Transcript An introduction to the NRAC formula and the work of TAGRA

An introduction to the NRAC
formula and the work of TAGRA
Needs based formula
To enable every person in Scotland to have
equal access to high quality health
services according to their need
• Based on population – but just a start
Resource allocation in practice
Population
Age-Sex
Cost Weights
Board
population
share
%
Relative
need due
to age and
sex profile
×
Additional Needs
Relative need
due to
morbidity and
life
×
circumstances
Unavoidable
Excess Costs of
Supply
×
Relative
costs of
providing
services to ═
different
geographical
areas
NRAC
Weighted
Target
Share
%
Spend per person (£)
-£50
-£100
-£150
Fife
Borders
£0
Shetland
Dumfries & Galloway
Western Isles
Forth Valley
Tayside
Lothian
Orkney
Grampian
Lanarkshire
Highland
Greater Glasgow & Clyde
-£200
Ayrshire & Arran
Difference between recommended NRAC spend per head and an
equal share (2011/12)
£350
£300
£250
£200
£150
£100
NRAC
£50
Spend per person (£)
-50
-100
-150
Fife
Borders
0
Shetland
Dumfries & Galloway
Western Isles
Forth Valley
Tayside
Lothian
Orkney
Grampian
Lanarkshire
Highland
Greater Glasgow & Clyde
-200
Ayrshire & Arran
Difference between recommended NRAC spend per head and an
equal share (2011/12) - Population
350
300
250
200
150
100
50
Spend per person (£)
-£50
-£100
-£150
Fife
Borders
£0
Shetland
Dumfries & Galloway
Western Isles
Forth Valley
Tayside
Lothian
Orkney
Grampian
Lanarkshire
Highland
Greater Glasgow & Clyde
-£200
Ayrshire & Arran
Difference between recommended NRAC spend per head and an
equal share (2011/12) - Age sex
£350
£300
£250
£200
£150
£100
£50
Age-sex
Spend per person (£)
-£50
-£100
-£150
Fife
Borders
£0
Shetland
Dumfries & Galloway
Western Isles
Forth Valley
Tayside
Lothian
Orkney
Grampian
Lanarkshire
Highland
Greater Glasgow & Clyde
-£200
Ayrshire & Arran
Difference between recommended NRAC spend per head and an
equal share (2011/12) - Age sex and MLC (cumulative)
£350
£300
£250
£200
£150
£100
Age-sex
£50
MLC
Spend per person (£)
-£50
-£100
-£150
Fife
Borders
£0
Shetland
Dumfries & Galloway
Western Isles
Forth Valley
Tayside
Lothian
Orkney
Grampian
Lanarkshire
Highland
Greater Glasgow & Clyde
-£200
Ayrshire & Arran
Difference between recommended NRAC spend per head and an
equal share (2011/12) - MLC and UXC (cumulative)
£350
£300
£250
£200
£150
£100
MLC
£50
UXC
Spend per person (£)
-£50
-£100
-£150
Fife
Borders
£0
Shetland
Dumfries & Galloway
Western Isles
Forth Valley
Tayside
Lothian
Orkney
Grampian
Lanarkshire
Highland
Greater Glasgow & Clyde
-£200
Ayrshire & Arran
Difference between recommended NRAC spend per head and an
equal share (2011/12)
£350
£300
£250
£200
£150
£100
NRAC
£50
-£50
-£100
-£150
Fife
Borders
£0
Shetland
Dumfries & Galloway
Western Isles
Forth Valley
Tayside
Lothian
Orkney
Grampian
Lanarkshire
Highland
Greater Glasgow & Clyde
-£200
Ayrshire & Arran
Spend per person (£)
Difference between recommended NRAC spend per head and an
equal share (2011/12) - Overall and HCHS
£400
£350
£300
£250
£200
£150
£100
£50
Overall
NRAC
HCHS
NRAC
Data sources
• Does not use SIMD
• Does not use data zones
• Requires national data
• Requires small area data
Data sources
Population
Age-Sex
Cost Weights
Board
population
share
%
Relative
need due to
age and
sex profile
×
Additional Needs
Relative need
due to morbidity
and life
× circumstances
• GROS data
• GP list data
Unavoidable
Excess Costs of
Supply
×
Relative costs
of providing
services to
═
different
geographical
areas
NRAC
Weighted
Target
Share
%
Data sources
Population
Age-Sex
Cost Weights
Board
population
share
%
Relative
need due to
age and
sex profile
×
Additional Needs
Relative need
due to morbidity
and life
× circumstances
Unavoidable
Excess Costs of
Supply
×
• Differs by specialty – SFR 5s
• Up to 20 different age bands
Relative costs
of providing
services to
═
different
geographical
areas
NRAC
Weighted
Target
Share
%
Data sources
Population
Age-Sex
Cost Weights
Board
population
share
%
Relative
need due to
age and
sex profile
×
Additional Needs
Relative need
due to morbidity
and life
× circumstances
Unavoidable
Excess Costs of
Supply
×
Relative costs
of providing
services to
═
different
geographical
areas
Acute and Care of the Elderly
Maternity
• Standardized mortality rates
• Mean house price
• Long term limiting illness rate
• Birth rate
NRAC
Weighted
Target
Share
%
Data sources
Population
Age-Sex
Cost Weights
Board
population
share
%
Relative
need due to
age and
sex profile
×
Additional Needs
Relative need
due to morbidity
and life
× circumstances
Unavoidable
Excess Costs of
Supply
×
Relative costs
of providing
services to
═
different
geographical
areas
Mental health and learning difficulties
• Severe disablement allowance
• % living in one person households
• % living in socially rented housing
NRAC
Weighted
Target
Share
%
Data sources
Population
Age-Sex
Cost Weights
Board
population
share
%
Relative
need due to
age and
sex profile
×
Additional Needs
Relative need
due to morbidity
and life
× circumstances
• Urban rural classification
• Community travel survey
• SAF remoteness adjustment
Unavoidable
Excess Costs of
Supply
×
Relative costs
of providing
services to
═
different
geographical
areas
NRAC
Weighted
Target
Share
%
TAGRA
Background to TAGRA
• Formed after NRAC report
• Maintains and develops formula
• Brings together Government, NHS
Boards, and academics
• Forum for stakeholder engagement
• Work programme of improvements
Members – from boards
Richard Copeland
NHS GG&C
Garry Coutts
NHS Highland
Karen Facey
NHS Forth Valley
Malcolm Iredale
NHS Highland
Alan Gall
NHS Grampian
Douglas Griffin
NHS GG&C
Fiona Ramsay
NHS Forth Valley
Andrew Richmond
NHS Tayside
John Ross Scott
NHS Orkney
George Walker
NHS Lothian
Recent work
• The impact of the NRAC formula on
remote and rural areas of Scotland
• Overall, treatment appropriate
• Areas for further work
2011/12 work plan
• Further work on remote and rural issues
• Review of MLC adjustment
Questions?