NDA Resource Allocation Research
NDA Resource Allocation Research
- What is a resource allocation system
- Reviews of research literature and experience elsewhere
- Resource Allocation Feasibility Study Phase 1
- Phase 2 Feasibility Study - InterRAI and Face
Research in 2015
One of the important building blocks of the reform programme for disability services is the development of new resource allocation models and units of cost to provide a basis upon which the transition from a traditional programme type to more individual costing approaches can take place.
The National Disability Authority has been engaged in a programme of research to inform its advice to the Department of Health and the HSE on the optimum model to guide individualised budgeting for people with disabilities. Following the Value for Money and Policy Review of Disability Services, the focus has also been extended to look at how to ensure resource allocation between different service providers is better matched to need.
A resource allocation system is a system to match resources for support services to assessed needs. Resource allocation models typically contain the following elements:
- A needs assessment questionnaire
- A scoring system to translate needs into points
- A formula to translate points into appropriate budgets
- A process to look at how needs can be met from an indicative budget
- A process to address exceptional needs
The National Disability Authority published a paper in 2011 which reviewed resource allocation models in other jurisdictions. This informed the decision to trial the Supports Intensity Scale and the In Control questionnaires with a sample of Irish service users (see Resource Allocation Feasibility Study Phase 1 below).
The National Disability Authority undertook study visits to 3 UK local authorities to look at their resource allocation systems in more detail, and at the transition process undertaken.
The National Disability Authority has also recently completed a review of the research evidence on transitions to personal budgets in five countries drawing on the limited number of studies of this topic.
The objective of the Resource Allocation Feasibility Study Phase 1 was to examine the appropriateness of AAIDD’s Supports Intensity Scale (SIS) system and In Control’s RAS 5 system for application as a resource allocation system for disability services in Ireland. The research was a process evaluation of these two established tools. The feasibility study looked at the characteristics of the needs assessment dimension of the system, but did not study the costing methodologies that can be applied to each instrument. A later stage of the research will study costing methodologies.
As part of the research, one hundred and twelve adults with disabilities who received services from a wide range of specialist providers were interviewed using both the SIS and RAS 5 questionnaires. An external evaluator was appointed to document the strengths and weaknesses of each system. An Advisory Committee comprised of nominees of key disability representative bodies, along with members of the Department of Health and the Health Service Executive was also convened for the duration of the study.
The study found that both questionnaires were feasible and acceptable. For almost all the service users, their ranking in terms of support need was similar whether the more detailed assessment tool (SIS) or the shorter assessment tool (RAS 5) were used. Reasons for differences for the small number of inconsistent cases were explored, which suggests that addressing some inconsistencies in use of a tool, and small additions to either tool could ensure the relevant issues driving support needs are captured. The study found that RAS 5 is quicker to administer, and cheaper to operate, whereas the SIS collects more detailed information that could be used to inform other processes such as more in-depth needs assessment or person-centred planning.
Read the report on the Resource Allocation Feasibility Study Phase 1 below.
Resource Allocation Feasibility Study Phase 1
Resource Allocation Feasibility Study Phase 2
The National Disability Authority received a formal request from the Department of Health, following discussions with the HSE, to widen the original consideration of assessment systems to include another two – InterRAI and FACE.
InterRAI has been selected by the HSE to be the single assessment tool for older people, and if the disability version of this system were to work well, there could be obvious benefits in having a common language and assessment framework over the life course. New evidence from the UK shows that the FACE family of needs assessment tools, already used by some HSE and other mental health service providers here, may provide a better match of resources to assessed need than In Control’s RAS 5. As the ultimate purpose of our study is to examine how a common needs assessment system could be used to guide allocation of resources, it would be prudent to take the opportunity to test the FACE system with disability service users at the same time as testing InterRAI.
During 2013 the two systems were tested, as an extension of the previous feasibility study. The National Disability Authority invited the participating organisations in the greater Dublin area from Phase 1 to take part in this exercise, and there were 40 participating service users covering a spectrum of disability, support needs and living arrangements.
The results showed strong correlations across all four assessment tools, which is not surprising given each collects similar core information around key drivers of care and support needs. Some differences between the tools were also identified.
The National Disability Authority published a paper in 2014 which reviewed the four resource allocation tools. In general, the conclusion of both field trials was that the four tools produced similar rankings of support needs.
The National Disability Authority will prepare an advice paper, in line with the recommendations contained in the Value for Money and Policy Review, based on this feasibility study. This will guide on the optimal choice of a resource allocation model and how indicative costings should be arrived at, based on such a model.
 “Individualised budgeting is an umbrella term that may take many forms, ranging from a method of determining resource allocation to agencies based on assessed client need and actual costs; to a ‘money follows the client’ model; a brokerage system or a personal budget model administered by the individual service user. With individualised budgeting, the main transfer to the service user is the transfer of choice and control over funding decisions. This might or might not involve the transfer of actual funds to the individual” (page 172, Value for Money and Policy Review of Disability Services in Ireland, Department of Health, July 2012).