IRF Stage 2 Test Sites & Workshop

“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 PartnershipAudit Commission Dec 2007

Fundamentally…

•Context

•Test Sites

Test Site Workshop

Context: Recognising The Perfect Storm

• Demographic pressures

• Economic pressures• Historic patterns of;

investment; management and resource use.Marginal or S

trategic planning?

Perform

ance or Variation?

Bottom lin

e or Opportu

nity Cost?

Administration or S

tewardship?

•Inter-dependency

•Chasms to cross: Health & social care;Community & Institutional care

•Variation

Context: Scottish Health & Social Care System

To:•Improve population Health•Improve individual experience•Reduce costs

Requires:•Defined Population•Per Capita Resources•Care Integrator

Context: Triple Aim

Stage 1: Mapping

Stage 1: Mapping

Stage 2: Test sites

MappingTest sites should know:

•Per Capita Health and Social Care expenditure Practice/Locality/CHP;By care type;Balance of Care.

•Patient level hospital activity and costsPer capita hospital expenditure for care groups;Per capita hospital expenditure by age/sex;Site/Specialty analysis

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?•New Care and Clinical pathways?•Can we redesign the bicycle whilst still pedalling?

•Tariffs for hospital care•Total CHP budgets•Programme Budgeting

•Pooled Budgets•Lead Commissioner•Transactional agreements

•All feasible under current Scottish legislation

“New” Financial Frameworks

•US PACE;

•Quebec SIPA & PRISMA;

•Sierra Social HMO

•English Care Trusts;

•ADEL reforms Sweden;

•Other?

IRF Reference Pack 1“What works elsewhere”

•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 socialcare: five laws revisited. Journal of Integrated Care 13 (5), 3–11.

Hudson et al (2002) National Evaluation of the Use of Section 31Partnership Flexibilities of the Health Care Act of 1999.

Fundamentally…

Appreciating Timescales….

• ….have been pushy to date

• …..still look tight

• …….looking at 2010 and 2011; can we afford to delay or slow down? Can we afford not to?

Agreed Financial models embedded into Partner Financial and Performance management arrangements :

•Defined Population;•Total control over resources for defined population;•Flexibility to determine how resource is used;•Assumption of financial risk;•Shared Incentives to promote SBC.

What does success look like?Preparation

Johri 2003Kodner 2006

•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?Implementation

External action-based evaluation……..

• Define evaluation criteria• Create an effective learning and support network for the

test sites• Disseminate and share learning• Knowledge base to support Health Boards, CHPs and

Local Authorities

Test Site Evaluation

1) SpecificationWhat?31st December 2009

2) Development PlanHow?31st December

3) Implementation PlanWhen?28th February 2010…. If you are going to hit

1st April

Test Site Timeline (Group Sessions):

IRF Stage 2 Test Sites Descriptions…..

Then Coffee

•Phase 1 Mapping Network •Social Care Costing Network•Test Site Network:

Regular formal workshopsInformal contacts

Resources:Local team and knowledge baseIRF teamOther Related Programme Resources eg. SDC; Housing DemonstratorISDIRF resources for OD

IRF Networks

IRF Stage 2 Test Sites & Workshop

Next Meets in December