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 Strategic planning? Performance or Variation? Bottom line or Opportunity Cost? Administration or Stewardship?

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” 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 2: Test sites

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

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

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

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

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) Community Health Partnership

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

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

South-East CHP # 1 CHP

Mid Highland CHP # 2 CHP

A CHP Spend/head>75yrs 2008/09

GP Direct Impact GP Practices

What Difference? Acute General Hospital City Practice GM OBDs (Average2006/ /08)

A 40 Bed Ward Hospital GM Capacity Planning

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

A SW Area Older Persons Balance of Care 2008/09

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 Partnership Audit 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 (fair share)? Understanding Performance & 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