1. The Integrated Resource Framework Dr Sheena MacDonald Senior Medical Advisor

2. “Clinicians & Care Professionals.. have a crucial role... It is they who commit resources.” “Governance structures need to allow them freedom to act and to ensure there is accountability for their actions.” “Finance needs to be structured in a way that supports this.” Prescription for Partnership Audit Commission Dec 2007 Starting Point for the IRF… It’s not just about Finance Departments

3. Integrated Resource Framework Context - a perfect storm Demographic pressures Economic pressures Planning in the margins of historic activity Marginal or strategic planning? Performance or variation? Bottom line or opportunity cost? Administration or stewardship?

4. Integrated Resource Framework Policy Partnership working across health and social care Shifting the Balance of Care NHS Quality Strategy Reshaping Care for Older People Two planning disconnects Within health – between primary/community and acute Between health and social care Need to shift resources to support shift towards better, more appropriate care – and better outcomes

5. IRF underpinned by the Triple Aim of a rational care organisation, defined by the Institute of Health Improvement (IHI) as: 1. Improving population health 2. Improving individual experience 3. Reducing costs Each test site will use an “integrator” structure to direct resource use across health and social care and oversee progress towards the Triple Aim. Integrated Resource Framework Triple Aim

6. Some supposedly simple questions: Do you know how much you spend per head on people over 75 yrs? Across Health and Social Care? Is there variation: by locality? by GP? in the type of care provided? in outcomes? Integrated Resource Framework

7. Diagnostics – Endoscopic 0 2 4 6 8 10 12 AB C D E F G H I J K L M N O P Q R S T U V W X Y GP Practice GP Referrals by 500 Patients GP Referrals to all Nationally Reported Endoscopic Tests – April 08 to March 2009

8. Emergency Inpatient Admissions 0 5 10 15 20 25 30 35 40 AB CD E F G H I J K L M N O P Q R S T U V W XY Gp Practice Admissions per 500 of total population 0 5 10 15 20 25 30 35 40 45 Distance from the BGH General Medicine BGH Emergency AdmissionsDME Community & BGH Emergency Admissions GP Acute Community & BGH Emergency AdmissionsOut of Area Emergency Admissions Mileage Total Emergency Admissions to General Medicine, GP Acute and DME Beds by Practice - 2008/09

9. Referrals to A&E GP Referrals to A&E 2005/06 – 2008/09 Chart 17 - GP Referrals to A&E per 500 patients for 2005/06 to 2008/09 0 10 20 30 40 50 60 70 80 90 Practice Referrals per 500 Patients 2005/062006/072007/082008/09 AB CD E F G H I J K L M N O P Q R S T U V W XY Z

10. Outpatient Referrals Comparison of Outpatient Referrals to the BGH and Out of Area by Practice for 2008/9 0 20 40 60 80 100 120 140 160 180 GP Practice Referrals by 500 Practice Population 0 5 10 15 20 25 30 35 40 45 Mileage to BGH BordersOther ScottishOther EnglishMileage ` AB CD E F G H I J K L M N O P Q R S T U V W XY

11. Moving Forward……. How do we engage clinicians Where do we, as clinicians, influence the patient pathway and the concomitant distribution of resources Where and how could we influence the patient pathway if the current constraints imposed upon us by lack of integrated resources were removed