Integrated Resource Framework: Using IRF to Inform Improvement

1. Integrated Resource Framework:Using IRF to Inform Improvement Demonstrating Impact – East Region Learning Event 8th February 2013

2. Outline • What is IRF? • IRF output • 2010/11 IRF mapping • Patient level data • Work with partnerships • Examples of work around country • Questions and next steps

3. What is IRF? • Joint development by SG, NHS and COSLA to understand activity and resources across Health and Social Care • Focus on activity and resources for geographic populations instead of by traditional methods i.e. Total Health Budget, LA Budgets etc • Aim is to make it easier for Partnerships to understand resource and activity envelope • Provide an evidence base for supporting change and the shifting balance of care within and across Health and Social Care • Present data at: • Strategic level • Population level • Patient/client cohorts • Specialty level • Individual patient

4. IRF national mapping • Two ways of mapping - top down and bottom up • Top down: Costs Book (NHS), LFR3 (Council) • Bottom up: national patient level data collections • Aim is to allocate as much expenditure as possible for key service areas to each Partnership • Build up from patient level or modelling allocation of Board/Council level

5. What does IRF mapping data look like? NHS: • Hospital based services • Non elective (emergency) inpatients; Elective and day case inpatients; Accident and emergency; Outpatients • Community based services • Community Health (District Nursing, AHPs etc); GPs and prescribing Council: • Accommodation based • Care homes; residential respite • Community based • Home care; self directed support

6. IRF mapping output • 2010/11 costs across health and social care mapped (all ages; 65+; 75+) across Scotland • All H&SC: £10.2bn; £4.4bn; £3.1bn • Hospital care: £5.0bn; £2.2bn; £1.4bn • Community Health: £1.4bn; £389m; £208mn • GMS and prescribing: £1.7bn; £571m; £294m • Local Authority: £2bn (18 plus); £1.2bn (65+)

7. Scotland – Institutional/Community – 65+ (total resource £4.4bn)

8. Scotland – Institutional/Community – 65+ (£4.4bn)

9. Scotland – Hospital – 65+ (£2.2bn)

10. Scotland – Hospital – 75+ (£1.4bn)

11. Scotland – Community Health, GMS and prescribing – 65+ (£939m)

13. Patient-level data • Costing methodology builds from patient level up where possible • Acute hospital discharges (elective and non-elective; Inpatient and day case) • Mental health hospital discharges (elective and non-elective) • Geriatric long stay unit discharges • Community prescribing • Maternity hospital discharges (IP and DC) • Aim to expand patient level cost base • Patient level data also available for • A&E attendances • Consultant led new outpatient appointments

14. Patient-level data • Allows data to be used at the lowest level • Individual patient pathways • Build up to various geographic and planning levels • E.g. GP practice and localities • Link in additional data • Client level social care data linked for three Tayside partnerships; also Lothian

15. Partnership working High level resource use • All partnerships mapped (2010/11) • Split by Hospital and Community Based Care • All by CHP some data by GP practice • High resource cohorts • 50% of each service cost is spent on 14% of social care clients and 8% of health patients • Different age groups • Patient pathways to understand what makes these individuals high resource • Cross over between health and social care • 17% service users using health and social care • 66% health only • 16% social care only

16. Partnership working Sub-partnership • Distribution of spend below partnership level • Variation across regions • Impact of deprivation Strategic • IRF underpinning “analysis” section of Joint Commissioning • Projecting future spend in line with aging population

17. Partnership working - ADP • Define substance misuse cohort • Use data from criminal justice and ADP services to augment data • Prevalence and population characteristics • Size and distribution of spend • Comparative to non substance misuse population • Follow as service is redesigned

18. Breakdown of costs Non-substance misuse: Substance misuse:

19. Cost per capita by age

20. Partnership working - Dementia • Define dementia cohort • Use data from GP LTC register • Prevalence and population characteristics • Compare dementia with rest of population to estimate cost of illness • What health and social resources do dementia patients use? • Comparative to non dementia population • Forecast future demand as a result of demographic pressure • Assist with planning and evaluating services redesign

21. Cost attributable to Dementia

22. Projected cost of dementia

23. Partnership working Anticipatory care plans • Examined health activity and resource patients receiving ACP • Select matched cohort to measure ACP success • Follow over time Emergency Admissions • Pathways, diagnoses

24. Partnership working Delayed discharges • Health and social care activity around a delayed discharge • Pathways • Aid and evaluate service redesign • Compare to SPARRA • Are the same patients being targeted to prevent admission also more prone to delayed discharge? GPs • Working with 8 GP practices on health inequalities projects. • Using IRF approach to understand current activity and resource of target groups.

25. Future • Patient level costing becoming mainstream • Methodology refined • Improved reference information • Improve/expand patient level data collection • Particularly community healthcare and social care • 2011/12 IRF mapping available in April • Develop routine IRF mapping processes, improved access to data

26. Questions • How can IRF leads work better to support partnerships? • Are the right people aware of IRF? • Are partnerships able to share data in support of IRF? • Are ISD able to share IRF output effectively?