The Integrated Resource Framework Paul Leak Simon Steer

The Integrated Resource Framework Paul Leak Simon Steer

Clinician/Practitioner Workshop • Context • IRF Overview • Emerging Themes

Integrated Resource Framework What and Why The IRF Enables a comprehensive understanding of total resource allocation within health, and across health and adult social care. Stage 1: Mapping • NHS Expenditure • Social Care Expenditure • Population Characteristics Stage 2 : Test sites Develop Financial Mechanisms to let £ follow the patient Within NHS and between NHS and Social Work.

Stage 1: Mapping • 9 NHS Boards & 12 Local Authorities • 2008/09 Expenditure: End June 2010 • 2009/10 Expenditure: End Dec 2010 • Local approach

Analysis of Spend Locality/CHP =17% Practice =27% £ 1, 567 Patient =49%

Board Spend Mapped to CHP Populations

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? • Can we redesign the bicycle whilst still pedalling?

Phase 2: Test Sites 4 NHS Boards and 12 and local authority Partners agreeing financial mechanisms to move resources between health and social care: • Lothian • Highland • Tayside • Ayrshire and Arran

Phase 2: Test Sites • Defined Population; • Total Per capita Resources; • Integrator ØTotal control over resources for defined population; ØFlexibility to determine how resource is used; ØAssumption of financial risk; ØShared Incentives to improve Outcomes; Johri 2003 Kodner 2006

Integrated Resource Framework Integrator • Local choice, but likely to be CHPs • Integration of investment resources (commissioning) • Predicated on understanding existing: ØActivity ØCosts ØOutcomes

Integrated Resource Framework Highland test site Two Partnerships NHS Highland Council NHS Highland Argyll and Bute Council Population of interest Strategic – 75 years plus District – Adult Care Initiative – Small steps of change Integrator District

Integrated Resource Framework Lothian test site Four Partnerships NHS Lothian and City of Edinburgh Council NHS Lothian and West Lothian Council NHS Lothian and East Lothian Council NHS Lothian and Midlothian Council Population of interest Older people (Edinburgh) Early years (West Lothian) Frail elderly (East Lothian) Dementia and frail elderly (Midlothian) Integrator - under discussion

Integrated Resource Framework Tayside test site Three Partnerships NHS Tayside and Perth and Kinross Council NHS Tayside and Dundee City Council NHS Tayside and Angus Council Population of interest Older people and people with learning difficulties (Perth and Kinross) Complex cases (Dundee City) Older people (Angus) Integrator CHPs

Integrated Resource Framework Ayrshire and Arran test site Three Partnerships NHS Ayrshire & Arran and North Ayrshire Council NHS Ayrshire & Arran and East Ayrshire Council NHS Ayrshire & Arran and South Ayrshire Council Population of interest Vulnerable children (North Ayrshire) Complex cases (East Ayrshire) Older people (South Ayrshire) COPD cases (pan Ayrshire) Integrator CHPs

Integrated Resource Framework New financial arrangements Evidence suggests some or all of these models may be appropriate in the test sites: Within NHS Tariffs to value hospital activity Devolved budgets to CHPs Between NHS and Local Authority Extensive pooled budgets Lead commissioner model

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

Integrated Resource Framework Test site evaluation Action research 1. Monitor progress until end 2011 2. Assess impact - resources and outcomes 3. Feed evidence back in to ongoing implementation 4. Implications and guidance for others

Where will we be? April 6 m Target Population Expenditure Mapped Outcomes Mapped Integrator agreed Mechanisms embedded Integrator empowered Investment Plans Go live Evaluation 12 m 18 m

Emerging Themes

Variation

Variation Spend/head>75 yrs 2007/08

Variation Spend/head>75 yrs 2007/08

Practice Direct Impact

Balance of Care

Fundamentally… • 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.

The Integrated Resource Framework Paul Leak Simon Steer