1. The Integrated Resource Framework Paul Leak Simon Steer

2. Context IRF Overview Emerging Themes Clinician/Practitioner Workshop

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

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

7. Board Spend Mapped to CHP Populations

8. 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?

9. 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

10. 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 ; Phase 2:Test Sites Johri 2003 Kodner 2006

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

12. 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 Integrated Resource Framework Highland test site

13. 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 Lothian test site

14. 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 Tayside test site

15. 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 Ayrshire and Arran test site

16. 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 Integrated Resource Framework New financial arrangements

17. 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?

18. 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 Integrated Resource Framework Test site evaluation

19. Where will we be? Target Population Expenditure Mapped Outcomes Mapped Integrator agreed Mechanisms agreed Mechanisms embedded Integrator empowered Investment Plans Go live Evaluation April6m12m18m

20. Emerging Themes

21. Variation

22. Variation Spend/head>75yrs 2007/08

24. Practice Direct Impact

25. Balance of Care

26. 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. Fundamentally…

27. The Integrated Resource Framework Paul Leak Simon Steer