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Resource Allocation and Targeting Social Need in Northern Ireland's Health and Personal Social Services

This document explores the principles and practices of resource allocation in Northern Ireland's Health and Personal Social Services (HPSS). It discusses the weighted capitation methodology, which considers demographic factors, additional needs, and rural costs while addressing the measurement of social need and evaluating historical expenditure trends. The report emphasizes the importance of meeting diverse client needs through tailored allocation formulas for different care programs. It also highlights current research and the significance of addressing inequalities in service provision.

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Resource Allocation and Targeting Social Need in Northern Ireland's Health and Personal Social Services

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  1. RESOURCE ALLOCATION AND TARGETING SOCIAL NEED NORTHERN IRELAND HEALTH AND PERSONAL SOCIAL SERVICES (HPSS) MARTIN MAYOCK INFORMATION & ANALYSIS UNIT DHSSPS

  2. INTRODUCTION • RESOURCE ALLOCATION IN NI HPSS – STRUCTURE AND BACKGROUND • WEIGHTED CAPITATION PRINCIPLES • MEASUREMENT OF SOCIAL NEED • NEEDS SENSITIVITY ANALYSIS • SUB-BOARD APPLICATION OF FORMULA • CURRENT RESEARCH

  3. NI HPSS – STRUCTURE AND FUNDING FLOWS THE DEPARTMENT 4 HEALTH AND SOCIAL SERVICES BOARDS 11 TRUST LOCALITY AREAS

  4. RESOURCE ALLOCATION IN NI HPSS - BACKGROUND • HISTORICAL EXPENDITURE • PERPETUATES EXISTING INEQUALITIES • POPULATION BASED METHODS • USED IN N. IRELAND SINCE 1978 • CAPITATION FORMULA REVIEW GROUP • ESTABLISHED 1994 • IMPROVE ON EXISTING FORMULA • FOURTH REPORT DUE MAY 2004

  5. STRUCTURE OF FORMULA • SEPARATE FORMULA FOR EACH OF NINE PROGRAMMES OF CARE (PoCs) EXAMPLES • ACUTE HOSPITAL SERVICES • ELDERLY CARE • MENTAL HEALTH • FORMULAE ARE SENSITIVE TO THE NEEDS OF EACH CLIENT GROUP

  6. WEIGHTED CAPITATION - PRINCIPLES • POPULATION SIZE • AGE/GENDER ADJUSTMENT • ADDITIONAL NEEDS ADJUSTMENT • OTHER ADJUSTMENTS • RURAL COSTS • INCOME ADJUSTMENT

  7. WEIGHTED CAPITATION- POPULATION • POPULATION SIZE IS MOST IMPORTANT ELEMENT CRUDE POPULATION PERCENTAGES (2002) • EHSSB 39% • NHSSB 25% • SHSSB 19% • WHSSB 17% • POPULATION SOURCE • MID-YEAR ESTIMATES (NISRA)

  8. WEIGHTED CAPITATION- AGE/GENDER • VERY YOUNG AND THE ELDERLY HAVE MOST NEED FOR SERVICES • MALES AND FEMALES ALSO HAVE DIFFERENT SERVICE NEEDS • THIS NEED WILL DIFFER DEPENDING ON SERVICE TYPE • MAJOR COSTING EXERCISE CARRIED OUT BY BOARDS • RESULTS USED TO INCREASE/DECREASE CRUDE POPULATIONS IN EACH PROGRAMME

  9. AGE/GENDER COSTS – ALL POCS

  10. WEIGHTED CAPITATION- ADDITIONAL NEEDS • IMPORTANT TO TAKE DIFFERENT ILLNESS LEVELS INTO ACCOUNT • FACTORS ASSOCIATED WITH INCREASED ILLNESS • DEPRIVATION RELATED • LIVING CIRCUMSTANCES • HEALTH STATUS • RURAL/URBAN LIVING • SERVICE USE AS A PROXY FOR NEED

  11. MEASUREMENT OF NEED - SMALL AREA ANALYSIS • DATA REQUIREMENTS • MEASURES OF UTILISATION/ACTIVITY • COST DATA • SOCIO-ECONOMIC DATA • HEALTH STATUS DATA • RURALITY DATA • ALL DATA REQUIRE A GEOGRAPHIC IDENTIFIER

  12. SMALL AREA ANALYSIS-SIMPLIFIED MODEL DEPRIVATION FACTORS NEED HEALTH STATUS FACTORS RURAL NEEDS FACTORS

  13. ADDITIONAL NEEDS FORMULAE - EXAMPLES • ACUTE SERVICES • SMR (ALL AGES) • ELDERLY LIVING ALONE • INCOME SUPPORT • FAMILY CREDIT • LOW BIRTHWEIGHT • FAMILY AND CHILD CARE • LONE PARENTS ON INCOME SUPPORT • CHILDREN WITH A LONG-TERM ILLNESS • CHILDREN IN SOCIAL RENTED HOUSING

  14. IMPACT OF NEEDS AT WARD LEVEL- TOP 5 DEPRIVED WARDS

  15. UNMET NEED • FORMULA ASSUMES UTILISATION IS AN ADEQUATE PROXY FOR NEED • UNDER UTILISATION AND HENCE UNMET NEEDS • DEPRIVED VERSUS AFFLUENT COMMUNITIES • RURAL VERSUS URBAN POPULATIONS • TEST DEVELOPED TO DETECT UNMET NEED AND CORRECT (STATISTICALLY) IF REQUIRED

  16. SUB-BOARD FORMULA USE • GUIDELINES PRODUCED AS PART OF CFRG REVIEW • DECREASED ACCUARACY WHEN APPLYING FORMULA TO SMALL POPULATION UNITS • CONSIDERATION SHOULD BE GIVEN TO LOCAL FACTORS • ETHNIC GROUPS/TRAVELLERS • LONG-TERM INSTITUTIONAL CARE • DRUG MISUSE • FORMULA SHOULD INFORM ALLOCATIONS NOT RIGIDLY SET THEM

  17. CURRENT CFRG RESEARCH • LEARNING DISABILITY ADMINISTRATIVE PREVALENCE STUDY • PHYSICAL AND SENSORY DISABILITY NEEDS STUDY • REFINED MENTAL HEALTH NEEDS INDEX • UPDATED FAMILY AND CHILD CARE NEEDS STUDY • UNMET NEED • COSTS ARISING FROM ECONOMIES/DISECONOMIES OF SCALE

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