The Integrated Resource Framework

Dr Sheena MacDonaldSenior Medical Advisor

“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

Starting Point for the IRF… It’s not just about Finance Departments

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?

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

IRF underpinned by the Triple Aim of a rational care organisation, defined by the Institute of Health Improvement (IHI) as:

1. Improving population health2. Improving individual experience3. 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 FrameworkTriple Aim

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

Diagnostics – Endoscopic

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GP Referrals to all Nationally Reported Endoscopic Tests – April 08 to

March 2009

Emergency Inpatient Admissions

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General Medicine BGH Emergency Admissions DME Community & BGH Emergency Admissions

GP Acute Community & BGH Emergency Admissions Out of Area Emergency Admissions

Mileage

Total Emergency Admissions to General Medicine, GP Acute and DME Beds by Practice - 2008/09

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

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Outpatient Referrals

Comparison of Outpatient Referrals to the BGH and Out of Area by

Practice for 2008/9

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A B C D E F G H I J K L M N O P Q R S T U V W X Y

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