Year of Care Explained

By Eileen Burns and Amit Arora

Payment by results (PbR) never fully addressed the management of long term conditions, and the importance of timely and seamless transition to and from the community for patients who live with them.

Year of Care (YoC) was suggested as a possible solution in 2011 by Richard Murray, Chief Economist at the Department of Health in his document, “Payment reform in the NHS”. The long-term conditions YoC tariff is designed to allow health and social care to be provided based on a person’s overall needs as opposed to what specific diseases they have. It fits with the work being undertaken across the NHS to make care better integrated. If it works as intended, it will allow funding to be moved around as needed to provide the most effective ‘package’ of care for the person over a 12-month period. The underpinning philosophy is that money should be present in the parts of the healthcare system best-suited to provide patient care. The financial model is based upon an annual risk-adjusted ‘capitation’ budget, based on levels of health care need.

A new kind of geriatrician – introducing interface geriatricians

Gillian Fox, Alison Cracknell, Sadia Ismail and Eileen Burns are all Consultants in Interface Geriatrics at Leeds Teaching Hospitals NHS Trust

Leeds Teaching Hospitals has a 60 bedded general adult medical admissions unit and a 60 bedded Elderly Admissions Unit with comprehensive geriatric assessment (CGA) embedded to either facilitate discharge to community services with ongoing assessment and/or rehabilitation where needed or begin treatment and investigation before transfer to an elderly care ward.

As part of the Leeds acute care model, 2012 saw the introduction of Interface Geriatricians (IGs). This service was developed with initial funding from the PCT (later CCGs) aiming to avoid admission where appropriate. We have developed a model for working for the IG that covers 3 key areas of interface – community, PCAL (primary care access line) and the emergency department (ED).

Unco-ordinated care: we need named responsible clinicians in hospital too!

Ron Murphy is a software designer, he blogs at ronmurp.net 

I read the “Named clinicians …” post today, and the linked post by Prof David Oliver. It addresses continuity of care after discharge. This is a concern, as he quotes, “we need to know that there is a clinician accountable for vulnerable older people in the community, just as there is in hospital”.

What works best in intermediate care?

The National Service Framework for Older People made intermediate care services a priority over a decade ago but little work had been done to describe and assess progress until last year’s first ever National Audit of Intermediate Care (NAIC).   The results were published in September 2012 and show that while large numbers of older people are benefitting from intermediate care services  – with the majority returning to their original place of residence after receiving intermediate care – there is considerable variation in how services are provided.

Intermediate care has dual objectives of preventing unnecessary acute hospital admissions and supporting timely discharge for those ready to leave hospital. The overall capacity of intermediate care is small relative to acute hospital provision. Estimates of potential demand for intermediate care services compared to the capacity identified in the audit, suggest overall capacity may be less than half of potential demand. This gap between demand and capacity raises the question of whether the current scale of intermediate care is sufficient to make an impact on hospital utilisation including reducing emergency admissions and time spent in acute care wards.

Debate:- Funding social care for older people- The Gathering Storm

The question of how to best fund care of frailer older people in their latter years remains unresolved. Current rules require all older people with assets above £23,250 to personally fund all care requirements and all assets [including property] are included in financial assessments. The arrangements have been criticised by many for forcing those who have worked hard to build assets through their life to

In the past 13 years there had been two independent commissions, three public consultations and now three white papers. The latest of these, the Dilnot report, called for a system for the elderly whereby there was universal coverage: the total cost of care would be capped at £35,000 with social support for old people extended to those with assets of £100,000, incurring a total estimated cost of £4.2 billion in 2025.

The social care issue is thorny and has multiple facets:-

• Can we afford it? – the present economic climate brings to harsh reality the ability of the welfare state model to provide for all aspects of life on limited resources
• Who should fund it? – the government, families or the third sector
• Universal coverage? – Should any legislation cover all people without any exclusions or prejudice? What happens to those, with financial means, who do not wish to contribute to their own care?
• Financial fairness? – What is “fair”?  Who should pay? How much should they pay?
• Equity of provision across the UK? – How do we minimise variability in how legislation and policies are exercised between regions?

What are your views on funding for long term care? Join the debate.

The Silver Book – guidelines for the emergency care of older people

The BGS is proud to announce the publication of the Silver Book, an essential guide to for all those involved in delivering emergency care to meet the needs of older patients and to promote continuous improvement in the standards of care.

The Silver Book recommends ways in which emergency admissions can be reduced and the experience of those admitted improved.  It considers all the clinical contacts which a patient might have during an emergency and suggests minimum standards and responses. A core focus of the Silver Book is the skills and competencies needed by healthcare staff to ensure they are better able to assess and manage frail older people. 

Innovative designs for living with dementia

An interesting feature in the last five minutes of this morning’s Today programme on Radio 4 spoke about the Design Council’s innovation competition around “Living Well with Dementia”, the winners of which are announced today.

The five winners are summarised on the Design Council website and range from the immediately pragmatic to more esoteric solutions.  All challenge the assumptions that little can be done to change the status quo for dementia sufferers and have potential to tackle day to day frustrations head on.  They include:

• An online service that matches family carers with locally available flexible work.
• A carers’ social networking site that assists families to co-ordinate informal care for their relative with dementia around busy work and social lives.
• A service providing “dementia dogs” for companionship and as a link to the community.
• A GPS wristband to help reassure carers to help locate patients with dementia.
• A fragrance release system to help stimulate appetite at mealtimes in care settings.

A live lecture, showcasing the projects, will take place online this afternoon from 1pm.  An exhibition showcasing the designs is being held at the Design Council, 34 Bow Street, London tomorrow, Friday 27th April 2012.

Failing the Frail: A chaotic approach to commissioning healthcare services for care homes

The BGS published its report, Failing the Frail, on the same day as the Care Quality Commission (CQC) published its Special Review of Care Home Residents Access to Healthcare Services.  The data collected by CQC as part of its review was analysed by the BGS under a data-sharing agreement and shows that primary care trusts (PCTs) do not accord sufficient priority to care home residents when planning and ensuring the delivery of local healthcare services.

Please see the BGS website for further details and a copy of the report.  

The BGS report was covered in the national press, including the Daily Telegraph, the Guardian and the BBC.