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The Integrated Resource Framework

The Integrated Resource Framework. Paul Leak Simon Steer. Clinician/Practitioner Workshop. Context IRF Overview Emerging Themes. Integrated Resource Framework What and Why.

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The Integrated Resource Framework

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  1. The Integrated Resource Framework Paul Leak Simon Steer

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

  3. 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.

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

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

  6. Board Spend Mapped to CHP Populations

  7. 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?

  8. 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

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

  10. Integrated Resource Framework Integrator • Local choice, but likely to be CHPs • Integration of investment resources (commissioning) • Predicated on understanding existing: • Activity • Costs • Outcomes

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

  12. 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

  13. 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

  14. 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

  15. 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

  16. 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).

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

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

  19. Emerging Themes

  20. Variation

  21. VariationSpend/head>75yrs 2007/08

  22. VariationSpend/head>75yrs 2007/08

  23. Practice Direct Impact

  24. Balance of Care

  25. 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.

  26. The Integrated Resource Framework Paul Leak Simon Steer

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