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Mapping Within The Integrated Resource Framework

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. Marginal or Strategic planning? Performance or Variation?

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Mapping Within The Integrated Resource Framework

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  1. Mapping Within The Integrated Resource Framework Alison Taylor Paul Leak Simon Steer

  2. What We Will Cover… • Context • The IRF… where it fits and why • The IRF Test Sites • Some Examples of Analysis • (Easy) Questions

  3. Marginal or Strategic planning? Performance or Variation? Bottom line or Opportunity Cost? Administration or Stewardship? Context: Recognising The Perfect Storm • Demographic pressures • Economic pressures • Historic patterns of; investment; management and resource use.

  4. 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”

  5. 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

  6. Corporate/Facilities/Reserves CHP 4 Acute CHP 3 CHP 1 CHP 2 What is Mapping?A £500m Cash Limited Budget

  7. Analysis of Spend Other =7% £1,639 Locality/CHP =17% Practice =27% Patient =49%

  8. CHP 4 Acute CHP 3 CHP 1 CHP 2 Board Spend Mapped to CHP Populations

  9. 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

  10. 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

  11. Test Sites Highland Tayside Lothian Ayrshire & Arran

  12. Three Networks • Phase 1 Mapping • Phase 2 Support • Social Care Reference Costs

  13. 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?

  14. Recent Outputs Early analysis of allocative equity and efficiency based on non coterminous localities and high level LA budget analysis

  15. Variation: CHP Expenditure per person (2009/10 weighted) Community Health Partnership

  16. Variation:2008/09 Older persons SW expenditure per person>75years Council Areas Care home/ Home care=2.1(2007/08 National average=1.7 (LGF4a, LFR3))

  17. SW Older Persons SpendCouncil Social work Spend/head (>75yrs) for Multi-Member Wards

  18. South-East CHP # 1 CHP

  19. Mid Highland CHP # 2 CHP

  20. A CHP Spend/head>75yrs 2008/09

  21. GP Direct Impact GP Practices

  22. What Difference?Acute General Hospital City Practice GM OBDs(Average2006/07-2007/08)

  23. A 40 Bed WardHospital GM Capacity Planning

  24. CHP #1 Balance of Care >75yrs 2009/10

  25. A SW Area Older Persons Balance of Care 2008/09

  26. Variation: Individual Experience

  27. 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

  28. Equity of Access (fair share)? Understanding Performance & Variation? Allocative Efficiency? Joint Resource Accountability & Mobility or Ikons? Riding Out The Perfect Storm • Demographic pressures • Economic pressures • Historic patterns of; investment; management and resource use.

  29. 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?

  30. Pooling Resources And The Integrated Resource Framework Alison Taylor Paul Leak Simon Steer

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