The Year of Care idea is beginning to take shape.   It represents a significant shift from a biomedcal to pscyho-social model of care and funding for long term conditions, with different risk sharing.  It will definitely affect respiratory care, and so commissioners and providers with an interest in respiratory care should keep an eye on progress of national pilots that are being set up.  They are intended to reflect the reality of long term conditions.

Multimorbidity

The LTC team quote data on multimorbidity from The Scottish School of Primary Care’s Multimorbidity Research Programme:

• Only 18% of patients with COPD have just COPD;

• Only 14 % of patients with diabetes have just diabetes;

• Only 5% of patients with dementia have just dementia

Year of care tariff

The DH England aims to have a national LTC “Year of Care Funding Model”, which incentivises the delivery of integrated health and social care for people with long term conditions (LTCs) based on their need rather than the disease and for those people who need support from more than just their GP practice. The three pillars of LTC policy are 1. risk profiling of GP practice populations - converted into groups according to their needs using a national assessment and classification system; 2. integrated professional teams, and 3. maximisation of the numbers of people who can "co-manage" or self care.

The policy papers say "The financial model will be an annual risk-adjusted capitation budget which is based on these levels of need. The model aims to improve outcomes and deliver a more effective use of resources by focussing providers on moving away from episodic, activity driven funding flows towards person centred care irrespective of organisational boundaries." This must be a good thing, and should start to incentivise the right behaviours in terms of services, particularly hospitals,  looking to their role in managing the care of populations. 

Recovery, rehabilitation and reablement

There will also be a shift of the bed days associated with the recovery, rehabilitation and reablement element of care from a hospital bed to other more appropriate models. The CQC (2010) reviewed variance in occupied bed-days for multiple admissions of >75s and concluded that better joining up of Social Care and Health across England would save £2billion.

The RRR model aims to change the responsibility for care, and the tariff, at the point when the patients’ needs change not at the point at which they change institutions.

Variation in social care and how reablement money is being used to fill funding gaps instead

However,  An atlas of variations in social care  newly published by MHP Health Mandate shows that not all resources earmarked for such purposes are currently used this way - so there will need to be careful monitoring in place.  This report claims "The number of emergency re-admissions to hospital for over 75s within 28 days of discharge could be reduced by 227,400 in England if all councils could reduce their admissions to those of the best performing quarter of councils. Such improvements could result in a national saving of £318.4 million per year for the NHS."

It also found that there is a greater than seven-fold variation in the proportion of older people receiving homecare following a care assessment (defined as a person receiving more than ten hours per week of care in their own home).   In some areas, 1 in 5 people are able to access homecare following an assessment, but in others this falls to 1 in 25 people.  The reasons for this variation are unclear.
 
In spite of the Government’s mental health strategy, No health without mental health, just 4% of the additional £648 million for social care in 2011/12 was spent on mental health services.
 
There is nearly a six-fold variation across local authorities in the weekly expenditure on self-directed support. This is relevant given the full impplementation of personal budgets by April 2013.

What's the timescale?

April 2012 – March 2013: Test implementation of the model
April 2013 – March 2014:Shadow LTC year of care currencies (local), and development of national pricing model
April 2014 – March 2015: National LTC year of care currencies and shadow prices
April 2015 – March 2016: National LTC year of care prices

For more information:

http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_133650