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An introduction to the NRAC formula and TAGRA
Background to TAGRA
• Formed after NRAC report
• Maintains and develops formula
• Brings together Government, NHS Boards, and academics
• Forum for stakeholder engagement
• Work programme of improvements
Members – from boardsRichard Copeland NHS GG&C
Garry Coutts NHS Highland
Karen Facey NHS Forth Valley
Malcolm Iredale NHS Highland
Alan Gall NHS Grampian
Douglas Griffin NHS GG&C
Fiona Ramsay NHS Forth Valley
Andrew Richmond NHS Tayside
John Ross Scott NHS Orkney
George Walker NHS Lothian
TAGRA core criteria
• Equity• Practicality• Transparency• Objectivity• Avoiding perverse incentives• Relevance• Stability• Responsiveness• Face validity
NRAC formula
Needs based formula
To enable every person in Scotland to have equal access to high quality health
services according to their need
• Based on population – but just a start
Resource allocation in practice
Relative need due to
morbidity and life
circumstances
Additional Needs
×
Unavoidable Excess Costs of
Supply
Relative costs of
providing services to
different geographical
areas
×
NRACWeighted
Target Share
%
═
Relative need due to age and sex profile×
Age-Sex Cost Weights
Population
Board population
share%
Difference between recommended NRAC spend per head and an equal share (2011/12)
-£200
-£150
-£100
-£50
£0
£50
£100
£150
£200
£250
£300
£350A
yrsh
ire &
Arr
an
Bor
ders
Fife
Gre
ater
Gla
sgow
& C
lyde
Hig
hlan
d
Lana
rksh
ire
Gra
mpi
an
Ork
ney
Loth
ian
Tay
side
For
th V
alle
y
Wes
tern
Isle
s
Dum
frie
s &
Gal
low
ay
She
tland
Sp
end
per
per
son
(£)
NRAC
Difference between recommended NRAC spend per head and an equal share (2011/12) - Population
-200
-150
-100
-50
0
50
100
150
200
250
300
350A
yrsh
ire &
Arr
an
Bor
ders
Fife
Gre
ater
Gla
sgow
& C
lyde
Hig
hlan
d
Lana
rksh
ire
Gra
mpi
an
Ork
ney
Loth
ian
Tay
side
For
th V
alle
y
Wes
tern
Isle
s
Dum
frie
s &
Gal
low
ay
She
tland
Sp
end
per
per
son
(£)
Difference between recommended NRAC spend per head and an equal share (2011/12) - Age sex
-£200
-£150
-£100
-£50
£0
£50
£100
£150
£200
£250
£300
£350
Ayr
shire
& A
rran
Bor
ders
Fife
Gre
ater
Gla
sgow
& C
lyde
Hig
hlan
d
Lana
rksh
ire
Gra
mpi
an
Ork
ney
Loth
ian
Tay
side
For
th V
alle
y
Wes
tern
Isle
s
Dum
frie
s &
Gal
low
ay
She
tland
Sp
end
per
per
son
(£)
Age-sex
Difference between recommended NRAC spend per head and an equal share (2011/12) - Age sex and MLC (cumulative)
-£200
-£150
-£100
-£50
£0
£50
£100
£150
£200
£250
£300
£350A
yrsh
ire &
Arr
an
Bor
ders
Fife
Gre
ater
Gla
sgow
& C
lyde
Hig
hlan
d
Lana
rksh
ire
Gra
mpi
an
Ork
ney
Loth
ian
Tay
side
For
th V
alle
y
Wes
tern
Isle
s
Dum
frie
s &
Gal
low
ay
She
tland
Sp
end
per
per
son
(£)
Age-sex
MLC
Difference between recommended NRAC spend per head and an equal share (2011/12) - MLC and UXC (cumulative)
-£200
-£150
-£100
-£50
£0
£50
£100
£150
£200
£250
£300
£350A
yrsh
ire &
Arr
an
Bor
ders
Fife
Gre
ater
Gla
sgow
& C
lyde
Hig
hlan
d
Lana
rksh
ire
Gra
mpi
an
Ork
ney
Loth
ian
Tay
side
For
th V
alle
y
Wes
tern
Isle
s
Dum
frie
s &
Gal
low
ay
She
tland
Sp
end
per
per
son
(£)
MLC
UXC
Difference between recommended NRAC spend per head and an equal share (2011/12)
-£200
-£150
-£100
-£50
£0
£50
£100
£150
£200
£250
£300
£350A
yrsh
ire &
Arr
an
Bor
ders
Fife
Gre
ater
Gla
sgow
& C
lyde
Hig
hlan
d
Lana
rksh
ire
Gra
mpi
an
Ork
ney
Loth
ian
Tay
side
For
th V
alle
y
Wes
tern
Isle
s
Dum
frie
s &
Gal
low
ay
She
tland
Sp
end
per
per
son
(£)
NRAC
NRAC 2011/12 MLC index
-20%
-15%
-10%
-5%
0%
5%
10%
15%
20%
Ayr
shire
& A
rran
Bor
ders Fife
Gre
ater
Gla
sgow
& C
lyde
Hig
hlan
d
Lana
rksh
ire
Gra
mpi
an
Ork
ney
Loth
ian
Tays
ide
Fort
h V
alle
y
Wes
tern
Isle
s
Dum
frie
s &
Gal
low
ay
She
tland
Per
cent
age
diff
eren
ce fr
om n
atio
nal a
vera
ge n
eed
(%)
Overall MLC
NRAC 2011/12 MLC index compared to MH&LD index
-20%
-15%
-10%
-5%
0%
5%
10%
15%
20%
Ayr
shire
& A
rran
Bor
ders Fife
Gre
ater
Gla
sgow
& C
lyde
Hig
hlan
d
Lana
rksh
ire
Gra
mpi
an
Ork
ney
Loth
ian
Tays
ide
Fort
h V
alle
y
Wes
tern
Isle
s
Dum
frie
s &
Gal
low
ay
She
tland
Per
cent
age
diff
eren
ce fr
om n
atio
nal a
vera
ge n
eed
(%)
Overall MLC
MH&LD MLC
The Additional Needs (1)
Needs
Utilisation
1Nationalaverage
The Additional Needs (2)
Needs
Utilisation
1
The Additional Needs (4)
Utilisation
10.85
Needs
MLC = constant + Coefficient*need
IG 1
Data sources
• Based on intermediate geography
• Requires national data
• Requires small area data
MH&LD indicators
• Severe disablement allowance
• % living in one person households
• % living in socially rented housing
Questions?
