Transcript IRF Stage 2 Test Sites

The Integrated Resource
Framework
Paul Leak
Simon Steer
Clinician/Practitioner
Workshop
•Context
•IRF Overview
•Emerging Themes
Integrated Resource Framework
What and Why
The IRF Enables a comprehensive understanding of total
resource allocation within health, and across health and
adult social care.
Stage 1: Mapping
• NHS Expenditure
• Social Care Expenditure
• Population Characteristics
Stage 2 :Test sites
Develop Financial Mechanisms to let £ follow the patient
Within NHS and between NHS and Social Work.
Stage 1: Mapping
•9 NHS Boards & 12 Local Authorities
•2008/09 Expenditure: End June 2010
•2009/10 Expenditure: End Dec 2010
•Local approach
Analysis of Spend
Locality/CHP
=17%
Practice
=27%
£1,567
Patient
=49%
Board Spend Mapped to CHP
Populations
30%
Argyll & Bute CHP
SSU
North CHP
SE CHP
Mid CHP
18%
7%
12%
14%
30%
27%
14%
30%
After Mapping:
•What does it look like?
•Do you like what you see?
•Does it fit with (stated outcomes and are
the patterns defensible?)
•Do you want to do something different?
•Can we redesign the bicycle whilst
still pedalling?
Phase 2: Test Sites
4 NHS Boards and 12 and local authority Partners
agreeing financial mechanisms to move resources
between health and social care:
• Lothian
• Highland
• Tayside
• Ayrshire and Arran
Phase 2:Test Sites
•Defined Population;
•Total Per capita Resources;
•Integrator
Total control over resources for defined population;
Flexibility to determine how resource is used;
Assumption of financial risk;
Shared Incentives to improve Outcomes;
Johri 2003
Kodner 2006
Integrated Resource Framework
Integrator
• Local choice, but likely to be CHPs
• Integration of investment resources (commissioning)
• Predicated on understanding existing:
Activity
Costs
Outcomes
Integrated Resource Framework
Highland test site
Two Partnerships
NHS Highland and Highland Council
NHS Highland and Argyll and Bute Council
Population of interest
Strategic – 75years plus
District – Adult Care
Initiative – Small steps of change
Integrator
District
Integrated Resource Framework
Lothian test site
Four Partnerships
NHS Lothian and City of Edinburgh Council
NHS Lothian and West Lothian Council
NHS Lothian and East Lothian Council
NHS Lothian and Midlothian Council
Population of interest
Older people (Edinburgh)
Early years (West Lothian)
Frail elderly (East Lothian)
Dementia and frail elderly (Midlothian)
Integrator - under discussion
Integrated Resource Framework
Tayside test site
Three Partnerships
NHS Tayside and Perth and Kinross Council
NHS Tayside and Dundee City Council
NHS Tayside and Angus Council
Population of interest
Older people and people with learning difficulties
(Perth and Kinross)
Complex cases (Dundee City)
Older people (Angus)
Integrator
CHPs
Integrated Resource Framework
Ayrshire and Arran test site
Three Partnerships
NHS Ayrshire & Arran and North Ayrshire Council
NHS Ayrshire & Arran and East Ayrshire Council
NHS Ayrshire & Arran and South Ayrshire Council
Population of interest
Vulnerable children (North Ayrshire)
Complex cases (East Ayrshire)
Older people (South Ayrshire)
COPD cases (pan Ayrshire)
Integrator
CHPs
Integrated Resource Framework
New financial arrangements
Evidence suggests some or all of these models
may be appropriate in the test sites:
Within NHS
Tariffs to value hospital activity
Devolved budgets to CHPs
Between NHS and Local Authority
Extensive pooled budgets
Lead commissioner model
What does success look like?
Evidence of:
•Improved outcomes;
•Shifts in the Balance of Care;
•Improved Clinical engagement;
•Improved Equity of access;
•Improved efficiency (Allocative/Utilisation).
Integrated Resource Framework
Test site evaluation
Action research
1.Monitor progress until end 2011
2.Assess impact - resources and outcomes
3.Feed evidence back in to ongoing
implementation
4.Implications and guidance for others
Where will we be?
April 6m
Target Population
Expenditure Mapped
Outcomes Mapped
Integrator agreed
Mechanisms agreed
Mechanisms embedded
Integrator empowered
Investment Plans
Go live
Evaluation
12m
18m
Emerging Themes
Variation
2,500
£ per person (Weighted)
2,000
1,500
1,000
500
0
1
2
3
Variation
Spend/head>75yrs 2007/08
CHP #1
£7,065 per person
10%
9%
41%
3%
17%
3%
Inpatient & Day case
Community
Outpatient
Care Home
7%
3%
Other Hospital
Home Care
2%
5%
GMS
Other Older adult
Prescribing
Other NHS
Variation
Spend/head>75yrs 2007/08
CHP 2
£7,199 per person
5%
7%
37%
11%
17%
3%
Inpatient & Day case
Community
Outpatient
Care Home
7%
3%
Other Hospital
Home Care
3%
7%
GMS
Other Older adult
Prescribing
Other NHS
60,000
£'000
Practice Direct Impact
120,000
Non-Contracted=£164.3m
Contracted=£39m
100,000
80,000
40,000
20,000
0
A&E attendances
New OP referrals
Diagnostics
Prescribing
Unplanned
admissions
Premises
Board Administered
Funds
Enhanced Services
QOF
Global Sum
Balance of Care
£2,222
£5,253
Institutional
Non-Institutional
Fundamentally…
•The best Integration is Local: Find local solutions
to local problems
Leutz (2005)
•Success depends on local leadership
(Hudson et al 2002)
Leutz W. (2005) Reflections on integrating medical and social
care: five laws revisited. Journal of Integrated Care 13 (5), 3–11.
Hudson et al (2002) National Evaluation of the Use of Section 31
Partnership Flexibilities of the Health Care Act of 1999.
The Integrated Resource
Framework
Paul Leak
Simon Steer