Mapping Within
The Integrated Resource
Framework
Alison Taylor
Paul Leak
Simon Steer
What We Will Cover…
•Context
•The IRF… where it fits and why
•The IRF Test Sites
•Some Examples of Analysis
•(Easy) Questions
Context:
Recognising The Perfect Storm
• Demographic
pressures
• Economic pressures
• Historic patterns of;
investment;
management and
resource use.
Context: Scottish Health & Social Care System
•Inter-dependency
Recognised by Joint Future…. but addressed in more than
token ways?
•Chasms
Health & social care;
Community & Institutional care
•Previous Joint Resource Models
Marginal budgets or real understanding of cost; activity and
variation
•Mapping and Variation …“Today’s key words”
Fit With Current Policy Context:
Triple Aim
To:
•Improve population Health
•Improve individual experience
•Reduce costs
Requires:
•Defined Population
•Per Capita Resources
•Care Integrator
Stage 1: Mapping
Stage 1: Mapping
Stage 2: Test sites
What is Mapping?
A £500m Cash Limited Budget
Corporate/Facilities/Reserves
30%
Argyll
CHP
4 & Bute CHP
Acute
SSU
North
CHPCHP
3
18%
CHP
SE
CHP1
Mid CHP
CHP
2
7%
14%
12%
Analysis of Spend
Other =7%
Locality/CHP
=17%
Practice
=27%
£1,639
Patient
=49%
Board Spend Mapped to CHP
Populations
30%
CHP 4
Argyll & Bute CHP
Acute
SSU
CHP
1
SE CHP
CHP
CHP
Mid 2
CHP
3
North CHP
18%
7%
12%
14%
30%
27%
14%
30%
Phase 1. Mapping
Test sites should know:
•Per Capita Health and Social Care expenditure
Practice/Locality/CHP;
By care type;
Balance of Care.
•Patient level hospital activity and costs
Per capita hospital expenditure for care
groups;
Per capita hospital expenditure by age/sex;
Site/Specialty analysis
Phase 2
“New” Financial Frameworks
•Tariffs for hospital care
•Total CHP budgets
•Programme Budgeting
•Pooled Budgets
•Lead Commissioner
•Transactional agreements
•All feasible under current Scottish legislation
Test Sites
Highland
Tayside
Lothian
Ayrshire & Arran
Three Networks
•Phase 1 Mapping
•Phase 2 Support
•Social Care Reference Costs
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?
Recent Outputs
Early analysis of allocative equity and
efficiency based on non coterminous
localities and high level LA budget
analysis
Variation: CHP Expenditure per person
(2009/10 weighted)
1,700
1,680
Spend per weighted head (£s)
1,660
1,640
1,620
1,600
1,580
1,560
1,540
1,520
1,500
SE
North
Mid
Community
Health Partnership
A&B
Variation:
2008/09 Older persons SW expenditure per
person>75years
3,000
2,500
£/head>75years
2,000
1,500
1,000
500
0
RSL
CSER
Council
Areas
Care Homes
Home Care
INBS
Other
Care home/ Home care=2.1(2007/08 National average=1.7 (LGF4a, LFR3))
SW Older Persons Spend
Council Social work Spend/head (>75yrs) for Multi-Member Wards
8
7
£000/Person (>75yrs)
6
5
4
Highland Average=£2,075/head
3
2
1
0
1
2
3
4
5
6
7
8
9
10
11
12
13
MMW
Home Care Care Homes
14
15
16
17
18
19
20
21
22
# 1 CHP CHP
South-East
New OPD Appointments
2%
A&E
1%
Prescribing
12%
Community Nursing
6%
Fup & Elective
13%
Emergency Admissions
25%
Corporate/Locality Management
8%
GP Direct Access Labs and
Radiology
1%
Tertiary/Other
9%
Total GP Contracted
14%
Care Homes
7%
Home care
2%
# 2 CHP CHP
Mid Highland
Prescribing
13%
Community Nursing
9%
A&E
2%
Fup & Elective
14%
New OPD Appointments
2%
Corporate/Locality
Management
10%
Emergency Admissions
19%
Tertiary/Res.
Transfer/Other
6%
GP Direct Access Labs
and Radiology
1%
Care Homes
5%
Total GP Contracted
18%
Home Care
1%
A CHP Spend/head>75yrs 2008/09
Prescribing, £525
Other older adult, £144
GMS, £201
Care Homes, £1,436
Community and Other,
£446
Home care, £556
OATS & SLA's, £217
Other Clinical Services,
£286
A&E, £169
Day Patients, £143
Emergency IP, £2,451
Outpatients, £256
Elective IP & Daycases,
£426
600
£/head
GP Direct Impact
1,200
1,000
800
400
200
0
55376
55906
55709
55836
55639
55412
55253
55249
55427
56006
55662
55889
55338
55893
55817
55860
55732
56011
55145
55841
55291
55408
55681
55431
55874
55361
55766
55696
55925
55751
55037
55535
55624
55395
55728
55658
55220
55287
55451
55605
55131
55357
55573
55610
55201
55930
55094
55569
55516
55080
55911
55003
56025
55381
GP Practices
What Difference?
Acute General Hospital City Practice GM OBDs
(Average2006/07-2007/08)
500
450
OBD/1000 weighted population
400
350
300
250
200
150
100
50
0
1
2
3
4
5
6
7
8
9
10
11
12
A 40 Bed Ward
Hospital GM Capacity Planning
80
70
60
GM Beds
50
40
30
20
10
0
1
2
3
CHP #1 Balance of Care >75yrs 2009/10
Non-Institutional
25%
Institutional
75%
A SW Area Older Persons Balance of Care
2008/09
Non-Institutional
33%
Institutional
67%
Variation: Individual Experience
Risk of death in hospital in 2007/08
0.8
0.7
Risk of death in hospital (%)
0.6
0.5
0.4
0.3
0.2
0.1
0
1
2
3
4
5
6
7
8
9
10
11
12
13
Starting Point for Integrated Resources…
It’s not just about Finance Departments
“Clinicians & Care Professionals.. have a crucial role... It
is they who commit resources.”
“Governance structures need to allow them freedom to
act and to ensure there is accountability for their actions.”
“Finance needs to be structured in a way that supports
this.”
Prescription for Partnership
Audit Commission Dec 2007
Riding Out The Perfect Storm
• Demographic
pressures
• Economic pressures
• Historic patterns of;
investment;
management and
resource use.
Starting Point for Pooling…..
Is the focus of the exercise the achievement of a
a mapped budget, …….or the understanding of
the cost and variation the mapping shows?
Pooling Resources
And
The Integrated Resource
Framework
Alison Taylor
Paul Leak
Simon Steer