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.


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.


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

15th meeting – 6 June 2016

14th meeting – 5th May 2016


13th meeting – 15 April 2016