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
0
500
1,000
1,500
2,000
2,500
1 2 3
£ pe
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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
20,000
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