1. IRF Stage 2 Test Sites & Workshop

2. “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 Fundamentally…

3. Context Test Sites Test Site Workshop

4. 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?

5. Inter-dependency Chasms to cross:  Health & social care;  Community & Institutional care Variation Context: Scottish Health & Social Care System

6. To: Improve population Health Improve individual experience Reduce costs Requires: Defined Population Per Capita Resources Care Integrator Context: Triple Aim Stage 1: Mapping Stage 2: Test sites

7. 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

8. 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? New Care and Clinical pathways? Can we redesign the bicycle whilst still pedalling?

9. Tariffs for hospital care Total CHP budgets Programme Budgeting Pooled Budgets Lead Commissioner Transactional agreements All feasible under current Scottish legislation “New” Financial Frameworks

10. US PACE; Quebec SIPA & PRISMA; Sierra Social HMO English Care Trusts; ADEL reforms Sweden; Other? IRF Reference Pack 1 “What works elsewhere”

11. The best Integration is Local: Find local solutions to local problems Leutz (2005) Success depends on local leadership (Hudson et al 2002) Leutz W. (2005) Reflections on integrating medical and social care: five laws revisited. Journal of Integrated Care 13 (5), 3–11. Hudson et al (2002) National Evaluation of the Use of Section 31 Partnership Flexibilities of the Health Care Act of 1999. Fundamentally…

12. Appreciating Timescales…. ….have been pushy to date …..still look tight …….looking at 2010 and 2011; can we afford to delay or slow down? Can we afford not to?

13. Agreed Financial models embedded into Partner Financial and Performance management arrangements : Defined Population; Total control over resources for defined population; Flexibility to determine how resource is used; Assumption of financial risk; Shared Incentives to promote SBC. What does success look like? Preparation Johri 2003 Kodner 2006

14. Evidence of:  Improved outcomes;  Shifts in the Balance of Care;  Improved Clinical engagement;  Improved Equity of access;  Improved efficiency (Allocative/Utilisation). What does success look like? Implementation

15. External action-based evaluation…….. Define evaluation criteria Create an effective learning and support network for the test sites Disseminate and share learning Knowledge base to support Health Boards, CHPs and Local Authorities Test Site Evaluation

16. 1)Specification What? 31 st December 2009 2) Development Plan How? 31 st December 3) Implementation Plan When? 28 th February 2010…. If you are going to hit 1 st April Test Site Timeline (Group Sessions):

17. IRF Stage 2 Test Sites Descriptions….. Then Coffee

18. Phase 1 Mapping Network Social Care Costing Network Test Site Network:  Regular formal workshops  Informal contacts Resources:  Local team and knowledge base  IRF team  Other Related Programme Resources eg. SDC; Housing Demonstrator  ISD  IRF resources for OD IRF Networks

19. IRF Stage 2 Test Sites & Workshop Next Meets in December