12 Exploring the difference made by Support at home Still recognising the role of personalisation, the Acute Trusts and Community Care. Ellins et publication of the draft Care Bill in February al. (2012) explored older people’s experiences 2013 put forward new duties for local authorities of care transitions and highlighted that how to promote wellbeing, prevention services, people are treated, interactions and interpersonal information and advice, a stronger framework for relationships have the biggest impact on patient eligibility and assessment, new rights for carers experiences. Lack of communication, clarity and and an approach that recognises and builds on involvement in their discharge arrangements was the strengths of people and communities. Yet the often cited as the most frustrating thing. They reality is that, at the same time, local councils are found that people with moderate levels of need, 2 facing cuts to their social care budgets , leading hence those who are not usually eligible for a many of them to raise their eligibility thresholds care package, can end up feeling isolated and for the receipt of social care and support, and unsupported. making it increasingly difficult for people to access these services.3 commissioning priorities The NHS is entering into a period of major Alongside structural reform, the NHS structural reform in the way its services are commissioning process is changing. In England, provided and funded. There is a focus on reducing NHS decision-making has shifted from Primary hospital stays by shifting care and treatment Care Trusts to GP consortia, and in Scotland new from acute hospital-based care to the community commissioning models are being explored which delivered by community-based, multi-agency could change the way services are delivered. teams. The discharge process inevitably works to Reducing unnecessary emergency hospital extremely tight timescales and is often described admissions is a clear priority for everyone. This as fraught with communication issues between the outcome carries the largest financial incentive for the newly formed Clinical Commissioning Groups 4 2 Following funding cuts of 28% in the Spending Review, Local Authorities in their Quality Premium targets. have reduced their budgets by £2.68 billion over the past 3 years, reported in the ADASS Budget Survey, May 2013 3 The number of people receiving publicly funded social care has fallen 4 Of the Quality Premium targets, avoiding unnecessary emergency by 17% since 2006/7, while the population aged 85 years and over has admissions is the largest portion worth 25%. There are 4 national targets risen by more than 20% over the same period, reported in The King’s applicable to all CCGs and 3 local ones allowing them to respond to the Fund Briefing (2013), The Care Bill: Second Reading in the House needs of their local population. See Quality Premium: 2013/14 guidance of Lords. for CCGs, NHS England, March 2013.