Mapping Within The Integrated Resource

Framework

Alison Taylor

Paul Leak

Simon Steer

•Context

•The IRF… where it fits and why

•The IRF Test Sites

•Some Examples of Analysis

•(Easy) Questions

What We Will Cover…

Context: Recognising The Perfect Storm

• Demographic pressures

• Economic pressures• Historic patterns of;

investment; management and resource use.Marginal or S

trategic planning?

Perform

ance or Variation?

Bottom lin

e or Opportu

nity Cost?

Administration or S

tewardship?

•Inter-dependencyRecognised by Joint Future…. but addressed in more than token ways?

•ChasmsHealth & social care;Community & Institutional care

•Previous Joint Resource ModelsMarginal budgets or real understanding of cost; activity and variation

•Mapping and Variation …“Today’s key words”

Context: Scottish Health & Social Care System

To:•Improve population Health•Improve individual experience•Reduce costs

Requires:•Defined Population•Per Capita Resources•Care Integrator

Fit With Current Policy Context: Triple Aim

Stage 1: Mapping

Stage 1: Mapping

Stage 2: Test sites

What is Mapping?A £500m Cash Limited Budget

30%

7%

12%14%

18%

Argyll & Bute CHP

SE CHP Mid CHP

North CHPSSU

Corporate/Facilities/Reserves

Acute

CHP 1 CHP 2

CHP 3

CHP 4

Analysis of Spend

Patient=49%

Practice=27%

Locality/CHP=17%

£1,639

Other =7%

14%

27%

30%

30%

30%

7%

12%14%

18%

Argyll & Bute CHP

SE CHPMid CHP

North CHP

SSU

Board Spend Mapped to CHP Populations

Acute

CHP 4

CHP 3CHP 2CHP 1

Phase 1. MappingTest sites should know:

•Per Capita Health and Social Care expenditure Practice/Locality/CHP;By care type;Balance of Care.

•Patient level hospital activity and costsPer capita hospital expenditure for care groups;Per capita hospital expenditure by age/sex;Site/Specialty analysis

•Tariffs for hospital care•Total CHP budgets•Programme Budgeting

•Pooled Budgets•Lead Commissioner•Transactional agreements

•All feasible under current Scottish legislation

Phase 2“New” Financial Frameworks

Highland

Tayside

Lothian

Ayrshire & Arran

Test Sites

•Phase 1 Mapping•Phase 2 Support•Social Care Reference Costs

Three Networks

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)

1,500

1,520

1,540

1,560

1,580

1,600

1,620

1,640

1,660

1,680

1,700

SE North Mid A&B

Sp

end

per

wei

gh

ted

hea

d (

£s)

Community Health Partnership

Variation:2008/09 Older persons SW expenditure per

person>75years

0

500

1,000

1,500

2,000

2,500

3,000

RSL CSER INBS

£/h

ea

d>

75

ye

ars

Care Homes Home Care Other

Care home/ Home care=2.1(2007/08 National average=1.7 (LGF4a, LFR3))

Council Areas

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

0

1

2

3

4

5

6

7

8

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22

MMW

£000

/Per

son

(>75

yrs)

Home Care Care Homes

Highland Average=£2,075/head

South-East CHPPrescribing

12% Community Nursing6%

Fup & Elective13%

Corporate/Locality Management8%

Home care2%Care Homes

7%

Total GP Contracted14%

GP Direct Access Labs and Radiology

1%

Emergency Admissions25%

New OPD Appointments2%

A&E1%

Tertiary/Other9%

# 1 CHP

Mid Highland CHP

GP Direct Access Labs and Radiology

1% Total GP Contracted18%

Home Care1%

Care Homes5%

Tertiary/Res. Transfer/Other

6%

Corporate/Locality Management

10%

Fup & Elective14%

Community Nursing9%

Prescribing13%

A&E2%

New OPD Appointments2%

Emergency Admissions19%

# 2 CHP

A CHP Spend/head>75yrs 2008/09

A&E, £169

Other Clinical Services, £286

OATS & SLA's, £217

Home care, £556

Outpatients, £256Day Patients, £143

Elective IP & Daycases, £426

Care Homes, £1,436

Other older adult, £144

Prescribing, £525

GMS, £201

Emergency IP, £2,451

Community and Other, £446

GP Direct Impact

0

200

400

600

800

1,000

1,200

55

38

15

60

25

55

00

35

59

11

55

08

05

55

16

55

56

95

50

94

55

93

05

52

01

55

61

05

55

73

55

35

75

51

31

55

60

55

54

51

55

28

75

52

20

55

65

85

57

28

55

39

55

56

24

55

53

55

50

37

55

75

15

59

25

55

69

65

57

66

55

36

15

58

74

55

43

15

56

81

55

40

85

52

91

55

84

15

51

45

56

01

15

57

32

55

86

05

58

17

55

89

35

53

38

55

88

95

56

62

56

00

65

54

27

55

24

95

52

53

55

41

25

56

39

55

83

65

57

09

55

90

65

53

76

£/h

ea

d

GP Practices

What Difference?Acute General Hospital City Practice GM OBDs

(Average2006/07-2007/08)

0

50

100

150

200

250

300

350

400

450

500

1 2 3 4 5 6 7 8 9 10 11 12

OB

D/1

00

0 w

eig

hte

d p

op

ula

tio

n

A 40 Bed WardHospital GM Capacity Planning

0

10

20

30

40

50

60

70

80

1 2 3

GM

Be

ds

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

Non-Institutional25%

Institutional75%

A SW Area Older Persons Balance of Care 2008/09

Institutional67%

Non-Institutional33%

Risk of death in hospital in 2007/08

0

0.1

0.2

0.3

0.4

0.5

0.6

0.7

0.8

1 2 3 4 5 6 7 8 9 10 11 12 13

Ris

k of

dea

th in

hos

pita

l (%

)

Variation: Individual Experience

“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 PartnershipAudit Commission Dec 2007

Starting Point for Integrated Resources… It’s not just about Finance Departments

Riding Out The Perfect Storm

• Demographic pressures

• Economic pressures• Historic patterns of;

investment; management and resource use.

Equity of Access (fa

ir share)?

Understanding Perform

ance & Variation?

Allocative Efficiency?

Joint Resource Accountability

& Mobility or

Ikons?

Is the focus of the exercise the achievement of a a mapped budget, …….or the understanding of the cost and variation the mapping shows?

Starting Point for Pooling…..

Pooling Resources And

The Integrated Resource Framework

Alison Taylor

Paul Leak

Simon Steer