1. RESOURCE ALLOCATION AND TARGETING SOCIAL NEED MARTIN MAYOCK INFORMATION & ANALYSIS UNIT DHSSPS NORTHERN IRELAND HEALTH AND PERSONAL SOCIAL SERVICES (HPSS)

2. INTRODUCTION RESOURCE ALLOCATION IN NI HPSS – STRUCTURE AND BACKGROUND WEIGHTED CAPITATION PRINCIPLES MEASUREMENT OF SOCIAL NEED NEEDS SENSITIVITY ANALYSIS SUB-BOARD APPLICATION OF FORMULA CURRENT RESEARCH

3. NI HPSS – STRUCTURE AND FUNDING FLOWS THE DEPARTMENT 4 HEALTH AND SOCIAL SERVICES BOARDS 11 TRUST LOCALITY AREAS

4. RESOURCE ALLOCATION IN NI HPSS - BACKGROUND HISTORICAL EXPENDITURE –PERPETUATES EXISTING INEQUALITIES POPULATION BASED METHODS –USED IN N. IRELAND SINCE 1978 CAPITATION FORMULA REVIEW GROUP –ESTABLISHED 1994 –IMPROVE ON EXISTING FORMULA –FOURTH REPORT DUE MAY 2004

5. STRUCTURE OF FORMULA SEPARATE FORMULA FOR EACH OF NINE PROGRAMMES OF CARE (PoCs) EXAMPLES –ACUTE HOSPITAL SERVICES –ELDERLY CARE –MENTAL HEALTH FORMULAE ARE SENSITIVE TO THE NEEDS OF EACH CLIENT GROUP

6. WEIGHTED CAPITATION - PRINCIPLES POPULATION SIZE AGE/GENDER ADJUSTMENT ADDITIONAL NEEDS ADJUSTMENT OTHER ADJUSTMENTS –RURAL COSTS –INCOME ADJUSTMENT

7. WEIGHTED CAPITATION - POPULATION POPULATION SIZE IS MOST IMPORTANT ELEMENT CRUDE POPULATION PERCENTAGES (2002) –EHSSB39% –NHSSB25% –SHSSB19% –WHSSB17% POPULATION SOURCE –MID-YEAR ESTIMATES (NISRA)

8. WEIGHTED CAPITATION - AGE/GENDER VERY YOUNG AND THE ELDERLY HAVE MOST NEED FOR SERVICES MALES AND FEMALES ALSO HAVE DIFFERENT SERVICE NEEDS THIS NEED WILL DIFFER DEPENDING ON SERVICE TYPE MAJOR COSTING EXERCISE CARRIED OUT BY BOARDS RESULTS USED TO INCREASE/DECREASE CRUDE POPULATIONS IN EACH PROGRAMME

9. AGE/GENDER COSTS – ALL POCS

10. WEIGHTED CAPITATION - ADDITIONAL NEEDS IMPORTANT TO TAKE DIFFERENT ILLNESS LEVELS INTO ACCOUNT FACTORS ASSOCIATED WITH INCREASED ILLNESS –DEPRIVATION RELATED –LIVING CIRCUMSTANCES –HEALTH STATUS –RURAL/URBAN LIVING SERVICE USE AS A PROXY FOR NEED

11. MEASUREMENT OF NEED - SMALL AREA ANALYSIS DATA REQUIREMENTS –MEASURES OF UTILISATION/ACTIVITY –COST DATA –SOCIO-ECONOMIC DATA –HEALTH STATUS DATA –RURALITY DATA ALL DATA REQUIRE A GEOGRAPHIC IDENTIFIER

12. SMALL AREA ANALYSIS -SIMPLIFIED MODEL NEED DEPRIVATION FACTORS HEALTH STATUS FACTORS RURAL NEEDS FACTORS

13. ADDITIONAL NEEDS FORMULAE - EXAMPLES ACUTE SERVICES –SMR (ALL AGES) –ELDERLY LIVING ALONE –INCOME SUPPORT –FAMILY CREDIT –LOW BIRTHWEIGHT FAMILY AND CHILD CARE –LONE PARENTS ON INCOME SUPPORT –CHILDREN WITH A LONG-TERM ILLNESS –CHILDREN IN SOCIAL RENTED HOUSING

15. IMPACT OF NEEDS AT WARD LEVEL - TOP 5 DEPRIVED WARDS ELECTORAL WARD LGDAGE/GENDER WEIGHTED SHARE (%) AGE/GENDER & NEEDS WEIGHTED SHARE (%) CHANGE IN SHARE (%) SHANTALLOW EAST DERRY 0.12 0.27 127.6 COLLIN GLENLISBURN 0.43 0.74 73.8 UPPER SPRINGFIELD BELFAST 0.29 0.48 62.5 ST PETERSDERRY 0.10 0.16 58.9 ARDOYNEBELFAST 0.37 0.56 49.7

16. UNMET NEED FORMULA ASSUMES UTILISATION IS AN ADEQUATE PROXY FOR NEED UNDER UTILISATION AND HENCE UNMET NEEDS –DEPRIVED VERSUS AFFLUENT COMMUNITIES –RURAL VERSUS URBAN POPULATIONS TEST DEVELOPED TO DETECT UNMET NEED AND CORRECT (STATISTICALLY) IF REQUIRED

17. SUB-BOARD FORMULA USE GUIDELINES PRODUCED AS PART OF CFRG REVIEW DECREASED ACCUARACY WHEN APPLYING FORMULA TO SMALL POPULATION UNITS CONSIDERATION SHOULD BE GIVEN TO LOCAL FACTORS –ETHNIC GROUPS/TRAVELLERS –LONG-TERM INSTITUTIONAL CARE –DRUG MISUSE FORMULA SHOULD INFORM ALLOCATIONS NOT RIGIDLY SET THEM

18. CURRENT CFRG RESEARCH LEARNING DISABILITY ADMINISTRATIVE PREVALENCE STUDY PHYSICAL AND SENSORY DISABILITY NEEDS STUDY REFINED MENTAL HEALTH NEEDS INDEX UPDATED FAMILY AND CHILD CARE NEEDS STUDY UNMET NEED COSTS ARISING FROM ECONOMIES/DISECONOMIES OF SCALE