Morbidity and life circumstances

Subgroups – Morbidity and life circumstances

The NRAC Committee made recommendations for the on-going maintenance and development of the formula (see NRAC report, Annex 10 ).  They recommended that the Morbidity and Life Circumstances (MLC) element of the formula should be updated at least every 3 years – the updating to include the variables making up the needs indices and the coefficients measuring the relationship between indices and costs. The programme of updating the MLC is being taken forward by TAGRA on a rolling basis through the work of the MLC subgroup.

TAGRA agreed that the detailed analysis to review the MLC adjustment, undertaken by the technical subgroup, should begin by examining the Mental Health and Learning Difficulties care programme and then continue with the other care program­mes.  The morbidity and life circumstances subgroup examining the  Mental Health and Learning Difficulties care programme was established in April 2011; the subgroup completed their final report in December 2012 which included recommendations to TAGRA on potential changes to the formula.

Further information on the work of this subgroup is available below.

Acute care programme

• At the April 2013 meeting TAGRA agreed that the next care programme to be reviewed would be the acute care programme. The subgroup held its first meeting in February 2014.

Remit

Having regard to TAGRA’s core criteria; to recommend to TAGRA changes to the Acute MLC indices, which will improve the ability of the formula to allocate funds between the territorial NHS Boards on a fair and equitable basis.

In particular, the group is asked to consider:

• Granularity  – the appropriate level at which to specify any adjustment factors;
• Time – the degree to which observations should be aggregated over time, in order to provide stable adjustment factors;
• Structure – the form, the age grouping and  the clinical and service scope, specified for the adjustment factors;
• Indicators – the most appropriate indicators to use within any adjustment, including but not limited to indicators of need and indicators of supply, rurality, and urbanity; and,
• Costing method – to assess the effects of a change in costing method (should that be agreed by TAGRA) on the adjustment factors;
• Unmet need investigating whether resource utilisation is a good proxy for need and indicating a formulaic solution if any shortfall is found.

The group is also asked to undertake a Health Inequalities Impact Assessment with support from NHS Health Scotland.

Membership

The subgroup is designed to have a wide membership to reflect the diversity of stakeholder interests in the Acute Morbidity and Life Circumstances (MLC) adjustment. Membership of the subgroup is made up of a mixture of NHS board members, academics/experts in the area, representatives from ISD (Information Services Division of NHS National Services Scotland) and analysts from the Scottish Government.

• Sarah Barry (University of Glasgow)
• Roger Black (National Services Scotland)
• Angela Campbell (Scottish Government)
• Pauline Craig (NHS Health Scotland)
• Andrew Daly (NHS Greater Glasgow &Clyde)
• Frances Elliot (Scottish Government)
• Karen Facey (Chair)
• David Garden (NHS Highland)
• Lynne Jarvis (National Services Scotland)
• Peter Martin (National Services Scotland)
• Alisdair McDonald (NHS Lothian)
• Chris Mueller (National Services Scotland)
• Paudric Osborne (Scottish Government)
• Fiona Ramsay (NHS Forth Valley)
• Diane Skåtun (University of Aberdeen)
• Judith Stark (National Services Scotland)
• Matt Sutton (University of Manchester)
• Sarah Touati (National Services Scotland)
• Evan Williams (Scottish Government)

16th meeting – 21 July 2016

• TAGRA – Acute MLC subgroup – 16th meeting – 21 July 2016 – Agenda
• TAGRA – Acute MLC subgroup – 16th meeting – 21 July 2016 – Minute of previous meeting
• TAGRA – Acute MLC subgroup – 16th meeting – 21 July 2016 – Paper TAMLC57 – Matters Arising
• TAGRA – Acute MLC subgroup – 16th meeting – 21 July 2016 – Paper TAMLC58 – Unmet need analysis part 2
• TAGRA – Acute MLC subgroup – 16th meeting – 21 July 2016 – Paper TAMLC59- SIMD unmet need analysis methodology
• TAGRA – Acute MLC subgroup – 16th meeting – 21 July 2016 – TAMLC60 – Revised Detailed Work Plan

15th meeting – 6 June 2016

• TAGRA – Acute MLC subgroup – 14th meeting – 6 June 2016 – Agenda
• TAGRA – Acute MLC subgroup – 15th meeting – 6 June 2016 – Minute of previous meeting
• TAGRA – Acute MLC subgroup – 14th meeting – 6 June 2016 – Paper TAMLC54 – Matters Arising
• TAGRA – Acute MLC subgroup – 15th meeting – 6 June 2016 – Paper TAMLC55 – Unmet need analysis for new model
• TAGRA – Acute MLC subgroup – 14th meeting – 6 June 2016 – TAMLC56 – Revised Detailed Work Plan

14th meeting – 5th May 2016

• TAGRA – Acute MLC subgroup – 14th meeting – 5 May 2016 – Agenda
• TAGRA – Acute MLC subgroup – 14th meeting – 5 May 2016 – Minute of previous meeting
• TAGRA – Acute MLC subgroup – 14th meeting – 5 May 2016 – Paper TAMLC50 – Matters Arising
• TAGRA – Acute MLC subgroup – 14th meeting – 5 May 2016 – Paper TAMLC51- Analysis of new model
• TAGRA – Acute MLC subgroup – 14th meeting – 5 May 2016 – TAMLC52 – Revised Detailed Work Plan
• TAGRA – Acute MLC subgroup – By email – Paper TAMLC53 – Indicator selection results part 5

 

13th meeting – 15 April 2016

• TAGRA – Acute MLC subgroup – 13th meeting – 15 April 2016 – Agenda
• TAGRA – Acute MLC subgroup – 13th meeting – 15 April 2016 – Minute of previous meeting
• TAGRA – Acute MLC subgroup – 13th meeting – 15 April 2016 – Paper TAMLC46 – Matters Arising
• TAGRA – Acute MLC subgroup – 13th meeting – 15 April 2016 – Paper TAMLC47 – Indicator selection results part 3
• TAGRA – Acute MLC subgroup – 13th meeting – 15 April 2016 – TAMLC48 – Revised Detailed Work Plan _Printer version
• TAGRA – Acute MLC subgroup – By email – Paper TAMLC49 – Indicator selection results part 4
  

  12th meeting – 15 March 2016

  • TAGRA – Acute MLC subgroup – 12th meeting – 15 March 2016 – Agenda
  • TAGRA – Acute MLC subgroup – 12th meeting – 15 March 2016 – Minute of previous meeting
  • TAGRA – Acute MLC subgroup – 12th meeting – 15 March 2016 – Paper TAMLC42 – Matters Arising
  • TAGRA – Acute MLC subgroup – 12th meeting – 15 March 2016 – Paper TAMLC43 – Indicator selection results part 2
  • TAGRA – Acute MLC subgroup – 12th meeting – 15 March 2016 – Addendum to paper TAMLC43 – Indicator selection results part 2
  • TAGRA – Acute MLC subgroup – 12th meeting – 15 March 2016 – TAMLC45 – Revised Detailed Work Plan _Printer version

  11th Meeting – 20 January 2016

  • TAGRA – Acute MLC subgroup – 11th meeting – 20 January 2016 – Agenda
  • TAGRA – Acute MLC subgroup – 11th meeting – 20 January 2016 – Minute of previous meeting
  • TAGRA – Acute MLC subgroup – By email – Paper TAMLC36 – Potential indicators and supply variables
  • TAGRA – Acute MLC subgroup – 11th meeting – 20 January 2016 – Paper TAMLC37 – Matters Arising
  • TAGRA – Acute MLC subgroup – 11th meeting – 20 January 2016 – Paper TAMLC38 – Reference model analysis
  • TAGRA – Acute MLC subgroup – 11th meeting – 20 January 2016 – Paper TAMLC39 – Supply variables selection
  • TAGRA – Acute MLC subgroup – 11th meeting – 20 January 2016 – Paper TAMLC40 – Indicator selection results part 1
  • TAGRA – Acute MLC subgroup -11th meeting – 20 January 2016 – TAMLC41 – Revised Detailed Work Plan _Printer version

  10th meeting – 18 August 2015

  • TAGRA – Acute MLC subgroup – 10th meeting – 18 August 2015 – Agenda
  • TAGRA – Acute MLC subgroup – 10th meeting – 18 August 2015 – Draft outline for final report
  • TAGRA – Acute MLC subgroup – 10th meeting – 18 August 2015 – Minute of previous meeting
  • TAGRA – Acute MLC subgroup – 10th meeting – 18 August 2015 – Paper TAMLC31 – Matters Arising
  • TAGRA – Acute MLC subgroup – 10th meeting – 18 August 2015 – Paper TAMLC32 – HIIA briefing
  • TAGRA – Acute MLC subgroup – 10th meeting – 18 August 2015 – Paper TAMLC33 – Unmet need investigation methodology
  • TAGRA – Acute MLC subgroup – 10th meeting – 18 August 2015 – Paper TAMLC34 – Revised Potential Candidate Variables table
  • TAGRA – Acute MLC subgroup -10th meeting – 18 August 2015 – TAMLC35 – Revised Detailed Work Plan _Printer version

  9th meeting – 9 June 2015

  • TAGRA – Acute MLC subgroup – 9th meeting – 9 June 2015 – Agenda
  • TAGRA – Acute MLC subgroup – 9th meeting – 9 June 2015 – Minute of previous meeting
  • TAGRA – Acute MLC subgroup – 9th meeting – 9 June 2015 – Paper TAMLC26 – Matters Arising
  • TAGRA – Acute MLC subgroup – 9th meeting – 9 June 2015 – Paper TAMLC27 – Exploratory analysis – Age split
  • TAGRA – Acute MLC subgroup – 9th meeting – 9 June 2015 – Paper TAMLC28 – Unmet need analysis
  • TAGRA – Acute MLC subgroup – 9th meeting – 9 June 2015 – Paper TAMLC29 – Revised potential candidate variables table
  • TAGRA – Acute MLC subgroup – 9th meeting – 9 June 2015 – TAMLC30 – Revised Detailed Work Plan v2

  8th meeting – 19 March 2015

  • TAGRA – Acute MLC subgroup – 8th meeting – 19 March 2015 – Agenda
  • TAGRA – Acute MLC subgroup – 8th meeting – 19 March 2015 – Minute of previous meeting
  • TAGRA – Acute MLC subgroup – 8th meeting – 19 March 2015 – Paper TAMLC21 – Matters Arising
  • TAGRA – Acute MLC subgroup – 8th meeting – 19 March 2015 – Paper TAMLC22 – Geography, Time Span and SIMD evaluation
  • TAGRA – Acute MLC subgroup – 8th meeting – 19 March 2015 – Paper TAMLC23 – Revised potential candidate variables table
  • TAGRA – Acute MLC subgroup – 8th meeting – 19 March 2015 – Paper TAMLC24 – Update on unmet need
  • TAGRA – Acute MLC subgroup – 8th meeting – 19 March 2015 – Paper TAMLC25 – High level work plan

  7th meeting – 14 January 2015

  • TAGRA – Acute MLC subgroup – 7th meeting – 14 January 2015 – Agenda
  • TAGRA – Acute MLC subgroup – 7th meeting – 14 January 2015 – Minute of previous meeting
  • TAGRA – Acute MLC subgroup – 7th meeting – 14 January 2015 – Paper TAMLC18 – Matters Arising
  • TAGRA – Acute MLC subgroup – 7th meeting – 14 January 2015 – Paper TAMLC19 – Exploratory analysis
  • TAGRA – Acute MLC subgroup – 7th meeting – 14 January 2015 – Paper TAMLC20 – Potential candidate variables – Issues around SIMD and redrawn Data Zones

  6th meeting – 2 October 2014

  • TAGRA – Acute MLC subgroup – 6th meeting – 02 October 2014 – Agenda
  • TAGRA – Acute MLC subgroup – 6th meeting – 02 October 2014 – Minute of previous meeting
  • TAGRA – Acute MLC subgroup – 6th meeting – 02 October 2014 – Paper TAMLC15 – Unmet need
  • TAGRA – Acute MLC subgroup – 6th meeting – 02 October 2014 – Paper TAMLC16 – Matters Arising
  • TAGRA – Acute MLC subgroup – 6th meeting – 02 October 2014 – Paper TAMLC17 – Review of casemix adjustment
  • Multimorbidity presentation
  • Unmet Need presentation

  5th meeting – 26 August 2014

  • TAGRA – Acute MLC subgroup – 5th meeting – 26 August 2014 – Agenda
  • TAGRA – Acute MLC subgroup – 5th meeting – 26 August 2014 – Minutes of previous meeting
  • TAGRA – Acute MLC subgroup – 5th meeting – 26 August 2014 – Paper TAMLC11 – Matters Arising
  • TAGRA – Acute MLC subgroup – 5th meeting – 26 August 2014 – Paper TAMLC12 – Health Inequalities Update
  • TAGRA – Acute MLC subgroup – 5th meeting – 26 August 2014 – Paper TAMLC13 – Review of casemix adjustment
  • TAGRA – Acute MLC subgroup – 5th meeting – 26 August 2014 – TAMLC14 – DRAFT Work Plan v1

  4th meeting – 14 May 2014

  • TAGRA – Acute MLC subgroup – 4th meeting – 14 May 2014 – Agenda
  • TAGRA – Acute MLC subgroup – 4th meeting – 14 May 2014 – Minutes of previous meeting
  • TAGRA – Acute MLC subgroup – 4th meeting – 14 May 2014 – Paper TAMLC06 – Matters Arising
  • TAGRA – Acute MLC subgroup – 4th meeting – 14 May 2014 – Paper TAMLC07 – Comparisons of current and PLICS methods
  • TAGRA – Acute MLC subgroup – 4th meeting – 14 May 2014 – Paper TAMLC08 – Proposal to TAGRA on use of PLICS
  • TAGRA – Acute MLC subgroup – 4th meeting – 14 May 2014 – Paper TAMLC09 – Potential Candidate Variables
  • TAGRA – Acute MLC subgroup – 4th meeting – 14 May 2014 – Paper TAMLC10 – Functional Form

  3rd meeting – 1 April 2014

  • TAGRA – Acute MLC subgroup – 3rd meeting – 01 April 2014 – agenda
  • TAGRA – Acute MLC subgroup – 3rd meeting – 01 April 2014 – minutes of previous meeting
  • TAGRA – Acute MLC subgroup -3rd meeting – 01 April 2014 – Paper TAMLC02 – Remit terms of reference_Final
  • TAGRA – Acute MLC subgroup – 3rd meeting – 01 April 2014 – Paper TAMLC04 – Current NRAC cost ratio calculations
  • TAGRA – Acute MLC subgroup – 3rd meeting – 01 April 2014 – Paper TAMLC05 – Comparisons of current and PLICS methods
  • TAGRA – Acute MLC subgroup – 3rd meeting – 01 April 2014 – PLICS presentation

  2nd meeting – 12 March 2014

  • TAGRA – Acute MLC subgroup – 2nd meeting – 12 March 2014 – agenda
  • TAGRA – Acute MLC subgroup – 2nd meeting – 12 March 2014 – minutes of previous meeting
  • TAGRA – Acute MLC subgroup – 1st meeting – 4 February 2014 – Paper TAMLC02 – Remit terms of reference_v2
  • TAGRA – Acute MLC subgroup – 2nd meeting – 12 March 2014 – Paper TAMLC03 – Potential Candidate Variables
  • TAGRA – Acute MLC subgroup – 2nd meeting – 12 March 2014 – Health Inequalities Impact Assessment
  • TAGRA – Acute MLC subgroup – 2nd meeting – 12 March 2014 – Greater Glasgow & Clyde NRAC Report

  1st meeting – 4 February 2014

  • TAGRA – Acute MLC subgroup – 1st meeting – 4 February 2014 – agenda
  • TAGRA – Acute MLC subgroup – 1st meeting – 4 February 2014 – Paper TAMLC01 – Current Acute MLC adjustment
  • TAGRA – Acute MLC subgroup – 1st meeting – 4 February 2014 – Paper TAMLC02 – Remit and terms of reference
  • TAGRA – Acute MLC subgroup – 1st meeting – 4 February 2014 – Resource Allocation Formula purpose and methods

   

  Mental Health and Learning Difficulties care programme

  In 2011, TAGRA agreed that the detailed analysis to review the MLC adjustment, undertaken by the technical subgroup, should begin by examining the Mental Health and Learning Difficulties care programme.

  Remit

  The Morbidity and Life Circumstances subgroup examining the Mental Health and Learning Difficulties care programme was established in April 2011. TAGRA asked the subgroup to consider:

  • Geography – the appropriate geographic level at which to undertake any adjustment;
  • Structure – to include, but not limited to, whether (a) there should continue to be a single mental health and learning difficulties index, or whether the care programmes should be separated; and (b) whether separate adjustments for different ages should be considered;
  • Indicators – the most appropriate indicators to use within any adjustment, including but not limited to need indicators and indicators of supply, rurality, and urbanity; and
  • Cost data – the degree and manner in which cost data should be aggregated in order to provide a stable adjustment.
  • When considering these issues, the subgroup will take account of work being undertaken by other organizations and groups in this area to ensure that new methods and data are considered as they become available.

  Final Reports: Mental Health & Learning Difficulties Care Programme

  • MLC Subgroup: Mental Health & Learning Difficulties Care Programme Technical Report (Executive Summary)
  • MLC Subgroup: Mental Health & Learning Difficulties Care Programme Technical Report
  • MLC Subgroup: Mental Health & Learning Difficulties Care Programme Impact Analysis
  • Overall Impact Analysis
  • Quality Assurance Report

  Meeting papers

  Papers and minutes from the meetings of the subgroup are available below:

  8th meeting – 28 November 2012

  • TAGRA – MLC subgroup – 8th meeting – 28 November – agenda.doc
  • TAGRA – MLC subgroup – 7th meeting – 28 November – minutes of previous meeting.DOC

  Further paper discussed at the meeting, not published here since it is part of a draft for the final report:

  • TAGRA – MLC subgroup – 8th meeting – 28 November – paper TMLC26 – FinalRepDraft 2

  7th meeting – 14 November 2012

  • TAGRA – MLC subgroup – 7th meeting – 14 November – agenda.doc
  • TAGRA – MLC subgroup – 7th meeting – 11 October – minutes of previous meeting.doc
  • TAGRA – MLC subgroup – 7th meeting – 14 November – paper TMLC22 – geography and time, under 65s.doc
  • TAGRA – MLC subgroup – 7th meeting – 14th November – paper TMLC23 – geography and time, over 65s.doc
  • TAGRA – MLC subgroup – 7th meeting – 14 November – paper TMLC24 – urban rural markers,under 65s.doc
  • TAGRA – MLC subgroup – 7th meeting – 14 November – paper TMLC25 – urban rural markers, over 65s.doc

  6th meeting – 11 October 2012

  • TAGRA – MLC subgroup – 6th meeting – 11 October – agenda.doc
  • TAGRA – MLC subgroup – 6th meeting – 11 October – minutes of previous meeting.doc
  • TAGRA – MLC subgroup – 6th meeting – 11 October – paper TMLC19 – Needs Indices, under 65s.doc
  • TAGRA – MLC subgroup – 6th meeting – 11 October – paper TMLC 19 Addendum – Needs Indices, under 65s.doc
  • TAGRA – MLC subgrou – 6th meeting – 11 October – Paper TMLC20 – Needs Incides, over 65s.doc
    

  Further paper discussed at the meeting, not published here since it is part of a draft for the final report:

  • TAGRA – MLC subgroup – 6th meeting – 11 October – paper TMLC21 – draft final report

  5th meeting – 10 September 2012

  • TAGRA – MLC subgroup – 5th meeting – 10 September – agenda.doc
  • TAGRA – MLC subgroup – 5th meeting – 10 September 2012 – minutes of previous meeting.doc
  • TAGRA – MLC subgroup – 5th meeting – 10 September 2012 – paper TMLC15 – Detailed work plan.doc
  • TAGRA – MLC subgroup – 5th meeting – 10 September – paper TMLC16 – initial results on needs indices, over 65s.doc

  Further papers discussed at the meeting, not published here since they are parts of a draft for the final report:

  • TAGRA – MLC subgroup – 5th meeting – 10 September 2011 – paper TMLC17 – draft MH&LD report outline
  • TAGRA – MLC subgroup – 5th meeting – 10 September 2012 – paper TMLC18 – draft RCB

  Papers between meetings – Summer 2012

  • TAGRA – MLC subgroup – Summer 2012 – paper TMLC12 – outliers and functional form.doc
  • TAGRA – MLC subgroup – Summer 2012 – paper TMLC13 – previous update for TAGRA (TAGRA(2012)02).doc
  • TAGRA – MLC subgroup – Summer 2012 – paper TMLC14 – Indicators of need.doc

  4th meeting – 14 March 2012

  • TAGRA – MLC subgroup – 4th meeting – 14 March 2012 – agenda.doc
  • TAGRA – MLC subgroup – 4th meeting – 14 March 2012 – minutes of previous meeting.doc
  • TAGRA – MLC subgroup – 4th meeting – 14 March 2012 – Paper TMLC11 – over 65s.doc

  3rd meeting – 27 February 2012

  • TAGRA – MLC subgroup – 3rd meeting – 27 February 2012 – agenda.doc
  • TAGRA – MLC subgroup – 3rd meeting – 27 February 2012 – minutes of previous meeting.doc
  • TAGRA – MLC subgroup – 3rd meeting – 27 February 2012 – Paper TMLC10 – under 65s.doc
  • TAGRA – MLC subgroup – 3rd meeting – 27 February 2012 – Paper TMLC11 – over 65s.doc

  2nd meeting – 29 November 2011

  • TAGRA – MLC subgroup – 2nd meeting – 29 November 2011 – agenda.doc
  • TAGRA – MLC subgroup – 2nd meeting – 29 November 2011 – minutes of previous meeting.doc
  • TAGRA – MLC subgroup – 2nd meeting – 29 November 2011 – Paper TMLC08 – under 65s.doc
  • TAGRA – MLC subgroup – 2nd meeting – 29 November 2011 – Paper TMLC09 – over 65s.doc

  1st meeting – 16 June 2011

  • TAGRA – MLC subgroup – 1st meeting – 16 June 2011 – agenda.doc
  • TAGRA – MLC subgroup – 1st meeting – 16 June 2011 – Paper TMLC01 – Current MH&LD model2.doc
  • TAGRA – MLC subgroup – 1st meeting – 16 June 2011 – Paper TMLC02 – remit and terms of reference2.doc
  • TAGRA – MLC subgroup – 1st meeting – 16 June 2011 – Paper TMLC03 – age split2.doc
  • TAGRA – MLC subgroup – 1st meeting – 16 June 2011 – Paper TMLC04 – Geography2.doc
  • TAGRA – MLC subgroup – 1st meeting – 16 June 2011 – Paper TMLC05 – Indicators2.doc
  • TAGRA – MLC subgroup – 1st meeting – 16 June 2011 – Paper TMLC06 – Discussion2.doc
  • TAGRA – MLC subgroup – 1st meeting – 16 June 2011 – presentation2.ppt
  • TAGRA – MLC subgroup – 1st meeting – 16 June 2011 – work plan2.xls