Edinburgh Shadow Health and Social Care Partnership

Joint Strategic Needs Assessment

Topic Paper 11

Preamble

This data was sourced from the Lothian IRF pilot, now subsumed in HSCDIIP. The data set was discontinued beyond 2012-13 and so updates will not be available on a comparable basis.

Further, the work was carried out before and separately from work to determine budget allocations for integration.

High health and social care resource individuals for City of Edinburgh Council area 2010/11

The analysis includes patients/clients aged 16 years and older, resident in the City of Edinburgh Council (CEC) area in 2010/11. Health and social care costs are based on cost data within Lothian’s Integrated Resource Framework (IRF) for the financial year 2010/11. 2010/11 is currently the most recent complete health and social care data in IRF. Caveats apply to the cost data within the Lothian IRF:

  • IRF health cost data assigned at patient level reflects full economic costs and therefore contains direct costs as well as overheads.
  • Some health cost data is unreconciled (outpatients, A&E attendance, long stay inpatients).
  • The only primary care cost at patient level in the Lothian IRF is community prescribing. This is therefore the only primary care cost that is included in total health costs in this analysis.

Health and social care costs have very skewed distributions:

  • 2.4% of CEC residentsaccount for 50% of total health care costs
  • 8.4% of CEC residentsaccount for 50% of all social care costs

Patients/clients that account for 50% of health or social care costs are called High Resource Individuals (HRI). Four categories of CEC residents were created based on their health and social care resource use. CEC residents who were HRI for healthcare costs AND HRI for social care (SC) costs were categorised as ‘HRI health and HRI social care’. CEC residentswho were HRI for health care costs only were categorised as ‘HRI health’. CEC residentswho were HRI for social care costs only were categorised as ‘HRI social care’. CEC residents who accounted for the remaining 50% of health and/or social care costs were categorised as ‘Non-HRI’. These are illustrated in Figure 1 below.

  1. HRI health and HRI SC = High health care costs and high social care costs
  2. HRI health = High healthcare costs but not high social care costs
  3. HRI SC = High social care costs but not high health care costs
  4. Non-HRI= low health and social care costs

Leonie Hunter 20 March 2015

Figure 1: Numbers of CEC residents in Lothian IRF in the fourresource use groups 2010/11. Total number n=309,775

50% of healthcare costs

Non-HRI n= 300,704

Overall resource use

  • HRI health and HRI SC have the highest cost per head but lowest total costs
  • Non-HRI group have the lowest cost per headbut highest total costs
  • HRI Health group have a lower cost per head than HRI SC group but higher total cost

Table 1: Total Lothian IRF health and social care costs and costs per head by resource group for CEC resident 2010/11

Headcount / CostPerHead / Total Cost
HRI health and HRI SC / 188 / £68,619 / £12,900,295
HRI health / 7,181 / £29,764 / £213,736,667
HRI SC / 1,702 / £48,731 / £82,940,828
Non HRI / 300,704 / £882 / £265,092,228

Resource use split by health and social care use (Table 2; Figures 2-3)

  • HRI health only and HRI social care only groups have higher health and social care costs per head respectively than the ‘HRI health AND HRI SC’ group.
  • High SC only group has the highest total social care costs.
  • Non HRI group has the highest total health costs though the lowest health cost per head.
  • 53% of the HRI health only group also have associated social care costs; 98% of the HRI SC only group have associated health costs (Table 3).
  • Non HRI group has a higher SC cost per head than health cost per head, but 99.8% of this group have associated health costs compared to only 6% with associated social care costs (Table 3).

Table 2: Resource use split by health and social care costs.

Headcount / CostPerHead / Total cost
Health / Social care / Health / Social care / Health / Social care
HRI health and HRI SC / 188 / 188 / £24,229 / £44,390 / £4,555,002 / £8,345,293
HRI health / 7,181 / 3,836 / £26,699 / £5,739 / £191,722,379 / £22,014,288
HRI SC / 1,670 / 1,702 / £1,941 / £46,827 / £3,241,942 / £79,698,886
Non HRI / 300,057 / 16,894 / £663 / £3,910 / £199,039,867 / £66,052,361

Table 3: Proportion of patients with health and social care use by resource groups

% of group with health care costs / % of group with social care costs
HRI health and HRI SC / 100% / 100%
HRI health / 100% / 53.4%
HRI SC / 98.1% / 100%
Non HRI / 99.8% / 5.6%

Figure 2: IRF 2010/11 cost per head split by health and social carefor CEC residents

Figure 3: Total IRF costs 2010/11 split by health and social care for CEC residents

Characteristics of the resource groups

The following charts compare the age (Figure 4), sex (Figure 5), and deprivation profiles (Figure 6) for the four groups. The chart showing long term conditions (LTCs) (Figure 7) shows the proportion of patients with 1,2,3,4, or 5+ LTCs where at least one LTC is recorded (we only have LTC data for 95/125 practices in Lothian; hypothyroidism and epilepsy are missing; asthma and stroke/TIA are incomplete).

Age (Figure 4)

  • In the three HRI resource groups the highest proportion of patients are in agebands 76-84 years and 85+ years.
  • HRI social care only group has the highest proportion of clients aged 85+.
  • The non-HRI group has a higher proportion of patients in younger agebands

Leonie Hunter 20 March 2015

Figure 4: Age profile of the four resource groups for CEC residents for 2010/11

Gender (Fig 5)

  • Higher proportion of females than males in all groups
  • Highest proportion of females compared to males inHRI social care only group

Figure 5: Gender profile of the four resource groupsfor CEC residents for 2010/11

Deprivation

  • The three HRI groups have a higher proportion of residents in Q1 and Q2 (most deprived quintiles) compared to the non-HRI group.

Figure 6: Deprivation profile of the four resource groupsfor CEC residents for 2010/11

Multimorbidity

  • The ‘HRI health and HRI SC’ and ‘HRI health only’ groups have a higher proportion of patients with multimorbidity than the other two groups.
  • 67% of patients with a record of a LTC have two or more LTCs in the ‘HRI health and HRI SC’ group.

Figure 7: Proportion of patients in each resource group with 1, 2, 3, 4, or 5 or more LTCs for CEC residents in 2010/11. NB denominator for this analysis is number of patients with a record of at least one LTC.

Summary

  • A very small percentage of patients/clients account for 50% of total health and social care costs.
  • High resource individuals are older than non-HRI individuals.
  • Further work needs to explore the health and social care needs of these HRIs.
  • To effect change at a population level the non-HRI group (the majority of the population) needs to be targeted. Upstream population level interventions that improve health will potentially reduce the cost of future ‘HRIs’.

Leonie Hunter 20 March 2015