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NHS Benchmarking NetworkJune 2020

Raising standards through sharing excellence

Community Services benchmarking Deep dive report for Community Integrated Care Teams (CICTs)

Raising standards through sharing excellence

© NHS Benchmarking Network (NHSBN)

Citation for this document: NHS Benchmarking NetworkDeep dive report for Community Integrated Care Teams. June 2020

Community Services benchmarking - Deep dive report for Community Integrated Care Teams

ContentsSection 1: Introduction Content of this report Executive summary Community Integrated Care Teams

Section 2: National policy context Community Services Community Integrated Care Teams

Section 3: Key Findings - Community Integrated Care Teams Service model, structure and linkages Management of Frailty Clinical leadership and governance Assessment and care planning Medical cover Access Activity Workforce Finance Quality and outcomes

Section 4: References

Appendix 1: The Community Services benchmarking project

Page 4Page 5

Page 6Page 10

Page 12Page 15Page 16Page 17Page 18Page 19Page 21Page 25Page 270

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Page 32


3

4


Section 1: Introduction

Section 1: IntroductionWhen reviewing this document, please note:

the 2019 Community Services project collected and analysed data for the NHS financial year 2018/19. The “2018 project” refers to 2017/18 data

any reference to the “national average” within this document refers to the mean average of 2019 project participants

all charts and data in this report refer to the overall UK position. Peer group profiling is available in the online toolkit

on bar charts, each blue bar represents an individual service. The orange horizontal line represents the mean average value of all services

this report is an overview national report and therefore the charts in this report do not show the position of any one organisation in particular. Member organisations who participated in the Community Services project can check their individual positions in the online toolkit, which is issued to members once the dataset has been finalised. This allows individual comparison of every metric collected against the sample position.

Content of this report

NHSBN Community Services 2019 - Community Integrated Care Teams

Face to face contacts per 100,000 population

Routinely screen for frailty Patient facing time

Average length of a contact

Nursing staff in the team Average waiting time

Referrals received per 100,000 population

Document a joint personalised care plan

Face to face contacts per service user

33,979 50% 58%

40 mins

69% 11 days

4,272

61%

15

5


Section 1: Introduction

Executive summary Community Integrated Care TeamsAll participating CICTs are shown to accept referrals from acute trusts, social care and ambulance services. Self referrals or referrals via family and carers are less frequently accepted by CICTs, reported at 67% and 72% of participating services using this form of referrals respectively.

The mean number of referrals received per 100,000 registered population was reported at 4,272 in 2019. This is a 48% increase in the amount of referrals received since the reporting in the 2016 project, which may be a factor of CICTs being adopted as a model or service organisation and delivery over the last few years of project operation.

On average, 2,083 unique service users per 100,000 registered population are cared for by CICTs. Since 2016, there has been a 35% increase in the number of unique services users reported per 100,000 registered population, from 1,543. The increase of unique service users similarly mirrors the rise in referrals, suggesting growth in demand levels to the service.

On average, CICTs deliver 33,979 face to face contacts per 100,000 population. The average number of face to face contacts per unique service user is 15, with the average length of the contact being 40 minutes.

The CICT workforce discipline mix is predominantly made of nursing staff, at 69%. AHPs account for 15% of the workforce, followed by 14% support staff. There has been an increase in the percentage of social care input into CICTs, increasing from 0.02% in 2018 to 1.4% in 2019.

Clinical staff pay costs represent the largest proportion of the CICT total budget, accounting for 53% of the total budget spent during 2018/19. The clinical staff pay cost budget remains fairly consistent from 2018/19 to 2019/20, around £1.49 million per 100,000 registered population.

Half of the participating CICTs routinely screen for frailty when a person is referred to the service, with 44% of teams carrying out Comprehensive Geriatric Assessment (CGA) in the community.

CICTs test high on the NHS Friends and Family Test (FFT), with an average score of 96%. The satisfaction score has remained high the past few years, showing that overall users are happy with their experience of CICTs.

Total referrals received per 100,000 registered population

2018

2017

2019

2016

1,000

3,000

2,000

0

4,000

1,500

3,500

2,500

4,500

500

6


Section 2: National Policy Context

National policy contextCommunity ServicesEngland

The NHS Long Term Plan, published in January 2019, highlights the importance of community services in supporting service users in the community and reducing unnecessary hospital admissions. The Long Term Plan sets out to:

boost ‘out-of-hospital’ care, and dissolve the historic divide between primary and community health services

increase investment in primary medical and community health services, which will equate to an extra £4.5 billion a year by 2023/24. Extra money will start to flow to community via Sustainability and Transformation Partnership (STP)/ Integrated Care Systems (ICS) and Primary Care Networks (PCN) via Directed Enhanced Service (DES) contracts in 2020/21. The Long Term Plan Implementation Framework outlines funding allocations, with funding for Primary Care flowing more quickly than funding for Community Services

increase the capacity and responsiveness of community and intermediate care services via a new offer of urgent community response and recovery support. These services will aim to prevent unnecessary admissions to hospitals and residential care, as well as ensure a timely transfer from hospital to community

expand community multidisciplinary teams aligned with new Primary Care Networks based on neighbouring GP practices. Expanded neighbourhood teams will comprise a range of staff such as GPs, Pharmacists, District Nurses, Community Geriatricians, Dementia workers and AHPs.

Yes

No

Does your organisation operate with any Primary Care Networks (PCNs)?

0% 60%

40%

20%

100%80%

69% 31%

7



Although the focus of community services within the NHS Long Term Plan is on adult services, wider children’s services and providing a strong start in life for children and young people is also highlighted in the plan. The Long Term Plan sets out to:

bring together the NHS, Local Authorities and other local partners through local maternity systems, with the aim of ensuring women and their families receive seamless care, including when moving between maternity or neonatal services or to other services such as primary care or health visiting

expand and invest in mental health services for children and young people

design and implement models of care that are age appropriate, closer to home and bring together physical and mental health services. These models will support health development by providing holistic care across Local Authority and NHS services, including primary care, community services, speech and language therapy, school nursing, oral health, acute and specialised services

roll out clinical networks to ensure improvement in the quality of care for children with long-term conditions such as asthma, epilepsy and diabetes.

Wales

Community services strategy in Wales is contained within the document A Healthier Wales: Our Plan for Health and Social Care and sets a clear ambition to bring health and social care services together for the benefit of service users. This is not a new vision, but is supported by clear expectations, milestones and design principles to establish new models of care in every part of Wales.

The overall aim is to provide services that are designed and delivered around the needs and preferences of individuals, with greater emphasis on sustaining a healthy population and preventing ill health. To achieve this ambition, Wales must continue to break down the barriers that prevent health and social care services and their wider partners from operating across the whole system, delivering seamless care to the people of Wales.

Good planning arrangements are critical to bring together multiple providers and allow the system to be pre-emptive and anticipatory, ensuring that the right level of care is provided at the right time, from the right source and in the right setting.

8



A Healthier Wales outlines the following strategies, all of which relate to the provision of community services:

services which support people to stay well, not just treat them when they become ill when people need help, health and social care services will work with them and their loved ones

to find out what is best for them and agree how to make those things happen. This is the basis of the ‘person-centred approach’

more services will be provided outside of hospitals, closer to home, or at home, and people will only go into hospital for treatment that cannot be provided safely anywhere else. This ‘community-based approach’ will help take pressure off the Welsh hospitals, reduce the time people have to wait to be treated, and the time they spend in hospital when they have to go there

health and social care services will use the latest technology and medicines to help people get better, or to live the best life possible if they aren’t able to get better.

Northern Ireland

Northern Ireland have a strategy which, in tandem with the modernisation of acute hospitals, seeks to expand the range of services that can be delivered in the community and is described in A Healthier Future. This encompasses the following:

the key aim is to support an increasing number of people to live independent lives, preferably in their own homes

to do this, the Health and Social Care Board and the Public Health Agency in Northern Ireland need to develop effective alternatives to hospital care, which are designed to reduce inappropriate admissions and unnecessary lengths of stay

there also needs to be a strong focus on rehabilitation in tandem with assessment of long term care needs to avoid unnecessary reliance on residential and nursing home care.

To deliver on this vision, the following strategies are being pursued in relation to community services provision in Northern Ireland:

secure an appropriate balance between hospital and community based services within local health economies

continue the expansion and evaluation of intermediate care as a way of working that is designed to prevent unnecessary hospital admission, promote faster recovery from illness, support timely discharge, maximise independent living and improve the quality of assessment of long-term health and social care needs

https://www.scie-socialcareonline.org.uk/a-healthier-future-a-twenty-year-vision-for-health-and-wellbeing-in-northern-ireland-2005-2025/r/a11G00000017yy6IAA

9



Scotland

The newly created Public Health Scotland’s strategy around community services is embodied in A Fairer Healthier Scotland 2017-22. There are five strategic priorities that have been developed in partnership with stakeholders, including providers of community services. These are as follows:

Fairer and healthier policy - ensure that knowledge and evidence is used by policy and decision makers. This is so that strategies focus on fairness and influence the social determinants of health and wellbeing.Children, young people and families - ensure the knowledge and evidence provided is used to implement strategies focused on improving the health and wellbeing of children, young people and families.A fair and inclusive economy - providing knowledge and evidence on socio-economic factors and their impact on health inequalities. This is to contribute to more informed and evidence-based social and economic policy reform.Healthy and sustainable places - ensure the knowledge and evidence provided is used to improve the quality and sustainability of places. This will increase their positive effect on health and wellbeing.Transforming public services - working in partnership with and support public sector organisations to design and deliver services that have fairer health improvement and the protection of human rights at their core.

in co-operation with the independent sector, expand the use of supported living, domiciliary care, day care and assistive technologies as alternatives to residential accommodation, focusing on rehabilitation and independent living

develop a range of housing and care options for different levels of support, offering a continuum of care as people’s needs change

contribute to the development of a region-wide single assessment process, focused upon the person and designed to streamline and improve decision making about long-term health and social care needs and simplify access to services

expand the range of flexible and responsive respite and support services for carers increase the take up of Direct Payments engage actively with users and the voluntary and community sector in the design and delivery

of services

10



CICTs are a relatively new service model used throughout the NHS, coming into fruition after a national shift in focus to integrated care within the community.

CICTs are based around a collective of General Practitioner (GP) areas, typically covering 30,000 - 50,000 people. These teams join up a range of community health and social care professions and GPs to support patients with complex health needs living within the community.

People living with multiple, complex health needs are more likely to be reliant on the support of local health and social care services to live independently. The input into the person’s care will often cover a variety of services and staff disciplines such as GPs, Pharmacists, the Local Authority, District Nurses, Physiotherapists, etc. Integrated care teams, therefore, offer a streamlined approach to treat this cohort of patients by offering joined up care, as opposed to the traditional method of accessing care via a single service.

Within the teams is a web of knowledge and connections, that can be easily accessed to ensure the person receives the appropriate care from the correct professional. As such, the care delivered by CICTs is tailored to the individual’s needs.

Community Integrated Care Teams

The NHS Long Term Plan, 2019 details the various testing done on alternative models of integrated care ‘Vanguards’ and Integrated Care Systems. The results showed that despite less funding to these services, they had a positive impact on emergency admissions, and ‘demonstrated the benefits of proactively identifying, assessing and supporting patients at higher risk to help them stay independent for longer’.

Figure 1: Growth in emergency admissions per capita 2014/15 to 201718: MCP and

PACS Vanguards vs. the rest of the NHS.

Primary & Acute Care Systems

Multispeciality Community Provider

Vanguards

Non-Vanguard rest of the NHS

8%

4%

2%

0%

6%

1%

5%

3%

7%

Note: The MCP and PACS combined emergency growth rate is 1.6% which is statistically significantly lower than the rest of the NHS with 95% CI (the upper limit for a significant value is 3.1%)Source: NHS England analysis of Secondary Uses Service (SUS) data.

6.9%

2.6%

0.9%

11



The Multispeciality Community Provider Vanguards can be recognised as CICTs, emphasising the value of the CICT model, in reducing the number of hospital admissions, as shown in Figure 1.

Chapter one of The NHS Long Term Plan, focuses on the creation of a new service model, that boosts out of hospital care by integration across primary care and community services. An investment of £4.5 billion is said to be pumped into primary and community care services, with part of this going towards the expansion of community multidisciplinary teams aligned with new Primary Care Networks (PCNs).

PCNs are groups of local GPs, collaborating as a network with shared funding, knowledge and staff, whilst maintaining the independence of an individual practice. PCNs are still in development, yet will be responsible for assessing their local population for risk of unwarranted health outcomes and working with community services to support people who most need it.

Additional funding for primary care will flow through the Primary Care Networks and be disseminated amongst the individual practices. As well as the direct investment into primary care, additional funding will be available by the ‘Shared savings’ scheme that will incentivise PCNs to reduce avoidable A&E attendances, admissions and delayed discharges. As a result, these schemes are likely to encourage PCNs to invest in the set up of CICTs and support the delivery of these teams.

Initiatives such as the Better Care Fund (BCF) have also been introduced to encourage integration across health and social care organisations, to support people with long-term health conditions. The BCF is an added incentive for Community Providers to create CICTs and build links with their PCNs and the Local Authority.

The increase of national focus on integrated care, matched with investment into service collaborations, is likely to result in more CICTs developing across the country by 2023/24. In addition to the number of services, we may expect that CICTs will be responsible for a larger volume of patients, thus increasing the activity delivered.

12


Section 3: Key Findings - Community Integrated Care Teams

Community Integrated Care Teams - service model, structure and linkagesThere is currently no officical definition of Community Integrated Care Teams (CICTs). In order to help member organisations who participate in the Community Services project determine whether their local service should be included in the benchmarking project, the Network’s Community Reference Group have agreed the following definition:

Key findings

a Community Integrated Care Team (CICT) is a multi-disciplinary and frequently, multi-agency team, providing complex clinical care to service users in their own homes (including residential care homes) and in local clinics and health centres. The core function of the CICT is long-term condition management, providing patients with support for self-management and keeping people as independent as possible in their own homes.

CICTs will also support complex discharges from hospital. Typically, CICTs will provide care over a longer time period; as a rule, continuing beyond 6 weeks. The team should be professionally and functionally integrated, but staff do not necessarily have to work for the same organisation. The CICT may offer both physical and mental health care. Most CICTs will be organised around Primary Care Networks.

the management of people living with frailty and non-medical prescribing are common functions of CICTs, with 94% of participants in the 2019 project providing these services. Over three quarters of teams further provide end of life care (88%), wound care (77%) and crisis response services (77%). Less frequent functions of CICTs include supporting patients manage and maintain their own home, where 39% of services offered housing support

of the CICTs taking part in the 2019 project, 58% provide mental health care to patients in addition to physical health care

CICTs remains an adult focussed service, where 100% of participants provide care to adults only, with no services caring for children. This finding is consistent to the 2018 results.

13



Services provided

Management of people living with frailty

CHC assessment

Safeguarding

Non-medical prescribing

End of life/ palliative care

Other

Wound care

Crisis response

Home based intermediate care

0% 60%

40%

20%

100%80%

Yes No

Re-ablement (social care)

Single condition rehabilitation

Social care (not re-ablement

Bed based intermediate care

Community IV therapy

Telehealth/telecare

Housing support

94%

94%

88%

77%

77%

77%

72%

71%

71%

65%

59%

56%

53%

47%

41%

39%

6%

6%

12%

23%

23%

23%

28%

29%

29%

35%

41%

44%

47%

53%

59%

61%

14



Over three quarters of CICTs report that they are organised around groups of GP practices, reflecting increasing alignment with PCN groups and sub-groups. 6% of CICTs are structured around an individual GP practice and 18% stated another organisation model

a variety of methods are used by CICTs to link with GPs. 50% of services answered that GPs attend the weekly MDT meetings, 56% state their team leader regularly meets with GPs to discuss cases, and ‘other’ methods are used by 92% of services. Narrative was collected on what was meant by ‘other’, which included reference to telephone and email contact, monthly MDT meetings, shared IT systems and ad-hoc contact

new questions were introduced into the 2019 Community Services project, to gauge the integration of Community Services and Primary Care Networks (PCNs)

the results from the 2019 project show that during 2018/19, 38% of CICTs were fully linked with their local PCN, 63% reported that PCNs were still in development, whilst no services reported an absence of PCNs within their local area

100% geographical coverage of the PCN contract Direct Enhanced Service (DES) by 1st July 2019 was outlined by NHS England (NHS England, 2019). NHSBN will be able to report national findings against the coverage of PCNs during the next iteration of the project.

Community Integrated Care Teams - service model, structure and linkages

Team organisation

Development stage of Primary Care Networks

Individual GP practices

Groups of GP practices

Other

Fully developed

In development

Doesn’t exist currently

6%

76%

18%

38%

63%

https://www.england.nhs.uk/wp-content/uploads/2019/04/pcn-faqs-000429.pdf

15



Community Integrated Care Teams - Management of FrailtyThe management of frailty is an integral part of the CICT function. Early recognition of frailty is essential to provide appropriate care for the patients, as such 50% of CICTs routinely screen for frailty when a person is referred to the service. This can help prevent hospital admissions by stopping a further state of decline before its too late. 25% of services are shown to use the electronic frailty index (eFi) to obtain registers of people identified as frail. When assessing patients for frailty, the Rockwood Clinical Frailty scale is the most popular tool in use; used by 82% of CICTs who screen for frailty.

The results from the 2019 project further show that 44% of CICTs carry out Comprehensive Geriatric Assessment (CGA) in the community. CGA, according to the British Geriatrics Society (BGS), is a holistic and multidimensional assessment of a patient, carried out by a number of specialists of many disciplines in older people’s health. CGA is considered best practice for optimising outcomes for older people. This is the highest reported figure in the project since 2015, which suggests that care of the frail and elderly population has become a larger priority for these teams, whereby the identification of a patient living with frailty allows the team to provide a more effective and personalised care plan. For the CICTs who don’t currently carry out a CGA, 20% have plans to eventually do so.

Frailty management in the community

Does the CICT routinely screen for frailty when a person is

referred to the CICT?

Do you use the electronic frailty index (eFI) obtainable

via primary care health records to obtain registers of people

identified as frail?

0% 60%

40%

20%

100%80%

50%

75%

50%

25%

Yes No

16



Community Integrated Care Teams - Clinical leadership and governanceThe donut chart reflects that CICTs are mostly nurse led (56%). However there is a variety of leadership models amongst CICTs, with 11% being led by GPs, therapists and non clinical staff.

Given the variety of professionals involved in CICTs, MDT meetings allow for staff to convene to discuss patient care and plan for future treatment and support. Weekly MDT meetings were said to be held in 89% of CICTs in 2019. This method of working has shown a slight increase throughout the project, reported at 83% in 2014.

The bar chart below reflects the dissemination of CICT performance reports, highlighting which stakeholders receive this information. Where performance reports were produced, 100% went to internal management/board, however 10% of respondents reported performance reports were not provided during 2018/19.

Consultant led GP led

Nurse led Therapy led

Social care led Not clinically led

56%

11%

6%11% 6%

11%

Clinical leadership within the CICT

Performance report recipients

Internal management/ board

No performance reports

Health & Wellbeing board

Local authority commissioners

Multi-agency integrated care board

CCG Commissioners

100%

94% 6%

41% 59%

39% 61%

17% 83%

10% 90%

0% 60%

40%

20%

100%80%

Yes No

17



Community Integrated Care Teams - Assessment and care planningThe role of “Accountable Lead Professional for service users” is taken on by staff in 59% of CICTs. For services where this is not the case, this role was then mainly taken on by the service user’s own GP (89%).

The stacked bar chart below, reflects the different resources used for patient care. The results show that 61% use a joint personalised care plan, 56% of CICTs use a single patient record, 39% use a shared assessment framework across health and social care, whilst only 33% use a dependency tool to access acuity.

61% 39%

56% 44%

39% 61%

33% 67%

Yes No

0% 60%

40%

20%

100%80%

Is a joint personalised care plan documented for

each service user?

Do you use a dependency tool to assess acuity and

prioritise workload?

Do you use a shared assessment framework across

health and social care?

Do you use a single patient record?

Care planning

18



Community Integrated Care Teams - Medical cover

Consultant geriatrician (in house)

Consultant geriatrician (sub-contracted)

GP and consultant geriatrician

GP (in house)

GP (sub-contracted)

Service user’s own GP

82%

6% 12%

In hours medical cover

Consultant geriatrician

GP Out of Hours services

Other

94%

6%

Out of hours medical cover

The pie charts show the medical provision of CICTs both in hours and out of hours. The out of hour period is between 6.30pm – 8.00am during a weekday, all day at weekends and on bank holidays.

During ‘in hours’, the service user’s own GP mainly provides medical cover to patients (82%), whilst 12% of services have joint medical cover by a GP and consultant geriatrician and 6% of services state ‘other’ coverage. Similarly, GP out of hour services are mainly responsible for the medical provision within CICTs, during out of hour periods, reported at 94% in 2019.

Advanced Nurse Practitioner

Other

Advanced Nurse Practitioner

19



Community Integrated Care Teams - Access

The stacked bar chart shows the referral methods accepted by CICTs. The results show that multiple channels are used to accept patients on to the caseload, where all CICTs accept referrals from acute trusts, social care and ambulance services.

In order for a person to be accepted by the CICT team, there is an access criteria which the patient must meet.

In 2019, 47% of CICTs only allowed housebound/ partially housebound patients onto their service. 17% of CICTs state that the service user has to have at least one long term condition in order to be accepted to the service.

100%

94%

89% 11%

83% 17%

72% 28%

Yes No

0% 60%

40%

20%

100%80%

Acute trusts

Mental health

Ambulance services

Social care

Referral methods accepted by CICTs

Out of Hours GP

Self referral

Family or carer

Third sector

100%

100%

6%

67% 33%

20



Community Integrated Care Teams - AccessThe stacked bar chart to the left shows the CICT services available to patients during ‘out of hours’. Crisis response and district nursing services are those most available during ‘out of hour’ periods, with 61% of teams covering these services.

The average hours available during weekdays for CICTs is reported at 14 hours, out of a 24 hour period. 17% of respondents state that they operate a 24 hour service.

In comparison, at the weekend,

Yes No

0% 60%

40%

20%

100%80%

Services delivered during ‘out of hours’

Crisis response1

Night sitting service

Twilight DN

Evening/ night DN

Social Care Emergency2

Mental health crisis response

Other local arrangements

61% 39%

61% 39%

61% 39%

31% 69%

29% 71%

29% 71%

28% 72%

1 - Crisis response/ rapid response/ admission avoidance/ urgent care service2 - Social Care Emergency Duty Team

the average hours of availability of the CICT was reported slightly lower than a weekday, at 11 hours. 22% of the respondents showed no availability at the weekend.

Average waiting time (days)

0

30

20

10

40

The bar char to the left reflects the average waiting time in days for a patient to be seen by the CICT. Each blue bar represents the average waiting time per service, whilst the horizontal orange line shows the mean sample average.

In 2019, the average waiting time was reported at 11 days, compared with an average waiting time of 14 days in 2016.

Variation is shown across the CICT waiting times, ranging from a minimum of 1 day wait to a maximum of 39 days.

21



Community Integrated Care Teams - ActivityTotal referrals per 100,000

registered population

0

10,000

8,000

6,000

14,000

12,000

16,000

The chart to the left shows the total referrals received by CICTs per 100,000 registered population. Referrals are a good indication of the incoming demand to a service.

In 2019, CICTs are averaged to have received 4,272 referrals per 100,000 registered population.

This is a 48% increase in the amount of referrals received since 2016, and a 44% increase since 2018.

18,000

20,000

The rise in referrals could be a reflection of integrated care being a more recognised method to support patients with complex needs, or that CICTs are using an increased amount of sources to locate patients i.e social care.

4,000

2,000

Year

2019

2018

4,272

2,976

Average

2017

2016

3,710

2,891

22



Community Integrated Care Teams - Activity

Referral acceptance rate (%)

0%

100%

80%

60%

The chart to the left shows the average referral acceptance rate of CICTs to be 91%, which ranges from 56% to 100%.

The variation across the services could be a reflection of different capacities within the team and the number of inappropriate referrals placed from external sources.

40%

20%

Of referrals placed to CICTs, the average percentage of those accepted, assessed and seen within 28 days is 88%, suggesting that on average, there are 12% of patients who are waiting over 4 weeks to be seen by CICTs.

Referrals accepted, assessed and seen within 28 days (%)

0%

100%

80%

60%

40%

20%

23



Community Integrated Care Teams - ActivityUnique service users per

100,000 registered population

0

2,500

2,000

1,500

The number of unique service users, cared for by CICTs, per 100,000 registered population is 2,083. Since 2016, there has been a 35% increase in the number of unique services users reported per 100,000 registered population from 1,543.

This project further reports the number of unique service users per clinical WTE in establishment/ in post. There was a mean sample average of 103 unique service users

1,000

500

per clinical WTE in establishment, yet a median of 58 due to the large amount variation amongst services, from 28 to 558 unique service users per annum.

4,500

4,000

3,500

3,000

Face to face contacts per 100,000 registered population

0

100,000

80,000

60,000

In 2019, CICTs, on average, delivered 33,979 face to face contacts per 100,000 registered population, as shown on the chart to the left.

Face to face contacts are further reported per clinical WTE in establishment, at an average of 965 contacts. Face to face contacts per clinical WTE in post is higher at 1,077. The average number of face to face contacts per unique service user, is 15. This is a relatively high number of contacts per service user, reflecting the complex and long term health

40,000

20,000

conditions of patients, cared for under CICTs. The average length of a face to face contact delivered by CICTs is 40 minutes.

140,000

120,000

24



Community Integrated Care Teams - Activity

0%

50%

40%

30%

20%

10%

60%

Patient facing time58%

Patient non-facing time

9%

Indirect patient specific activity

13%

Non-patient specific activity

11%

Travel time9%

The radar chart displays the percentage of clinical time spent on an array of activities. The 2019 results show that patient facing activity takes up 58% of clinical time.

Clinical staff spend the remaining time on indirect specific activity such writing up patient notes (13%), non-patient specific activity (11%), non face-to-face contacts (9%) and travel time (7%).

Indirect patient facing time and non patient specific activity is fairly high, which might be explained by the additional time spent by CICTs liaising with various MDT staff members to coordinate patient care.

Analysis of clinical WTE time

25



Community Integrated Care Teams - Workforce

Staff

Medical

Nursing

0.1%

68.7%

Average

AHPs

MH workers

15.3%

0.2%

Social care

Pharmacist

1.4%

0.2%

Support functions

Phlebotomist

14.1%

0.1%

CICTs are a multidisciplinary team, where the staff cover a variety of professions yet are functionally integrated.

The radar chart below shows the workforce discipline mix of CICTs. Nursing staff are shown to make up the majority of the CICT workforce at 68.7%, AHPs account for 15.3% of the workforce, followed by an average of 14.1% support staff.

There has been an increase in the percentage of social care input into CICTs, increasing from less than 1% in 2018 to 1.4% in 2019.

0%

50%

40%

30%20%

10%

60%

Medical

Nursing

AHPs

MH workers

Social care

Pharmacist

Support functions

Phlebotomist

70%

Discipline mix

26



Community Integrated Care Teams - Workforce

Clinical staff vacancy rate (%)

0%

25%

20%

15%

Clinical staff vacancy rates are an indication of the workforce pressures Community Services face. CICTs reported an average vacancy rate of 8.6% in 2019. This figure is the lowest percentage reported since 2015, where vacancy rates were at 14.6%.

The average staff sickness rate within CICTs was reported at 4.7%, where sickness rates tend to stay relatively consistent across all services.

10%

5%

35%

30%

Sickness absence rate (%)

0%

5%

4%

3%

2%

1%

7%

6%

8%

27



Community Integrated Care Teams - Finance

Total costs - BudgetThe bar chart to the left compares the budget for CICTs in 2018/19 and 2019/20 (planned), per 100,000 registered population.

In 2018/19, the average clinical staff pay budget per 100,000 registered population was £1,489,079, with only a slight increase for 2019/20. This is a large proportion of the total budget, 12 times that of non clinical staff.

£0

£200,000

£600,000

£400,000

£1,000,000

£800,000

Clinical staff pay cost

Non-clinical staff pay cost

Non-pay cost

Indirect costs & overheads

Budget 2018/19 Budget 2019/20

Year/Cost

Budget 2018/19

Budget 2019/20

1,489,079

1,493,823

Clinical staff pay cost (£)

122,911

122,368

Non-clinical staff pay cost (£)

139,066

134,934

Non-pay cost (£)

447,421

413,541

Indirect costs and overheads (£)

The change of the budget from 2018/19 to 2019/20 is shown to decrease by an average of 8% for indirect costs & overheads per 100,000 registered population.

The average total budget for 2018/19 is a 43% increase in the figure reported in 2013/14 for CICTs.

£1,200,000

£1,400,000

£1,600,000

28



Budget vs Spend per 100,000 registered population

The bar chart to the left reflects the average CICT budget in 2018/19, in comparison to the actual spend per 100,000 registered population.

The results show that on average CICT spend was in line with their budget during 2018/19. An average of 6% saving was achieved on clinical staff pay costs, whilst an overspend of the budget was reported

Clinical staff pay cost

Non-clinical staff pay cost

Non-pay cost

Indirect costs & overheads

Budget 2018/19 Spend 2018/19

Year/Cost

Budget 2018/19

Spend 2018/19

1,489,079

1,401,125

Clinical staff pay cost (£)

122,911

123,413

Non-clinical staff pay cost (£)

139,066

151,186

Non-pay cost (£)

447,421

451,059

Indirect costs and overheads (£)


for non clinical staff pay costs (5%), non-pay costs (9%) and indirect costs & overheads (1%). 73% of services state that they achieved their CIP/CRES target during 2018/19.

£0

£200,000

£600,000

£400,000

£1,000,000

£800,000

£1,200,000

£1,400,000

£1,600,000

29



Bank spend as % of total budget

Agency spend as % of total budget

Bank and agency staff are often used to fill temporary vacancies within a service. On average, CICTs report to spend 3.1% on bank staff as a percentage of total pay budget, whilst a smaller amount of the 2018/19 budget was spent on agency staff (2.3%). Overtime spend was also collected in the project, where CICTs on average are shown to spend 1.1% of the total pay budget on overtime.

0%

3%2%1%

5%4%


6%

0%

3%

2%

1%

5%

4%

6%8%7%

9%7%

Additional funding as a result of The Better Care Fund allocations

The Better Care Fund (BCF) is a programme that covers the NHS and local government. The programme provides financial support to councils and NHS organisations that join up health and care services.

The pie chart to the left, shows the percentage of services who have received additional funding in 2018/19 as a result of The Better Care Funding allocations. The results show that 10% of CICTs received this additional funding, consistent with the 11% reported in 2017/18.

90%

10%

Yes No

30



Community Integrated Care Teams - Quality and outcomes

Friends & Family Test results - average score

0%

10%

30%

50%

The NHS Friends and Family Test (FFT) is used by providers and commissioners to test whether improvements are needed in the service. The score indicates the percentage of service users who were ‘extremely likely’ or ‘likely’ to recommend the service.

In 2019, CICTs scored an average score of 96.1% on the FFT. The satisfaction score has remained around 96%-97% since 2017.

70%

100%

20%

40%

60%

80%

90%

44 compliments per 100 WTE staff

CICTs were reported to receive, a mean average of 127 compliments per 100 WTE staff during the year, with a median average of 44 compliments. There is higher variation in the number of compliments received across services, likely to be a result of different recording methods, opposed to differences in the quality of the service. From the high FFT scores, it is shown that CICTs are likely to be recommended to others.

3 complaints per 100 WTE staff

A lower number of complaints were recorded for CICTs than compliments, with a mean average of 3 complaints per 100 WTE staff and a median average of 2 complaints. It was recorded that on average 89% of complaints were responded to within the services target time frame, of which, the average time frame is 30 days. Amongst services, an average of 1 SUI per annum was reported per 100 WTE staff, with an average of 91% of SUIS being fully completed within 60 days.

31


Section 4: References

ReferencesDepartment of Health (Northern Ireland). A Healthier Future: a Twenty Year Vision for Health and Wellbeing in Northern Ireland 2005-2025. 2004House of Commons. Health and Social Care Committee. Integrated care: organisations, partnerships and systems. 2018NHS England. Better Care Fund. https://www.england.nhs.uk/ourwork/part-rel/transformation-fund/bcf-plan/. [Accessed 4th May 2020]NHS England. Next Steps on the NHS Five Year Forward View. March 2017NHS England. NHS Long Term Plan Implementation Framework. June 2019NHS England. Primary Care Networks: Frequently Asked Questions. March 2019. https://www.england.nhs.uk/wp-content/uploads/2019/04/pcn-faqs-000429.pdf. [Accessed 15th June 2020]NHS England. The NHS Long Term Plan. January 2019NHS Health Scotland. A Fairer Healthier Scotland. A strategic framework for action 2017 – 2022. 2017R Fisher, R Throlby & H Alderwick. The Health Foundation. Briefing: Understanding primary care networks. July 2019The Health Foundation/Nuffield Trust. Community Services. What do we know about quality? November 2017The Kings Fund. Community health services explained. https://www.kingsfund.org.uk/publications/community-health-services-explained#:~:text=Community%20services%20play%20a%20key,the%20health%20and%20care%20system. [Accessed 4th May 2020] Welsh Government. A Healthier Wales: Our Plan for Health and Social Care. June 2018

https://www.england.nhs.uk/ourwork/part-rel/transformation-fund/bcf-plan/

https://www.england.nhs.uk/ourwork/part-rel/transformation-fund/bcf-plan/

https://www.england.nhs.uk/wp-content/uploads/2019/04/pcn-faqs-000429.pdf .

https://www.england.nhs.uk/wp-content/uploads/2019/04/pcn-faqs-000429.pdf .

https://www.kingsfund.org.uk/publications/community-health-services-explained#:~:text=Community%20se




Appendix 132

Community Services benchmarking projectThe Community Services project is one of the NHS Benchmarking Network’s longest standing projects, being a key area for members to want to benchmark, given the lack of national data available in this area. Community services represent over £10 billion of NHS expenditure and they play a key role in supporting service users at home and reducing unnecessary hospital admissions. The Next Steps on the NHS Five Year Forward View highlights the importance of close working with community services, with an aim to free up capacity in 2,000-3,000 hospital beds over the next two years. Despite this policy intention, The Nuffield Trust reports that funding given to NHS Trusts for community services fell by 4% last year. An NHS priority over the next 10 years is to help older people stay healthy and live independently in their communities, with a move towards more integrated care for this cohort. Community services provision is expected to play an important part in the NHS Long Term Plan.

National data on community services is currently limited and the Network’s Community Services project aims to fill this information gap, taking a view across all aspects of service provision including access, activity, workforce, finance and quality metrics. The project provides a detailed view of 25

different community services, and there is a series of case study reports for every single service benchmarked.

Appendix 1

Cardiac Community Team

Wheelchairs

Speech & Language Therapy (Child)

Speech & Language Therapy (Adult)

School Nursing

Respiratory Community Team

Podiatry

Physiotherapy (Child)

Physiotherapy (Adult)

Occupational Therapy (Child)

Occupational Therapy (Adult)

MSK

Integrated Sexual Health Service

Health Visiting

End of Life Community Team

Continence Community Team

Dietetics (Child)

Dietetics (Adult)

Diabetes Community Team (Adult)

Community Paediatrics

Community Matrons

Community Integrated Care Teams

Community Dental

Community / District Nursing

Children’s Community Nursing Team


Appendix 1 33

The Community Services benchmarking project runs on an annual cycle; project scoping taking place with the Community Reference Group from January through to April; data collection from May through to June; data analysis and validation in September and October, with the national event and other outputs being made available in November and December. There may be some changes to the community services where data is collected between the years the project has been operating.

The Community Services benchmarking project collects provider level data on access, activity, workforce, finance and quality and outcomes at aggregated organisational level for the whole year. Some organisations may chose to make multiple submissions, often where service models differ between different geographic areas or their service covers multiple CCG areas. The metrics are agreed with the Network’s Community Reference Group and definitions are provided for every metric to ensure consistency of interpretation of metrics. The Network provides a Helpline to help with interpretation and give advice on data collection. Metrics are reviewed at the end of each cycle, with a view to refining data collection, and ensure that metrics and definitions utilised are relevant and up-to-date. Metrics with a poor response rate tend to be discarded for the next year’s benchmarking. Within the membership, participants take part in the Community Services benchmarking project from all four UK countries. The project provides the most comprehensive dataset available in the NHS on Community Services.

Data is collected via an online data collection tool, input via the online data collection pages in the Network website members’ area. The project collects data for subsequent NHS financial years, running from 1st April to 31st March, so the 2019 iteration of the Community Services project collected data from 1st April 2018 to 31st March 2019. As the project has run for many iterations, time series analysis is available, through toggling between the years on the online toolkit.

During the data validation phase, all submissions are reviewed and participants are given the opportunity to amend or update their data where any outlier positions are identified. These are checked following the production of a draft online benchmarking toolkit, which shows the draft benchmarked findings for the whole sample against every metric collected. All outputs are anonymised, and provider organisations can see their own position(s) only.

Jan DecNovOctSepAugJulJunMayAprMarFeb

Project scoping Data collection ValidationValidation

& Draft toolkit

EventOther

outputs published


Appendix 134

Next cycle

Project outputs

Networking and sharing good practice

The Community Services project will feature in the Network’s 2020/21 work programme, collecting2019/20 outturn data. In response to member requests, the data specifications have been cut down and the number of community services being benchmarked in this year’s cycle has been reduced, to enable members to have the capacity to complete the benchmarking, following the coronavirus pandemic.

NEW Community Services Covid-19 trackerThe Network is also offering a NEW Community Services Covid-19 tracker dashboard project which reports on a monthly basis on a limited set of metrics to track the impact of the pandemic upon community services provision.

Every participant in the Community Services benchmarking project receives a suite of outputs. All of the outputs from the Community Services project are available via the members’ area of the NHS Benchmarking Network’s website. Log-in details are required to access the member’s area. To request new, or to be sent a reminder of existing log-in details, please email [email protected].

Once logged-in to the members’ area, each of the Network’s projects is listed on the home page. The following outputs can be accessed: Online toolkit Project reports Good Practice Compendium Presentations from the Network’s 2019 Community Services national conference

In addition to the project outputs, organisations who participated in the project are still able to view their data submission via the online data collection pages in a read-only format. Please contact Lucy Atherton if you need any assistance accessing the project outputs.

The Network is keen to facilitate networking and sharing good practice examples between project participants. If your organisation is interested in contacting other project participations, please email Lucy Atherton and, providing consent is granted, the relevant project lead contact details can be passed on. Please note, although some organisations choose to share their organisation’s identifier codes between each other, the Network keeps all data supplied to the benchmarking projects anonymous. The Network will never pass on identifier codes to colleagues outside your organisation.

https://www.nhsbenchmarking.nhs.uk/projects/community-service

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