This report presents the findings of the evaluation of the development and implementation of the Integrated Resource Framework (IRF) in four test site areas in Scotland. The IRF is a mechanism developed by the Scottish Government and partners to support shifts in the balance of care through integrated mapping information for health and social care and new joint financial mechanisms between Local Authorities and NHS Boards.
The IRF helped enable four NHS Boards and 12 Local Authorities to gain a clearer understanding of health and social care costs and activity. For the first time partners in the IRF test sites attempted to map cost and activity data across health and social care. Analysis of this data started to improve the evidence base on which planning decisions are made. The IRF test sites used the mapping data to examine equity, efficiency, variation and quality but encountered difficulties in engaging GPs and hospital clinicians in discussion of the data, and also in linking outcome data into the analysis.
The IRF enabled senior managers in NHS Boards and Local Authorities to coordinate joint working and empowered health and social care staff to reflect on how to work together to improve care pathways and care provision for local populations. The success of new ways of integrated working was linked to the extent to which relevant stakeholders were: represented in planning structures; incentivised to engage in analysis of data; and empowered to influence planning decisions.
The IRF work identified some of the limitations of current data, but also started to address some of these through national support of local innovation. It encouraged partners to experiment with new ways of jointly planning services and delivering care. Over the past two years, it has supported national policy direction to shift the balance of care and has contributed to the development of a growing culture of more integrated service delivery. Implementation of new financial mechanisms to facilitate resource transfer proved a lengthier undertaking than expected, and the value of new financial models is as yet untested.