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 Relative need due to morbidity and life circumstances Additional Needs × Unavoidable Excess Costs of Supply Relative costs of providing services to different geographical areas × NRAC Weighted Target Share % ═ Relative need due to age and sex profile × Age-Sex Cost Weights Population Board population share %

Data sources Does not use SIMD Does not use data zones Requires national data Requires small area data

Data sources Relative need due to age and sex profile Relative need due to morbidity and life circumstances Relative costs of providing services to different geographical areas NRAC Weighted Target Share % Unavoidable Excess Costs of Supply PopulationAdditional Needs ×× ×═ Age-Sex Cost Weights Board population share % GROS data GP list data

Differs by specialty – SFR 5s Up to 20 different age bands Data sources Relative need due to age and sex profile Relative need due to morbidity and life circumstances Relative costs of providing services to different geographical areas NRAC Weighted Target Share % Unavoidable Excess Costs of Supply PopulationAdditional Needs ×× ×═ Age-Sex Cost Weights Board population share %

Acute and Care of the Elderly Standardized mortality rates Long term limiting illness rate Maternity Mean house price Birth rate Data sources Relative need due to age and sex profile Relative need due to morbidity and life circumstances Relative costs of providing services to different geographical areas NRAC Weighted Target Share % Unavoidable Excess Costs of Supply PopulationAdditional Needs ×× ×═ Age-Sex Cost Weights Board population share %

Mental health and learning difficulties Severe disablement allowance % living in one person households % living in socially rented housing Data sources Relative need due to age and sex profile Relative need due to morbidity and life circumstances Relative costs of providing services to different geographical areas NRAC Weighted Target Share % Unavoidable Excess Costs of Supply PopulationAdditional Needs ×× ×═ Age-Sex Cost Weights Board population share %

Urban rural classification Community travel survey SAF remoteness adjustment Data sources Relative need due to age and sex profile Relative need due to morbidity and life circumstances Relative costs of providing services to different geographical areas NRAC Weighted Target Share % Unavoidable Excess Costs of Supply PopulationAdditional Needs ×× ×═ Age-Sex Cost Weights Board population 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 CopelandNHS GG&C Garry CouttsNHS Highland Karen FaceyNHS Forth Valley Malcolm IredaleNHS Highland Alan GallNHS Grampian Douglas GriffinNHS GG&C Fiona RamsayNHS Forth Valley Andrew RichmondNHS Tayside John Ross ScottNHS Orkney George WalkerNHS 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?