A Guide to Creating a Resource Allocation System

A Guide to Creating a Resource Allocation System

Step by Step Guide to

Creating a

Resource Allocation System

Contents

Introduction...... 3

A few things to remember before you start

An overview of the process

Step 1 Choose A Self Assessment Questionnaire

Step 2 Decide whether to adjust your Self assessment questionnaire

Step 3 Identify a Test Group

Step 4 Mapping Costs

Step 5 Mapping needs

Step 6 Completing The RAS4 spreadsheet

Step 7 Converting Needs to Funding Allocation

Step 8 Fine-tuning the Resource Allocation System

Step 9 Going Live!

Glossary

Introduction

This step by step guide will take you through the process of developing a resource allocation system. The guide is based upon In-Control RAS4, and is written as a hands on practical instruction manual. If you follow each step you will have a resource allocations system that;

• Provides an open and upfront indicative allocation of resources
• Is based on local pricing information,
• Can be set up in a such a way as to ensure affordability
• Enables self-assessment of entitlement
• Allows you to make decisions about strategic priorities, but allows local people control of their own life
• Controls costs, rations fairly and supports good governance
• Reduces the disincentive for family, friends, or community to provide support
• Allows you to incorporate different funding streams

This guide does not consider the role of, or need for an open and transparent resource allocation system, other material available through In-Control addresses these issues.

A few things to remember before you start

Keep it small and beautiful

Remember you are not redesigning your current assessment tools, you are creating a Resource Allocation System. You should resist a temptation to try and include everything your current assessment tool covers, you need to be selective. You are trying to measure the things that effect how much money it is reasonable to make available to someone, you are not trying to build up a detailed picture of every aspect of their life. There is plenty of opportunity for people to describe their needs and wishes in more detail at the planning stage.

The acid test to apply when deciding what to include in your system should be;

Do we need to know about this in order to make a decision on how much money someone should be entitled to?

Do reinvent the wheel

It doesn’t have to be perfect first time round

It’s a journey be prepared to learn as you go

Beg borrow and steal, but share nicely as well

An overview of the process

Step 1

Choose A Self Assessment Questionnaire

First you will need to choose one of the Self Assessment Questionnaires (SAQ) as a starting point for your work. This SAQ will be the basis of your resource allocation system, but you will be able to change it as you work through this process.

Take a look at both of the Self Assessment Questionnaires. These are provided as word files on the in-control website (SAQ1.doc & SAQ2.doc). You will notice the two frameworks follow the same outline but feature different Domains (areas of life), and have different fields (subdivision of the Domain ). You will also see the points are different in each SAQ.

SAQ1 has been developed from work in Devon, West Sussex and Lincolnshire, and is tailored towards Older People, and features the following Domains;

1 Meeting personal care needs

2 Eating and drinking (Nutritional needs)

3 Practical aspects of daily living

4 Physical and Mental Health and Well-being

5 Relationships & Social Inclusion

6 Choice and Control

7 Risk

8 (a) Family carer and social support

8 (b) Family carer and social support

SAQ2 has been developed from work in Essex, Sheffield, Newham and Lambeth, and is tailored towards working age adults, and features the following Domains;

1 Looking after myself – my personal needs

2 Relationships

3 Being part of the local community

4 Work, leisure and learning

5 Making decisions

6 Staying safe from harm

7 Complex needs and risks

8(a) Family carer and social support

8(b) Family carer and social support

Step 2

Decide whether to adjust your Self assessment questionnaire

You may decide that you wish to change the SAQ you use before you begin mapping needs and costs.

The changes you may like to think about would include;

• Adding a Domain
• Changing the wording of the fields
• Changing the points allocated to each field

The fields in each domain are deliberately wide and will not fit everyone exactly. This is designed to make it easy for people to use the system and say easily which statement fits them best. Resist the temptation to put too many fields in each domain.

If you do decide to make changes you will need to change the SAQ, the score Sheet, and the spreadsheet, to reflect the changes you make.

Step 3

Identify a Test Group

In order to ensure that your RAS reflects local needs and spending patterns you will need to identify a ‘Test Group’. The Data that comes from your test group will inform the indicative allocations your RAS generates.

The Test Group should comprise Care Management & Assessment staff and people known to them from their case load. To identify your test group

nominate at least 10 Care Managers, and ask that they identify 10 individuals that they know well. The 10 Care managers should select a broad cross-section of their caseload. If you have assessment staff working in teams with specific roles, such as review teams, it is important that they are included. Your aim is to produce a test group that is broadly representative of the population you serve. Given the current spending variations, you will need to think carefully about the implications of including service users from more than one social care group.

Care Managers will later be asked to complete the SAQ as a desktop exercise, for each of the people they have identified, this is a theoretical desktop exercise only.

You should now fill in Column B in the SAQ Data worksheet of the Ras4 Spreadsheet and complete the Test Group Index

Step 4

Mapping Costs

Having produced a representative list of 100 people receiving services, you now need to identify the cost of each care package.

Care packages will most likely be funded from a range of income streams, it is important to be clear at this stage which you are counting. You may choose to include or exclude any, but you need to do so consistently across the whole group.

If you exclude funding from a particular income stream you should not view your final allocation as including money that a person might receive from this source.

You Should now fill in column ‘R’ in the SAQdata worksheet of the RAS4 spreadsheet.

Step 5

Mapping needs

In order to ensure your RAS is reflective of the needs of people you serve you will need to undertake a mapping exercise. This is a theoretical desktop application of the SAQ and will build up a very detailed profile of needs, for your test group.

To map the needs of your test group you will need Care Managers to apply the SAQ to every person in your test group. The results of this application of the SAQ should be recorded on the score sheet supplied. (This score sheet also captures other helpful data). At the end of the exercise you will have 100 score sheets, the data from which will need to be entered into your RAS4 spreadsheet.

Using the score sheet

Provide a copy of the SAQ to each of the Care Managers, along with 10 score sheets. They will need to work through the SAQ completing the score sheet for each of the 10 people they have nominated.

Make the Completed Test Group Index available to the Care Managers they will need this to allocate each score sheet a reference number; this identifies each score sheet to a named person.

It is important that each score sheet is completed correctly and that each domain is scored. Nominate one person, not filling in the sheets, whose job it is to collect the completed score sheets and check they are filled in correctly there and then. This will save a lot of chasing around later.

You can now enter the data from your score sheets into columns ‘G-O’ in the SAQ Data Worksheet of your RAS4 Spreadsheet .

Step 6

Completing The RAS4 spreadsheet

The spread sheet is divided into 3 work sheets

1. SAQ Data
2. Weightings (SAQ1 SAQ2)
3. Summary sheet

SAQ Data

This worksheet captures the data from the mapping exercise and calculates indicative allocations. It is important that each cell in the light and dark blue columns (G-O & R) are completed as blank cells will skew your RAS. If you do not have data available and cannot make a ‘reasonable assumption’, then that person should be removed from the test group.

The spreadsheet will use the information you input to calculate the Indicative allocations so it is important that you input data accurately.

Weightings

The ‘weightings’ worksheet allows you to input the data you have captured from your mapping exercise. The data identifies how well each domain works for people in your test group, and calculates a relative weighting for each domain.

Tally the data form your worksheets and enter this into the relevant cells;

(D5- D13, F5-F13, G5-G15) this will populate the charts, and offer suggested points allocation for your RAS. These points, coming as they do from the information supplied by care managers in their mapping exercise, serve to link the RAS to ‘live’ information from your area. However these points’ weightings should be seen as suggestions only, acting as a starting point for discussion.

You may well choose to vary some of the points in your final RAS.

If you are considering replacing a Domain the charts in this sheet will inform your thinking.

Summary sheet

You do not need to enter any data into this worksheet , it provides a useful summary of information about your test group.

Step 7

Converting Needs to Funding Allocation

The RAS4 spreadsheet calculates a price point based upon the average cost of care packages entered and the average points from the SAQ’s. This links the RAS to local pricing information and needs.

The Price Point is used to calculate an indicative funding allocation for each individual.

The spreadsheet is set to do this by multiplying the number of points a person receives in the SAQ by the price point, and allocating 75% of this figure. (The multiplier is set as a default at 75% in order to encourage Individual Budgets to be set at cost-efficient levels.)

Step 8

Fine-tuning the Resource Allocation System

The system you have developed is very flexible and can be changed and adjusted in a number of ways. You may now manipulate the spreadsheet to help you reach decisions about your RAS.

There are a number of ways in which you may choose to fine-tune your RAS;

Change the priority afforded to each area of need

You can do this by increasing the points allocated to a field within one of the domains. (The ‘Replace’ function in the RAS4 Spreadsheet allows you to do this easily) This will change how much money each individual within the test group is allocated but it will not effect the overall spend.

Accounting for other factors

You can introduce further domains, you will need to capture data from your test group on this new domain area, but you can insert these figures into the spreadsheet without causing an overall increase in costs.

Increase or decrease the overall spend

You can do this either by changing the price point or the % multiple used to calculate the final allocation (set as a default at 75%)

Adjusting the spread of allocations

You will most likely find that using the allocation method built into the RAS4 spreadsheet will produce a much lower range of funding than is present within the current spending pattern, this is not necessarily a bad thing.

If you wish to increase the range of allocations, this is achievable by changing the percentage multiplier. Reducing the 75% figure for those with lower points and increasing it for those with higher points.

Matching current allocation patterns

The RAS4 allocations are unlikely to exactly match the cost of care previously allocated to individuals. Adjusting the points allocated to each field may produce a closer match for more or fewer people, however from our work to date it has not been possible to manufacture a set of principles that will lead to an exact match with the current spend.

In Control believes that this disparity is probably caused by the difficulty at present of consistently applying rational principles for resource allocation rather than because rational principles cannot be applied. Early evidence from piloting suggested that even cruder systems of resource allocation (e.g. RAS2 and RAS 3) led to significant value for money improvements while also providing a clear ethical framework for resource allocations.

The practical significance of the prevalent incoherence is that some people may presently receive services that cost more than their Individual Budget level would allow. In these circumstances it may be reasonable to agree time frame over which funding level changes up or down to a core recurrentfunding levelat the RAS4 allocation. In addition, providing any such additional transitional funding up-front may make it easier to manage the change to the new lower level.

As you make changes to your RAS you may now wish to rerun step 5. If you do this it is important that you apply the retesting to the same test group, so you can see the impact of your changes.

Step 9

Going Live!

You will now be ready to start using your RAS, it does not have to be perfect and it will probably not be the finished product. As you begin to use the RAS you will learn as you go. It is important to think now about how you will capture this learning. You will need to find out who the RAS works well for and why, who it works less well for, and what you can do to change this.

Remember there are many other local authorities developing resourceallocation systems, ensure you tap into their learning and ideas as well.

Further Help and Assistance

For further help and assistance in developing your Resource allocation system

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Glossary

RAS: Resource Allocation System

SAQ: Self Assessment Questionnaire

Domain: The areas of life covered within the SAQ

Field: The subdivision of each domain

Price Point: The amount of money used to calculate individual allocations in RAS4. Based upon local spend and needs analysis.

Indicative Allocation: The amount of money the RAS indicates should be made available to a person.

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