The £3.8 billion Better Care Fund is a single pooled budget to support health and social care services to work more closely together in local areas. In this audio slideshow, Richard Humphries and Laura Bennett explore the different ways in which clinical commissioning groups, local authorities and health and wellbeing boards can use the grant to promote integrated care and help shift care closer to home.

1. Making best use of
the Better Care Fund
Richard Humphries
Assistant Director of Policy, The King’s Fund
Laura Bennett
Research Assistant, The King’s Fund

2. What is the Better Care Fund?
› £3.8 billion pooled budget for health and social care
› £1.9 billion from clinical commissioning group allocations
› Aim - to promote integrated care closer to home
› Reduced hospital activity and income
› Tough national conditions
› Protection for social care services, seven day services, data
sharing, joint assessments and care planning, impacts on acute
sector, patient and public engagement
› Tight timescales
› First cut plan required by 14 February
› Final plans by 4 April

3. A resource for decision-makers
›
Health and care leaders are faced with the necessity of making
decisions based on the best available knowledge and evidence
›
Understanding of key local challenges and issues
›
Balance use of evidence with willingness to innovate and try
different approaches

4. 1. The sources of need and demand
Targeting interventions where they can have most impact:
›
Increasing number of people with multiple long-term conditions
means patients’ needs are cut across multiple health and social
care services
›
Small number of patients can consume a large proportion of
services
›
Knowing who these people are is essential

5. 2. Primary prevention
Enabling people to enjoy a healthy and active life within their
communities:
›
Individual and community level interventions (advice, education,
regulations)
›
Supporting people to maintain their independence (housing,
preparing for winter, preventing isolation and loneliness)

6. 3. Self-care
Supporting patients to manage their own condition:
›
Tailored interventions
›
Personalised self-management plan
›
Behavioural change programmes
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Support for carers

7. 4. Ambulatory care-sensitive conditions
Active management of ambulatory care-sensitive conditions:
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Early identification (risk stratification)
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Continuity of care with a GP
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Early senior review and structured discharge planning

8. 5. Risk stratification
Identifying individuals at high risk of future hospital admission:
›
Choose an appropriate predictive model and include GP data
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Identify patients most likely to benefit from preventive care
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Base catchment areas on distribution of high risk patients and
consider local needs for staff mix
›
Organise around GP practices

9. 6. Falls prevention
Screening, assessment and individualised intervention for those
at risk of falling:
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Strength and balance training
›
Home hazards
›
Vision
›
Medication review

10. 7. Care co-ordination
Bringing services together around the needs of service users:
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Holistic focus
›
Single entry point
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Shared electronic health record - ‘high-touch, low-tech’ approach
›
Neighbourhood level
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Engagement with GPs and secondary care

11. 8. Case management
Community-based, proactive approach to care:
›
Early action and prevention
›
Single point of access, shared assessment and access to clinical
records
›
Multi-professional teams based around GP practices
›
Holistic personal care plan
›
Case managers

12. 9. Intermediate care
Rehabilitation and re-ablement to facilitate a stepped pathway
out of hospital or prevent deterioration that could lead to a
hospital stay:
›
Shared assessment and personalised plan to address
physical, social and psychological needs
›
Appropriate skill-mix

13. 10. Emergency activity
Managing emergency activity, discharge planning and postdischarge support:
›
Capacity in the community
›
Structured individualised discharge plan
›
Early supported discharge

14. 11. Medicines management
Managing the complexities and risks of polypharmacy:
›
Educational information and outreach services
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Use of IT and decision-making support tools
›
Longer GP consultations for patients with multiple long-term
conditions
›
Improved systems for transfer of patient medication details at
admission and discharge
›
Patient perspectives and challenges in managing their medications

15. 12. Mental and physical health needs
Meeting the mental and physical health needs of patients and
service users:
›
Liaison services
›
Improved identification and support of mental health needs
among people with long-term conditions
›
Strengthened disease management and rehabilitation
›
Collaborative care models
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Training

16. 13. End-of-life care
Identifying and co-ordinating care for people who are at the end
of life:
›
Adequate capacity outside acute hospitals to facilitate discharge
›
Rapid response services in the community to prevent emergency
admissions

17. 14. Delivering integrated care
Well-developed, integrated services to provide a good patient
experience and reduce use of hospital beds:
›
Find common cause, develop a shared narrative and a persuasive vision
›
Establish a shared leadership and create time and space to develop understanding of
new ways of working
›
Identify service users and groups where potential benefits are greatest
›
Build integrated care from the bottom up and the top down
›
Pool resources to enable commissioners and integrated teams to use resources
flexibly
›
Innovate in the use of commissioning, contracting and payment mechanisms and the
use of the independent sector
›
Recognise that there is no ‘best way’ of integrating care
›
Support and empower users to take more control over their health and wellbeing
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Share information about users with appropriate information governance
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Use the workforce effectively and be open to innovations in skill-mix
(Ham and Walsh 2013)

18. More resources…
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The house of care model (Coulter et al 2013)
www.kingsfund.org.uk/houseofcare
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Sam’s story www.kingsfund.org.uk/carestory
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Integrated care map www.kingsfund.org.uk/caremap
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Publications www.kingsfund.org.uk/publications