What the system faced
With coasts and countryside, Dorset is a popular retirement destination and so the county has a higher-than-average proportion of older residents. Almost 30 per cent of those living in the area are 65 or over, compared to 19 per cent for England and Wales as a whole. 1
Generally speaking, healthcare need increases with age but the pattern is not uniform – social determinants, including deprivation, play an important role determining someone’s wellbeing. In allocating nationally-provided funding, leaders in the local integrated care system (ICS) wanted to ensure these complexities were taken into account to meet need best.
What the system did
Dorset ICS used a population health management approach to decide how to allocate national funding between primary care networks (PCNs). NHS England awarded all systems ageing well funding, designed to support the aspirations set out in the NHS Long Term Plan for England (published in early 2019).
Having allocated funds to support some core anticipatory care and urgent community response services provided across the ICS, there was almost £2 million left to allocate. This would typically have been split based solely on the size of the weighted population in each primary care network, but data analysis work allowed for a more nuanced approach.
The Dorset Intelligence and Insight Service is a data analytics tool supported by Power BI which has data feeds from most of the ICS’s constituent organisations. By uniting data from social care, acute care, mental health services, primary care, and community care with socio-economic information (including ethnicity, age, gender; education; housing; employment; it is possible to build up a detailed understanding of the needs of specific sectors and sub-sectors of the local population.
Working with a healthcare data analytics firm, staff at the ICS calculated the following for each primary care network’s population:
- The proportion living in the most deprived quartile of Dorset.
- The proportion living in rural villages.
- The proportion that is frail.
- The proportion at high or very high risk of an emergency admission.
- The proportion at high or very high risk of a fall.
A weighted score was then calculated for each PCN, giving a sense of which local populations were likely to have the greatest need for older people’s anticipatory care and urgent community response services.
The ageing well funding was apportioned based on this weighed score – the PCNs at the ‘top’ of the ‘ranking’ receiving a higher proportion of funding than those lower down, with less need.
Results and benefits
Applying a population health management approach means that there has been a more sophisticated allocation of funding, designed to help PCNs meet need. While the differences between funding amounts ultimately did not vary hugely between PCNs – it was between about £2,000 and £5,000 – the project did serve to highlight the principle of dividing funding based on more detailed indicators.
The data analysis is also making it possible to target specific interventions to specific populations through risk stratification. The assessment of falls risk has led to the creation of three different interventions:
- fall buddies (through which trained volunteers are paired up with an individual at high risk and offer support to become more confident and mobile)
- carousel clinics (held in a local community centre), which bring together the voluntary sector, social prescribers, pharmacists, occupational therapy, nurse practitioners, the fire and rescue service and the local housing association to offer advice to those at medium risk
- and workshops in sheltered accommodation for those at lower risk and to educate those caring for all at risk patients in residential and nursing homes.
Given this was a new means of allocating funding, there was the potential for objections from those within the primary care networks. Leaders on the project addressed this through careful engagement. This involved two online events, at which the methodology and rationale was detailed; sending the proposed methodology for funding to all PCNs; and individual meetings with each PCN. This is cited as having been important to the project’s success.
- Explain the rationale behind any population health management-based changes to funding allocation. Those in local areas need to understand why a decision has been made to use such an approach, the data being used to inform it, and what difference it is anticipated such a change will make.
- Ensure data sharing agreements are in place. In Dorset, there is a data sharing agreement across all constituent organisations. The PCNs also have patient information sharing agreements, supporting data sharing between organisations within those networks.
For more information contact Dr Simone Yule, Senior Partner at The Blackmore Vale Partnership and Clinical Director for Population Health Management for Dorset ICS.
- 1. https://www.dorsetcouncil.gov.uk/your-council/about-your-council/dorset-council-plan/understanding-dorset ↑