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Resource Allocation and Prioritisation Framework

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					RESOURCE ALLOCATION AND PRIORITISATION FRAMEWORK

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The proposal

This paper proposes a prioritisation tool for use over the next 12 – 24 months during which time a detailed piece of work will be undertaken by a health economist which will result in a more comprehensive prioritisation tool. It draws on examples of good practice and emerging ideas from within Tayside as well as work going on in other Health Board areas. NHS Tayside is currently making prioritisation decisions at a number of different groups and committees. The criteria being used are not consistent and there is a frustration within the service about how and why some requests for funding are being prioritised above other areas. There is still a sense that if you don‟t have a reference in the health plan then your service will not receive any additional funding. The proposal set out in this document seeks to offer a pragmatic way forward that ties funding decisions firmly to the strategic objectives of NHS Tayside. This approach will allow NHS Tayside to:     have a more structured pragmatic approach to prioritisation take time to develop a more sophisticated tool that will be owned and used by all parts of NHS Tayside. learn from the experience in other Health Boards and Health Authorities who have adopted sophisticated scoring systems. make an informed decision about whether it wants to adopt a pragmatic judgement based prioritisation system or a more sophisticated numerical system. Phases

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Phase 1 - A Resource Allocation Framework This was the subject of a paper produced by David Clark that was considered by the Health Improvement Committee on 6th February 2002. It set out the current position in respect of revenue and capital available to NHS Boards and the evolution of financial targets that accompany these resources. The paper also outlined factors affecting resource allocation and prioritisation processes within NHS Boards. The key areas are listed below: The external influences identified include:        national priorities: cancer, CHD and stroke, mental health, older people, children, health improvement targets, waiting times, delayed discharge, patient and public involvement, staff governance, workforce planning, maintaining financial balance, developing LHCCs and partnership working NHS pay bill family health service prescribing HTBS and the effect of “top slicing” and “ bottom slicing”. University Faculties of medicine nursing and dentists joint resourcing and joint management other external factors: indirect costs of increases in the price of oil, public utilities and the government decision on the level of business rates.

Internal influences include implementation of TASS, joint management of delayed discharges, and the pace of change and disinvestment Further work needs to be done in order to produce an agreed method of allocating resources. This work needs to consider the production of programme budget against national and aspirational benchmarks. This work when completed will influence the application of the prioritisation tool. Annual Revenue Resource Allocation Process The Directors of Finance have agreed the following process for annual resource allocation. The process described below should cover years 1 to 3 of the 5-year financial plan. The process for year 1 of the plan will clearly be more detailed and will be updated as more reliable information on resource availability, level of pay awards, cost pressures etc becomes available. Allocation of ringfenced funding for General Medical Services and Out of Hours Services will continue to be determined by LHCCs. Stage 1 Identify total additional funding available for the year, differentiating between general funding and nationally ringfenced development funding. 2 Add realistic cost reductions Notes Based on the SEHD‟s indicative Revenue Resource Limit and the three Directors of Finance estimate of additional funding which may be received in-year, including potential non-recurring income at both Board and Trust levels. For SEHD funding relating to national priorities e.g. cancer, delayed discharges the process should move directly to stage 10. Should be agreed on an NHS Tayside basis rather than setting unrealistic Trust targets, and if necessary, should include clinical areas where disinvestment may be appropriate. The Prioritisation Panel should agree a detailed NHS Tayside cost reduction programme, avoiding „unidentified‟ savings which create inyear financial difficulties. If possible proportionate allocation of cost reduction targets over directorates should be avoided. If this is not possible the target should be at a reasonable level, say 0.5%. Based on latest information available nationally and agreed by the three NHS Tayside Directors of Finance.

3

4 5

Deduct pay awards, inflation, NI & Superannuation uplifts and Capital Charges Indexation Deduct Prescribing uplift Deduct cost pressures

Based on previous year‟s trends but excluding new drugs, which should be prioritised within the development fund. Include only genuinely unavoidable pressures e.g. junior doctors new deal, new consultant contract, decontamination etc. Any other pressures should be treated as development proposals. Set up NHS Tayside short-term group to review and validate assumptions. Only developments already agreed and in the process of implementation should be included at this stage. Developments included in the previous year‟s financial plan but not yet implemented should be reviewed and included in the prioritisation process. 2

6

Deduct fully committed developments

Stage 7 Review planned strategic resource shifts

8

9

Any remaining balance should be used to create a development fund Apportion the development fund over strategic priorities, creating a number of development earmarks

Notes All planned resource shifts e.g. hospital to community, health to social care, acute to primary care, should be supported by robust financial plans showing where and when savings will be achieved or additional costs incurred and highlight any bridging requirement. If this figure is positive the process can move to the next stage, but if negative return to stage 2 and seek further cost reductions until a balanced position is achieved. The priority areas should be identifiable from the Local Health Plan and should include requirements for service redesign pump priming, bridging finance, waiting list initiatives, TASS implementation etc. The Prioritisation Panel should determine the level of investment in each priority area using the criteria described in section 4 of this paper. Trusts/LHCCs should not be independently planning and implementing service developments outwith this prioritisation process Or limit to developments of less than £50, 000.

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Flexibility should be maintained to move funding between budgets in a directorate or LHCC however moves in excess of £50,000 should be notified to the Chief Executive. Prioritise bids within each All bids for additional funding, including the revenue implications of development earmark capital schemes, should be prioritised within one of the development earmarks e.g. Child Health, Inequalities etc. The prioritisation should be undertaken by the strategic planning group for the particular service area. Prioritisation of nationally allocated ringfenced development funds e.g. cancer services, should be treated in a similar way to the locally determined development earmarks.

Phase 2 – A Prioritisation Tool An agreed prioritisation tool allows decision-makers to make informed choices about what are the best choices. It should give information about the level of benefit versus the cost of the project. Prioritising resources is one of the most challenging tasks for any health care system. There is already evidence from the allocation of cancer monies that a peer group of clinical staff and managers (the Tayside Cancer Network) can prioritise by considering detailed bids against clear criteria. The final list of bids were contained within the agreed financial envelope and consisted of a mixture of large and small capital and revenue bids. The challenge for NHS Tayside to is make choices between clinical specialties, care groups, acute and primary care, partnership working and cost pressures. This paper proposes a way forward. The key features of this tool are:    identification of criteria against which bids will be measured – these are derived from the strategic objectives of NHS Tayside a filtering mechanism a clear process to follow – a proforma is included in Appendix 1 3

  3

a decision making body – the Prioritisation Panel a timetable The Approach – Pragmatic v’s Scientific, Judgement v’s Scoring

Pragmatism and judgement The Tayside Cancer Network (an expert group) successfully prioritised bids for cancer services using a pragmatic and informed judgement based approach. The key features of this process were:        agreement on the successful bids was reached by discussion and negotiation at the TCN TCN agreed to make informed judgements on bids rather than score them TCN acknowledged that scoring is often subjective rather than scientific – this resulted in members being comfortable to “judge” the focus on what would give the greatest return for the funds allocated. This allowed many small bids to be funded balancing immediate problems such as waiting times against long term sustainability during the course of the meeting members of TCN prioritised the bids that they had submitted some members of TCN agreed that their own bid had a lower priority than another bids from different departments.

The key difference between this system and the current Tayside strategic level discussions both within Trust management teams and at the Tayside Clinical Board is that TCN is a group of clinical and management staff who have detailed knowledge of the area which they were being asked to make judgements about. The membership and training of the Prioritisation Panel is therefore extremely important in using this approach to making choices between clinical specialties, care groups, acute and primary care, partnership working and cost pressures. This is considered in section 5 of this paper. Comprehensive and scientific Argyll and Clyde Health Board and a number of Health Authorities in England have adopted Prioritisation Scoring Indices (PSI) which use explicit scoring and ranking methods in order to make prioritisation decisions. Health Boards across Scotland have different mechanisms for the allocation of resources and making decisions about how to spend this resource. The Argyll and Clyde PSI identifies 9 utility criteria which are weighted from a maximum score of +10 for a life saving intervention to (-5) for interventions that result in a significant risk of death. These criteria are used by a Prioritisation Panel who score the bids. This tool also considers the cost per person affected and takes the PSI score and the cost score together to give a final ranking order. The Public Health Department of NHS Tayside has just placed an advert for a health economist who will produce a detailed prioritisation framework for Tayside. It is estimated that this will take between 18 – 24 months. The new post holder will have the opportunity to review the effectiveness of the other comprehensive prioritisation processes which are currently being used. This will help NHS Tayside decided whether it is looking for a simple pragmatic system that relies overtly on judgement and negotiation or a more sophisticated numerical and scores based system. The Prioritisation Tool The proposed prioritisation tool is biased towards a pragmatic judgement based model but uses scoring to identify progress towards the criteria (i.e. the strategic objectives of NHS Tayside). The scores are not added together but when recorded on the summary sheet in Appendix 2 provide the Prioritisation Panel with a 4

helpful overview, which will inform the judgement they make. The final decision will be reached by a process of negotiation and informed judgement. The prioritsation tool will also be used to assess the impact of disinvestment proposals on the provision of services and progress towards the strategic objectives. There is a need to develop programme budgets which indicate current spend and the level of current spend in a programme area against targeted spend. This will need to be developed over the coming year. This will aid in identifying areas for disinvestment as well as shifting funds across the care pathway in line with the hierarchy of care model. 4 The Components

Dr Sheila Scott proposes the 4 main components. These are criteria, information and evidence, scoring method, and costs. Below is a slightly different approach. Agreed Criteria A B C D E F G H I J Scoring Makes significant progress towards = 3 points Make reasonable progress toward = 2 points Make some progress toward = 1 point Makes no progress toward = 0 points Information and evidence Appendix 1 is a draft proforma, which should be completed by those requesting additional funding. It includes a table to be completed by each member of the Prioritisation Panel when they consider the bid. Appendix 2 contains a summary sheet, which should be completed by each member of the Prioritisation Panel in advance of the prioritisation meeting. This paperwork will be used at all stages of the process. New developments in the field of drugs and therapeutics should have been discussed by the Area Drugs and Therapeutics Committee and their view included as part of the information in the bid. This Group will also be informed by the work of the Scottish Medicines Consortium. The Area Drug & Therapeutic Committee should also flag up pressures on other parts of the system which will result from the introduction of any new drug. Cost Each bid should give recurrent and non-recurrent costs and details of any capital required plus a provision for capital charges. A senior member of the finance staff should sign this off. The final paperwork should have the signature of the Director of Finance. This allows the Prioritisation Panel to make a subjective judgement about benefit versus cost. 5 Improving the health of population of Tayside or a target population Reducing health inequalities by addressing gaps in the provision of health services Addressing a national priority and Scottish Executive directives Improving patient/public, staff and partner involvement in planning and delivery of services Delivering effective integrated service/care in natural communities Progress towards implementing hierarchy of care model Addressing governance issues (includes clinical and non clinical governance e.g. clinical safety, sustainability, staff governance, finance) Addressing high scores from the risk management exercise (Cost pressure) If ringfenced – fit with specific criteria for ringfenced money Addresses agreed local priorities

Numerical systems are likely to more easily recognise high cost, high volume benefits and low cost medium to high benefits. It may be less sensitive, for example, the high cost of providing care for a ventilated child or a relatively low cost of providing high quality wheel chairs and seating for children with profound and complex needs. This is where a judgement-based system has advantages. Risk management NHS Tayside has recently achieved CNORIS stage 1 accreditation for its risk management process. This work must inform the prioritisation framework. The summary statement from the risk assessment should be included in the proforma along with the score. 5
Round 1 Health Plan

Process
Round 2 National Priorities & Ringfenced Finance and Resources Committee notify the level and conditions relating to the development fund notify the level and conditions relating to the development

tf
Oct Local Area Health Plans

nd
Community Plans Clinical Services Strategy Health Plan

Bids signed off by Director of Finance

PAF

1st Dec

1st June SMG - TUH

Filtering Group

SMT - Board

SMG - TPC

Area Clinical Forum

Governance Health Improvement Committee Clinical Governance Committee Bids signed by Chief Executive Priority bids forwarded to Project Leader Change Management Prioritisation Panel

3rd Jan

1st Aug

1st week Feb

End Sept

Project Leader Change Management to inform bidders of decision

Tayside Clinical Board

May

Oct Finance and Resources Committee

April

Nov

6
May Dec

NHS Tayside Board

A full list of the bids submitted will be included in the Board paper containing the final recommendations of the Prioritisation Panel. The Tayside Clinical Board will comment on the final recommendations of the Prioritisation Panel before they go to the Board. The Health Improvement Committee and the Clinical Governance Committee will act in a governance capacity rather than as a filter group. They will draw to the attention of the Prioritisation Panel areas of priority from both an inequalities and governance perspective. Identification of priority area for funding Bids for additional funding will be considered providing they can be linked to priority areas or gaps identified in agreed strategies, the Local Health Plan or as part of the Performance Assessment process. A list of these areas will be produced by the Prioritsation Panel and agreed by the Tayside Clinical Board and will be issued along with the proforma for bids. This list will be reviewed every 6 months. The Finance and Resources Committee will also be asked to indicate the level of funding available in each year. Discussion at the Change Management Group on 14th August 2002 identified the following areas that have already been identified as priorities. A fuller list is included in Appendix 3.


PAF All the areas identified as part of the PAF annual review where NHS Tayside needs to improve performance


National Priorities and Inequalities Older people, mental health, CHD and stroke, child health and inequalities


         

Service Pressures local priorities within the local planning areas items within local health improvement programmes which health requires to action action related to implementation of the primary care strategy care and treatment issues for TPCT and primary care care and treatment issues identifies as part of the Clinical Services Strategy (TUH) priorities supported by the Tayside Clinical Board in principle at previous meetings infrastructure capital service redesign/bridging savings

A filtering mechanism - channels through which requests for funding or proposals for change should come The channels or filters for bids to be submitted to the Prioritisation Panel must be through one of the groups below:      Senior management team of Tayside NHS Board Senior Management Group of Tayside University Hospitals Senior Management Group of Tayside Primary Care and the three LHCCs Area Clinical Forum the Prioritisation Panel may also designate specific groups such as a clinical network or Tayside wide strategy group where appropriate e.g. TCN for cancer money. A list of these groups will be developed and agreed by the Prioritisation Panel. 7

The groups above should prioritise bids using the prioritisation set out in this paper and agree which bids should be forwarded to the Prioritisation Panel for consideration. It is the responsibility of the chair of the filter groups in Tayside University Hospitals, Tayside Primary Care and Tayside NHS Board to ensure that bids are both efficacious and efficient. Membership of the Prioritisation Panel A Prioritisation Panel is set up and meets twice a year with the following membership: Chief Executive, NHS Tayside (Chair) Chief Executive, Tayside University Hospitals Head of Service, Tayside Primary Care Medical Director* Director of Nursing* Director of Public Health, Tayside NHS Board Chair of the Area Clinical Forum  The Medical Director will come from one Trust and the Nursing Director from the other Trust.

In attendance:  Director of Finance, NHS Tayside Board Attendance is to make sure that the financial implications of each bid is considered and to provide technical advice. All bids must be signed off by the relevant Director of Finance and by the Chief Executive prior to being considered. Project Leader Change Management, NHS Tayside The Project Leader Change Management is responsible for managing the process prior to and following the meeting of the panel.



Delegation of responsibility by the Prioritisation Panel Where funding is ringfenced, the Prioritisation Panel can delegate the process of prioritisation within an allocated budget to a managed clinical network e.g. the TCN, Child Health Strategy Group, Primary Care Strategy Group. The network would be required to make recommendations to the Prioritisation Panel. The Prioritisation Panel can then decide to accept or reject. The budget The Prioritisation Panel will receive a clear statement from the Finance and Resources Committee about the level of funding available for allocation as part of the prioritisation process plus any restrictions or conditions for its allocation. (See annual revenue allocation process in section 2 of this paper). The Finance and Resources Committee will agree this before bids are requested for funding. The development fund will be divided into the following headings     priority development earmarks bridging finance for achieving strategic change service redesign pump priming funding ringfenced funding

The NHS Tayside allocation will be agreed within a paper presented by the Directors of Finance to the Finance and Resources Committee in August each year which sets out funding allocation expected from the 8

Scottish Executive. The Finance and Resources Committee will take into account unavoidable cost pressures such as the cost of junior doctors‟ hours, new consultant contract and commitments already made by NHS Tayside prior to notifying the development allocation. There will be close scrutiny of all such cost pressures by a short life NHS Tayside cost pressures group who will review and validate cost pressures and to make sure that developments are not included. All developments including new drugs and expansion of services will be considered as part of the prioritisation process. The Finance and Resources Committee will also indicate the level of capital funding available for consideration as part of the prioritisation process. The final details of the capital process are to be finalised. Savings targets will be set as part of the financial allocation paper presented to the Finance and Resources Committee. The prioritisation process will be used to access the impact of savings proposal on the strategic objective of NHS Tayside. The Prioritisation Panel should make their recommendations in the following categories.       Fund within the allocation from the F&R Fund should additional resources become available Fund from ringfenced allocation for this care group Fund from ringfenced allocation for this care group should additional resources become available Recommend funding within existing budget – i.e. redesign within department or Trust existing budget Reject

A Timetable - How often should we prioritise The Prioritisation Panel would meet twice a year.   The main prioritisation should take place once a year in January. This will allow the Health Plan and the financial plan to be consistent. In September, networks should present their priorities for large traunches of expected ringfenced monies e.g. child health, older people, mental health, cancer, development of primary care, development of secondary service, NOF.

This should reduce the need for consideration of one off bids and allow the Chief Executive of NHS Tayside to sign off bids with minor alterations to reflect the specific criteria issued from the Funder. The Prioritisation Panel would only meet as the Prioritisation Panel in year if the final submission was significantly different from that discussed in either September or February.

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Proposed Timetable Date 3rd October 2002 3rd 10th Round 1 Finance and Resources Committee set the level and conditions for the development fund – This will include ringfenced monies and so inform round 2 of this process. of Prioritsation Panel produce broad apportionment to development fund and make recommendations on priority areas for bids. Tayside Clinical Board agree broad apportionment of funds and made recommendations on priority areas for bids. Bids submitted to Filter Groups i.e. SMT, SMG, LHCC SMT, etc for consideration.

Between October

and

17th October 2002 1st December 2002

This will fit in with the timescale for the Health Plan. Prioritised bids submitted to Project Leader Change Management. 10th January 2003 Bids sent to Prioritisation Panel for consideration. End January 2003 Prioritisation Panel meets and considered bids. 1st week in February 2003 Project Leader Change Management informs bidders of outcome. 20th Feb 2003 Recommendations of Prioritisation Panel to TCB. th 6 March 2003 Recommendations of Prioritisation Panel to F&R. 13th March 2003 Recommendation of Prioritisation Panel to NHS Tayside Board. Date Round 2 st 1 June 2003 (this is to allow Bids submitted to Filter Groups i.e. SMT, SMG, LHCC SMT, flexibility over holiday period) etc for consideration. 3rd January 2002 1st August 2003 Mid August 2003 Beginning September 2003 End September 2003 October 2003 November 2003 December 2003 This will fit in with the timescale for the Health Plan. Prioritised bids submitted to Project Leader Change Management. Bids sent to Prioritisation Panel for consideration. Prioritisation Panel meets and considered bids. Project Leader Change Management informs bidders of outcome. Recommendations of Prioritisation Panel to TCB . Recommendations of Prioritisation Panel to F&R. Recommendation of Prioritisation Panel to NHS Tayside Board.

There may be variations in the timetable related to the notification of the annual Resource Allocation from the Scottish Executive Health Department and specific dates will vary from year to year. 6 Other Considerations

Getting ownership It is vital to the success of any prioritisation framework that it is considered fair and acceptable to the stakeholders in the system. In particular it must be valued by clinical staff that may see their bids being prioritised below the fundable projects line. 10

The first draft of this paper was considered by the Senior Management Team in July 2002 and the Change Management Group and the Directors of Finance in mid August 2002. The updated draft was circulated to the Chief Executives of Tayside NHS Board and Tayside University Hospitals and the Head of Service for Primary Care, the Chairs of the Finance and Resources Committee, The Health Improvement Committee, The Clinical Governance Committee, The Area Clinical Board and The Partnership Forum. It was also circulate to all members of the Change Management Group, which includes representatives from all parts of NHS Tayside including the three LHCCs. A senior manager from each of the three local authorities also receives a copy of all the papers from the Change Management Group. It has also been discussed at the three LHCCs joint meeting, the Executive Team and Tayside Clinical Board of Tayside Primary Care, The Executive Team and Senior Management Group of Tayside University Hospital. The Tayside Clinical Board supported the Resource Allocation and Prioritisation Framework at their meeting held on 19th September 2002. Joint working with our partners Bidders will, where appropriate, work jointly with local authority partners and voluntary agencies at the bid development stage. Working with citizens, patients and staff Bidders will, where appropriate, work jointly with citizens, patients and staff representatives at the bid development stage. Prioritisation Panel training Each member of the Prioritisation Panel will need to consider all the bids in terms their ability to deliver the proposed outcomes and their impact on improving the health of the population of Tayside. Members of the Prioritisation Panel must therefore be involved in agreeing the process and of putting on an NHS Tayside hat for the purposes of this exercise. Training will consider the use of the criteria and the approach to using a judgement based system. It should draw attention to how personal beliefs and experience influence responses to proposals and explore ways of maintaining as objective an approach as possible. Caroline Selkirk Project Leader Change Management 20th September 2002

Appendix 1

Proforma to be completed by those who wish to bid for additional funding. This includes the scoring table against the criteria to be completed by each member of the Prioritisation Panel Summary of the information that each member of the Prioritisation Panel must fill in prior to the prioritisation meeting. This will be the paperwork used at the meeting. Draft list of priority areas as discussed by the Change Management Group on 24th August. This will be developed as the relevant information is signed off and will be formally considered by the Tayside Clinical Board every 6 months. 11

Appendix 2

Appendix 3

Bibliography 1 2 3 4 5 Prioritisation in Grampian – A Discussion Paper (Draft). G Smith, Grampian Hospitals Trust July 2002. Dr Sheila Scott and Dr A Lees Developing a Prioritisation Framework, Blackwell Science LTD 2000 Health Expectations 3 Draft paper on prioritisation in Scotland Dr Sheila Scott and Dr Peter Williamson Wendy Peacock Prioritisation Framework for HIV Wendy Peacock Prioritisation Framework for Inequalities (currently in draft)

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Appendix 1 Prioritisation Panel Paperwork This is based on the Cancer in Scotland: Action for Change Investment & Implementation Planning Proforma 1 Area/service for investment

2

Proposer details Name of project lead: Job title: Address: Email: Fax: Phone: Names / job titles of other members of the service/ Network team: Abstract     

Name of budget holder: Job title: Address: Email: Fax: Phone:

3

Summary of actions and outcomes and fit with criteria

4

Area covered Geographical area: Anticipated catchment population: Anticipated number of patients who will benefit:

5

Strategic fit Briefly describe links to relevant strategies, CSBS, NHS Tayside strategic objectives and national and local priorities

13

6

Background Context to proposal:

Key drivers for change:  Critical issues:

7

Objectives Objectives (up to 5 SMART objectives):   

8

SA

Fit with criteria State how your project will deliver on the criteria and fill in the self assessment against the criteria using the scoring method below: Makes significant progress towards = 3 points Make reasonable progress towards = 2 points Make some progress toward = 1 point Makes no progress toward = 0 points Criteria How will your project deliver on these and outcome measures?  Improving the  health of population of Tayside or a target population  Reducing health  inequalities by addressing gaps in the provision of health services  Addressing a  national priority or Scottish Executive directive  Improving  patient/public, staff and partner involvement in planning and deliver of services

14

SA

Criteria  Delivering effective integrated service/care in natural communities  Progress towards implementing hierarchy of care model  Addressing a governance issue (clinical and non clinical)  risk management assessment

How will your project deliver on these and outcome measures? 





likelihood

consequence

actual control level

Risk exposure rate



9

If ringfenced – fit with specific criteria for ringfenced £  Addresses agreed local Priorities Implementation Key milestones/targets:

 

Timescales:

How proposal will be monitored/evaluated:

10

11

Financial information Total capital: Total non-recurring revenue: Total recurring revenue: Please remember to include IT & S, HR, OD plus Training and Development costs and Administration/Secretarial costs This section should also include information about proposed resource shifts between budgets Other supporting information

15

12

Declaration of support Signature Project lead: Director of Finance (TPC/Tayside University Hospitals Board) – circle as appropriate Supported by SMT, LHCC,SMG (circle as appropriate) Chief Executive of Trust who will hold budget): Health Board Chief Executive: Date

Please return completed forms to: Project Leader Change Management, Kings Cross Hospital, Clepington Road, Dundee To be filled in by Prioritisation Panel member Name of project: Scoring Makes significant progress towards = 3 points Makes reasonable progress toward = 2 points Makes some progress toward = 1 points Makes no progress toward = 0 points Recurrent Cost Non Recurrent Capital Capital costs

Likelihood RMS

Consequence

Risk exposure rate

Total (out of 250) Colour Red, Amber or Green

A B C D

E F G H I J

Criteria Improving the health of population of Tayside or a target population Reducing health inequalities by addressing gaps in the provision of health services Addressing a national priority or Scottish Executive directive Improving patient/public, staff and partner involvement in planning and deliver of services Delivering effective integrated service/care in natural communities Progress towards implementing hierarchy of care model Addressing a governance issue (clinical and non clinical) Addressing high scores from the risk management exercise (Cost pressure) If ringfenced – fit with specific criteria for ringfenced money Addresses agreed local priorities

Score

Comments

16

Appendix 2 SUMMARY SHEET TO BE FILLED IN BY MEMBERS OF PRIORITISATION PANEL PRIOR TO MEETING OF THE PANEL
A B C D E F G H I J Criteria Improving the health of population of Tayside or a target population Reducing health inequalities by addressing gaps in the provision of health services Addressing a national priority and Scottish Executive directives Improving patient/public, staff and partner involvement in planning and deliver of services Delivering effective integrated service/care in natural communities Progress towards implementing hierarchy of care model Addressing governance issues (includes clinical safety and sustainability) Addressing high scores from the risk management exercise (cost pressure) If ringfenced – fit with specific criteria for ringfenced money Addresses local priorities nequalities Health Inequalities Reducing Priority National Improvement Scoring Makes significant progress towards = 3 points Make reasonable progress towards = 2 points Make some progress toward = 1 points Makes no progress toward = 0 points RMS = Risk Management Score L =Likelihood C = consequence RER = Risk Exposure Rate control Col = Colour - red, amber or green

Cost
R = Recurrent NR = Non Recurrent C= Capital CC= Capital Charges Involvement Public Services Integrated Care Hierarchy Governance Management Risk Ringfenced Local Priority

Project

Cost

Risk Management

of

R

NR

C

CC

L

C

R E R

Col

A

B

C

D

E

F

G

H

I

J

1 2 3 4 5 6 7 8 9 10

17

Appendix 3 PRIORITY FOR INVESTMENT List of priority areas already identified This Appendix will need to be completed in more detail before it is considered by the Prioritisation Panel

1

PAF (NHS Tayside Review July 2002 - Areas of Concern)         Breastfeeding Sexual health Smoking Acute elective discharges Prescribing Mean wait for admission (and outpatients*) Conception Rates (13-15 years) Survival after Admission for AMI

* The Change Management Group suggested that outpatients should be added to the mean admissions area even though this was not specifically identified as part of PAF. * Priority areas will also be identified from the other PAF submissions. 2 2.1 National Priorities and Inequalities Child Health Strategy (agreed NHS Tayside Board 4th July 2002): The Child Health Strategy includes a range of key priorities plus an indication of areas for priority funding. Funding priorities:  Peer Led Listening Project  LHCC Local Plan for Children (for areas identified in strategy for LHCC action)  Community Nursing Teams  Further development of Breast Feeding Coordinator and accreditation  Dental Strategy (options 1 and 2 option 3)  Joint Health and LA protocol on provision of communication aids  Wheelchairs & Seating  Child Protection Training Coordinator Joint Health and Local Authority priorities  CAMHs  Sexual health  Substance misuse  Children with complex needs  Child protection  Looked after children   Other Public involvement Workforce planning           Health Priorities Windyridge reprovision Armitstead Phase 2 TICH Professions Allied to Medicine Child and young people friendly environment Screening Parent held child health records Vulnerable groups Strategy and leadership in child health Promoting the health of children and their families

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2.2 2.3

Older People To be provided by the Older People‟s Strategy Group Mental Health To be provided by the Mental Health Accountability Steering Group Cancer To be provided by the Tayside Cancer Network and the Tayside Palliative Care Network CHD and Stroke To be provided by 3 clinical networks for CHD, Stroke and Diabetes Inequalities: Two years ago the NHS Tayside and Local Authorities agreed the following four areas for priority investment:  Social Inclusion  Young People  Older People  Nutrition The Health Improvement Committee will be considering its priorities at a future meeting and will provide an updated list.

2.4

2.5

2.6

2.7 3

Other ringfenced funding pharmacy to be provided by the Tayside Pharmacy Steering Group. Service Priorities including capital projects, service redesign/bridging, savings and infrastructure those identified as part of risk management exercise Local priorities within the local planning areas Angus Dundee Perth and Kinross Items within Local Health Improvement Programmes which health requires to action Angus Dundee Perth and Kinross Action related to implementation of the Primary Care Strategy, Angus Dundee Perth and Kinross Care and treatment issues for TPCT and primary cares Care and treatment issues identifies as part of the Clinical Services Strategy (TUH) Priorities supported by the Tayside Clinical Board in principle at previous meetings The following have been identified through a review of the minutes of the Tayside Clinical Board  Retinopathy screening  Sleep apnoea service  Review of Family Planning  Hospital acquired infection and education of staff 19

3.1

3.2

3.3

3.4 3.5 3.6

    3.7 3.8 3.9 3.10

Anticoagulant therapy Beta interferon Managed Clinical Networks for CHD and Stroke (linked with diabetes network) PAF

Infrastructure Capital Service redesign/bridging Savings

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