review mechanisms are available.
- ICBs and local authorities should work together and use Section 75 of the NHS Action 2006 where appropriate to develop a joint funding roadmap and allow local authorities to be able to commission services, such as funded nursing care (FNC), on behalf of the ICB.
- ICBs should bring forward delayed payments to better support the operational stability of their social care partners. ICBs should also ensure that their continuing healthcare uplift is in line with the NHS National Payment Scheme 2023/25 and is an appropriate amount that meets the needs of the individual.
- ICBs should further seek to standardise the rate for D2A beds. A minimum standard rate of £1,500 would save the NHS £914 per week and enable better planning by providers. This policy recommendation was explored within Care England’s roadmap ‘Care For Our Future.’
- ICBs must ensure that they are meeting the legal requirements when commissioning FNC and NHS consumables. To support commissioning, Care England has produced a briefing note, informed by conversations with the Department of Health and Social Care, to clarify the legal definition of FNC and to support the commissioning of NHS consumables.
Principle 5: Delivering pragmatic engagement and maintaining clear communication with the sector
At the centre of successful winter planning is clear and concise communication. To ensure that adult social care providers can properly support ICBs and the NHS in reducing winter pressures, Care England suggests:
- ICBs must ensure they continue to communicate winter plans and developments to all social care partners within their locality to enable better partnerships.
- Where a local trade association is not formed, ICBs should engage with national trade associations that are reflect the diversity of the provision of care within the local area, to expand their reach and engagement with care providers.
- ICBs must respond to care provider emails in a prompt and timely manner.
- ICBs should organise forums or drop-in sessions that care providers can join and can be updated on the latest winter developments and allow care providers to become more involved in the intermediate care programme.
- ICBs should be transparent as to how social care providers can inform and be engaged with board discussions and decisions.
- Care Transfer Hubs should ensure that VSCE and Social Care providers know who their Senior Responsible Officer (SRO) is and how to internally raise escalation routes on hospital discharge and care pathways.
Care England wants to work with Integrated Care Systems to deliver these five principles. To collaborate further please email Louis Holmes, Digital and System Transformation Projects Manager at firstname.lastname@example.org.