Providing capacity through the Integrated Care Bureau

Identify and understand

In April 2018, a Bristol, North Somerset and South Gloucestershire (BNSSG) report highlighted that across BNSSG there was an above average growth in unplanned hospital admissions and we were admitting more patients than available capacity.

To provide extra capacity, ten stakeholder organisations came together to develop the Integrated Care Bureau, which acts as the front door to local health and social care community services. The ICB makes trusted assessments of which service will best meet patients’ needs, to help move people out of hospital and into the community after an acute admission.

Assess

An evaluation of the Integrated Care Bureau was required to review the impact of the new approach.

Plan

With ten stakeholders a robust evaluation was devised, using existing routinely collected quantitative data, new qualitative data and patient stories. The evaluation was required to answer four questions about the Integrated Care Bureau way of working.

1. Is the Integrated Care Bureau enabling optimal use of capacity across BNSSG and co-ordinating solutions across services?
2. Is the Integrated Care Bureau enabling improved earlier a) shared decision making across health and social care to affect b) a more timely discharge?
3. Is the Integrated Care Bureau enabling patients to return home, or as close to home as possible, more quickly, ultimately improving patient outcomes by keeping people well and independent?
4. Is the Integrated Care Bureau improving flow by reducing current stranded patient levels and Delayed Transfers of Care (DToCs) in the Acute bed base, and ensuring patients get the right input at the right time in the right place?
5. Is the ICB reducing demand for social care by reducing inappropriate demand and reducing long term social provision across the system?

Do

Data was collected, analysed, and written up as a report which was presented to a decision-making group. For each of the questions the evaluation needed to answer, findings indicated:

1. The Integrated Care Bureau was enabling optimal use of capacity across BNSSG and coordinating solutions across services.

• Following the implementation of Integrated Care Bureau, the number of Pathway 1 (P1) referrals received increased at all providers with a reduction in unutilised capacity. Most notably at one Community Health provider which went up to 25%. This followed with a reduction in the number of Pathway 2 referrals received by approximately 5%.
• There was a rise in the number of Community delays for Home First/pathway 1 and 2 across all Community Provider linked to the difficulties in sourcing Home Care through Local Authority (LA) provision.
• There was a 50% reduction in the number of times OPEL (Operational Pressures Escalation Level) 3 and 4 was declared as a system during the evaluation period.

2. The Integrated Care Bureau helped improve earlier a) shared decision making across health and social care to affect and b) a more timely discharge.

• The Staff / Stakeholder questionnaires exhibited several themes: speed of discharge; improved decision making; inter team discussion and clarity of pathways and process. Data also showed that Single Referral Forms (SRFs) could be conflicting, confusing and of poor quality which caused rejection and subsequent resubmission.

3. The Integrated Care Bureau helped enable patients to return home, or as close to home as possible, more quickly, ultimately improving patient outcomes by keeping people well and independent.

• The number of patients at home following Home First P1 is 92% post Integrated Care Bureau.
• Readmission rates vary depending on the types of pathway and the readmission reason.

4. The Integrated Care Bureau improved flow by reducing current stranded patient levels and Delayed Transfers of Care (DToCs) in the Acute bed base, and ensuring patients get the right input at the right time in the right place.

• The case studies indicated that without the system in place, Length of Stay (LOS) would have increased due to delays in decision making and inappropriate referrals.
• The number of escalation beds significantly decreased the winter of the pilot compared to winter previously.
• There had been significant reductions in LOS and associated savings from this.
• Average LOS was shown between a 10- and 20-day improvement in the length of time between assessment and discharge from each of the three Trusts.

5. The ICB reduced demand for social care by reducing inappropriate demand and reducing long term social provision across the system.

• Average LOS was shown between a 10- and 20-day improvement in the length of time between assessment and discharge from each of the three Trusts. It is worth noting it was reported that while inappropriate referrals decreased there was an increase in the demand for complex assessments a deep dive took place between the three LAs.

Review and act

The mixed methods evaluation findings and recommendations were presented to a decision-making group, to inform decisions about the future of the service. This led to Phase 2 of Integrated Care Bureau to be agreed and the digitalised solution put in place.