An introduction to the NRAC formula and the work of TAGRA

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

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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

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& A

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(£)

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

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Arr

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Bor

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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

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ire &

Arr

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Bor

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Fife

Gre

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Gla

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Ork

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Loth

ian

Tay

side

For

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Wes

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s

Dum

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Sp

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(£)

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

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ire &

Arr

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Bor

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Fife

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For

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(£)

NRAC

Difference between recommended NRAC spend per head and an equal share (2011/12) - Overall and HCHS

-£200

-£150

-£100

-£50

£0

£50

£100

£150

£200

£250

£300

£350

£400A

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£)

OverallNRAC

HCHSNRAC

Data sources

• Does not use SIMD

• Does not use data zones

• Requires national data

• Requires small area data

Data sources

Relative need due to age and sex

profile

Relative need due to morbidity

and life circumstances

Relative costs of providing services to

different geographical

areas

NRACWeighted

Target Share

%

Unavoidable Excess Costs of

Supply

Population Additional Needs

× × × ═

Age-Sex Cost Weights

Board population

share%

• GROS data

• GP list data

• Differs by specialty – SFR 5s

• Up to 20 different age bands

Data sources

Relative need due to age and sex

profile

Relative need due to morbidity

and life circumstances

Relative costs of providing services to

different geographical

areas

NRACWeighted

Target Share

%

Unavoidable Excess Costs of

Supply

Population Additional Needs

× × × ═

Age-Sex Cost Weights

Board population

share%

Acute and Care of the Elderly

• Standardized mortality rates

• Long term limiting illness rate

Maternity

• Mean house price

• Birth rate

Data sources

Relative need due to age and sex

profile

Relative need due to morbidity

and life circumstances

Relative costs of providing services to

different geographical

areas

NRACWeighted

Target Share

%

Unavoidable Excess Costs of

Supply

Population Additional Needs

× × × ═

Age-Sex Cost Weights

Board population

share%

Mental health and learning difficulties

• Severe disablement allowance

• % living in one person households

• % living in socially rented housing

Data sources

Relative need due to age and sex

profile

Relative need due to morbidity

and life circumstances

Relative costs of providing services to

different geographical

areas

NRACWeighted

Target Share

%

Unavoidable Excess Costs of

Supply

Population Additional Needs

× × × ═

Age-Sex Cost Weights

Board population

share%

• Urban rural classification

• Community travel survey

• SAF remoteness adjustment

Data sources

Relative need due to age and sex

profile

Relative need due to morbidity

and life circumstances

Relative costs of providing services to

different geographical

areas

NRACWeighted

Target Share

%

Unavoidable Excess Costs of

Supply

Population Additional Needs

× × × ═

Age-Sex Cost Weights

Board population

share%

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

Recent work

• The impact of the NRAC formula on remote and rural areas of Scotland

• Overall, treatment appropriate

• Areas for further work

2011/12 work plan

• Further work on remote and rural issues

• Review of MLC adjustment

Questions?