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

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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

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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

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Bor

ders

Fife

Gre

ater

Gla

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& C

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Hig

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For

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Sp

end

per

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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

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Gla

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& C

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Hig

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For

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Sp

end

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(£)

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

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Fife

Gre

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Gla

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& C

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Hig

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Ork

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Tay

side

For

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Wes

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Isle

s

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ay

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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

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& C

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Hig

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d

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Gra

mpi

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Ork

ney

Loth

ian

Tay

side

For

th V

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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

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ire

Gra

mpi

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Ork

ney

Loth

ian

Tays

ide

Fort

h V

alle

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Wes

tern

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Dum

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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

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Hig

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d

Lana

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mpi

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Ork

ney

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Tays

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Fort

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Wes

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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?