NRACAnalyticalPlan所分析的计划.doc

NRAC (2005) 59 1 NHSSCOTLAND RESOURCE ALLOCATION COMMITTEE ANALYTICAL FRAMEWORK INTRODUCTION This document sets out the framework for the analytical work to be carried out on behalf of the NHSScotland Resource Allocation Committee (NRAC). The purpose of this document is to set out the strategy, principles and processes for completing any analytical work. Analytical work in this context is defined as analysing data, preparing reports/papers, commissioning research, reviewing reports/papers, putting proposals to consultation and, ultimately, drawing up recommendations for an improved formula. The Aim is to keep this document concise while acting as a useful reference point when issues arise. This document should be viewed as a working document that will be refined an updated as the Committee progresses. OBJECTIVES NRAC was established in February 2005 with a remit to: 1. improve and refine the Arbuthnott Formula for resource allocation for NHSScotland; 2. advise on possible formulaic approaches to the parts of health expenditure not currently covered by the Formula (e.g. primary care dental, pharmaceutical and ophthalmic services); 3. keep under review the information available to support existing elements of the Formula and consider the inclusion of new data (e.g. ethnicity); 4. consider in the light of the pilot exercises adjustments to the Formula for unmet need; and 5. consider any relevant issues which are referred to it. The Committee is due to complete its work by March 2007 with a view to any changes to the formula being implemented in time for the financial year 2008-9. NRAC PRINCIPLES NRAC works to the following principles: Each member upholds the values of NHSScotland; -health care provided free at the point of need -equal opportunity of access to appropriate health care throughout Scotland 2 -providing a service in partnership that is patient focussed -promoting health improvement -undertaking effective public involvement. The Committee has collective responsibility and each member undertakes their role with honesty, integrity and political impartiality. Each Member is expected to consider complex issues and critically evaluate all evidence (including opinion) without prejudice to origin. Members contribute to the Committee as individuals using their skills and experience, their role is not to represent the views of their NHS Board. The Committee will seek to ensure openness and transparency in all its work: presenting the work we plan to do and consulting on elements along the way, explaining the rationale for our recommendations, communicating in language and formats that are easily accessible. PRINCIPLES OF ANALYSIS The starting point for this review will be the current Arbuthnott Formula as it is currently implemented and NRAC will seek to add to, subtract from, or modify elements of the formula if these changes can be shown to improve the performance of the formula while remaining true to the core criteria (see annex). Specifically: The economic basis of the formula, as it will be implemented, will remain the same, i.e. based on weighted capitation. However this does not preclude NRAC investigating alternative approaches to resource allocation with a view to making recommendations on their appropriateness and application in a Scottish context. Build on the evidence base and analytical work carried out under the auspices of NRRA and SCRA by looking for new or updated evidence (e.g. literature, research) and data sources that have emerged since the original formula was developed, or by carrying out new and innovative analyses. will also take account of changes to the management, structure and operation of the NHS that have occurred since the original formula was developed, and by assessing policy direction, and attempt to ensure that the formula remains future-proof for as long as possible. Ensure the formula remains a needs-based formula designed to ensure equity of access to NHS services to all residents of Scotland. WORK PLAN A project plan has been produced to ensure that the work of the committee meets the final deadline date of end of March 2007. 3 An analytical plan will be embedded within the wider project plan. This will plan the analytical work up to the public consultation and be updated after consultation with any subsequent analyses prior to preparing the final report. The analytical plan will be based on a breakdown of the key components of the current formula which require review plus any substantive issues raised by NRAC that require analytical work. Potential issues relating to resource allocation can be raised to NRAC from a number of sources, e.g. by NRAC members, SEHD, NHS Boards, professional groups and members of the public. However it is for NRAC to decide which of these issues should be addressed and how. The analytical plan will be structured as follows: Current Formula HistoryWill form part of the initial chapter of the consultation report. Review of the trends outputs of the formula over the past 5 years with some limited assessment on how well arbuthnott formula has achieved objectives Review of Population basesReview of the source of data for the population component of the formula. Age/sex weightsReview of methodology and data sources for the age- sex cost weight component of the formula Morbidity and Life CircumstancesReview of MLC adjustment, including additional needs. Commissioned research Excess costs of supplyReview of excess costs of supply including factors other than remoteness, e.g. market forces. Commissioned research Family Health ServicesReview and further work on the FHS reports completed by Deloitte in August 2005 Other ImpactsOther issues relevant to the formula requiring papers to be written, e.g. private sector, cross-boundary tariffs. Implementation IssuesPractical issues around how the formula, once derived, will be implemented. Consultation DocumentPulling together the various research strands, preparing and agreeing recommendations and preparing the consultation document. The Analytical Plan will be overseen by an Analytical Support Team (AST) composed of members of SEHD:ASD and ISD with input from others, for example those involved in the previous review, as necessary. A sub-group of AST will act as a steering group to liaise with the research contractors on a regular basis ensuring a two-way flow of information between NRAC and the research teams. Two sub-groups of NRAC will be formed to act as principal contacts for the steering group in relation to issues raised by the commissioned research 4 PROJECT STAGES AND TIMESCALES The work of the committee falls into three basic stages: pre-consultation, formal consultation and post consultation and these are addressed separately below. Greater detail of the work involved in each stage is included in the project plan. Pre-consultation Prior to consultation the analytical work of the committee will proceed with two streams running in parallel: a) commissioned research and b) in-house analytical work. The bulk of the analytical work will be carried out by research contractors. All analytical work that is to be fed into the consultation document will be completed by the end of May 2006. Research specifications will be prepared inviting bids for work on the MLC and remoteness elements of the current formula. The successful bidder will be required to give a detailed outline of the timescale for the project, agree milestones (linked to payments) and provide regular written and verbal updates on progress for the duration of the project. Final reports, outlining recommendations for changes to the elements of the formula, will be prepared by the contractors for NRAC. The results of the commissioned research together with the in-house analysis will be discussed by NRAC and the results brought together by SEHD to produce a single set of proposals for consultation. Consultation NRAC is planning to go to formal consultation in late summer of 2006 with proposed changes to the allocation formula. Good practice guidelines for SE consultations suggest that at least 3 months should be allowed for consultation responses. Given that the Minister is likely to want to consult on the final recommendations he receives from NRAC, consideration needs to be given to the timescale, effort and degree of ministerial involvement that is put into any consultation that NRAC wants to carry out. SEHD have a contract with Astron publishing to deal with all aspects of getting documents published. The length of this process depends on the format and scale of the publication but time can be reduced if, for example, publication is web-only and or paper formats are text- only and non-glossy. For consultation there will be a web-only consultation document, via the NRAC website, as a more cost-effective method and to reduce the time required for the publication phase. The document will not be in a formal publication format so as not to give the impression that the committee has reached firm conclusions in any way. A list of consultees will be drawn up in advance, including those who have expressed an interest in being consulted via the NRAC website. Post consultation DN: this section will be expanded at a later date 5 After consultation consideration needs to be given to: Analysis of consultation responses Reporting of consultation responses (e.g. how will consultations responses be formally acknowledged and answered) Analytical work on issues raised Update of formulae with more recent data where necessary Preparation of final report REPORTING NRAC will be preparing reports for the public domain at two stages during its lifetime: prior to consultation with proposals for changes, and post-consultation with final recommendations. NRAC needs to consider the best method and format for publishing its proposals and recommendations. Prior to consultation NRRA published a series of three glossy reports: a main report (Fair Shares for All), a short guide and a technical report. After consultation, the final report was published only on the web along with a short report. These reports described the results of consultation and the final recommendations. Criticisms of the NRRA reports are that the only glossy, hard copy reports in circulation do not describe the formula as it was finally implemented and there is no technical report to describe the additional work that was carried out after consultation (and there were some significant changes to proposals). On the positive side the short guides appear to useful to the general public and to those not wishing to trawl through the main report to understand the key issues in what is a technical area. NRAC may wish to consider to relative effort and resources that are allocated to