The Integrated Resource Framework

Paul Leak

Simon Steer

•Context

•IRF Overview

•Emerging Themes

Clinician/Practitioner Workshop

Integrated Resource FrameworkWhat 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 sitesDevelop Financial Mechanisms to let £ follow the patientWithin NHS and between NHS and Social Work.

•9 NHS Boards & 12 Local Authorities

•2008/09 Expenditure: End June 2010

•2009/10 Expenditure: End Dec 2010

•Local approach

Stage 1: Mapping

Analysis of Spend

Patient=49%

Practice=27%

Locality/CHP=17%

£1,567

14%

27%

30%

30%

30%

7%

12%14%

18%

Argyll & Bute CHP

SE CHPMid CHP

North CHP

SSU

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

•Defined Population;

•Total Per capita Resources;

•IntegratorTotal control over resources for defined population;Flexibility to determine how resource is used;Assumption of financial risk;Shared Incentives to improve Outcomes;

Phase 2:Test Sites

Johri 2003Kodner 2006

• Local choice, but likely to be CHPs

• Integration of investment resources (commissioning)

• Predicated on understanding existing:ActivityCostsOutcomes

Integrated Resource FrameworkIntegrator

Two PartnershipsNHS Highland and Highland CouncilNHS Highland and Argyll and Bute Council

Population of interestStrategic – 75years plusDistrict – Adult CareInitiative – Small steps of change

IntegratorDistrict

Integrated Resource FrameworkHighland test site

Four PartnershipsNHS Lothian and City of Edinburgh CouncilNHS Lothian and West Lothian CouncilNHS Lothian and East Lothian CouncilNHS Lothian and Midlothian Council

Population of interestOlder people (Edinburgh)Early years (West Lothian)Frail elderly (East Lothian)Dementia and frail elderly (Midlothian)

Integrator - under discussion

Integrated Resource FrameworkLothian test site

Three PartnershipsNHS Tayside and Perth and Kinross CouncilNHS Tayside and Dundee City CouncilNHS Tayside and Angus Council

Population of interestOlder people and people with learning difficulties (Perth and Kinross)Complex cases (Dundee City)Older people (Angus)

IntegratorCHPs

Integrated Resource FrameworkTayside test site

Three PartnershipsNHS Ayrshire & Arran and North Ayrshire CouncilNHS Ayrshire & Arran and East Ayrshire CouncilNHS Ayrshire & Arran and South Ayrshire Council

Population of interestVulnerable children (North Ayrshire)Complex cases (East Ayrshire)Older people (South Ayrshire)COPD cases (pan Ayrshire)

IntegratorCHPs

Integrated Resource FrameworkAyrshire and Arran test site

Evidence suggests some or all of these models may be appropriate in the test sites:

Within NHSTariffs to value hospital activityDevolved budgets to CHPs

Between NHS and Local AuthorityExtensive pooled budgetsLead commissioner model

Integrated Resource FrameworkNew financial arrangements

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?

Action research1.Monitor progress until end 20112.Assess impact - resources and outcomes3.Feed evidence back in to ongoing

implementation4.Implications and guidance for others

Integrated Resource FrameworkTest site evaluation

Where will we be?

Target Population Expenditure MappedOutcomes MappedIntegrator agreedMechanisms agreed

Mechanisms embeddedIntegrator empowered

Investment Plans Go live

Evaluation

April 6m 12m 18m

Emerging Themes

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500

1,000

1,500

2,000

2,500

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Variation

VariationSpend/head>75yrs 2007/08

CHP #1£7,065 per person

5%2%3%7%3%

17%

3%

9%

10%

41%

Inpatient & Day case Outpatient Other Hospital GMS Prescribing

Community Care Home Home Care Other Older adult Other NHS

VariationSpend/head>75yrs 2007/08

CHP 2£7,199 per person

7%3%3%7%

3%

17%

11%

5%7%

37%

Inpatient & Day case Outpatient Other Hospital GMS Prescribing

Community Care Home Home Care Other Older adult Other NHS

0

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40,000

60,000

80,000

100,000

120,000

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Contracted=£39m Non-Contracted=£164.3m

Practice Direct Impact

£5,253

£2,222

Institutional Non-Institutional

Balance of Care

•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 socialcare: five laws revisited. Journal of Integrated Care 13 (5), 3–11.

Hudson et al (2002) National Evaluation of the Use of Section 31Partnership Flexibilities of the Health Care Act of 1999.

Fundamentally…

The Integrated Resource Framework

Paul Leak

Simon Steer