Single Shared Assessment Indicator of Relative Need: Operational Guidance Users Handbook
Guidance to assist implementation of SSA-IoRN
SINGLE SHARED ASSESSMENT - INDICATOR OF RELATIVE NEED
OPERATIONAL GUIDANCE USERS' HANDBOOK
Health Department |
Community Care Division 2 Your ref: 7 July 2003 |
Chief Executives, Local Authorities |
Dear Colleague
JOINT FUTURE: DATA STRATEGY RESOURCE USE MEASURE (RUM) AND THE INTEGRATED CARE ASSESSMENT DATA SUMMARY
(RUM-ICADS)
I enclose a consultation paper setting out the proposed Joint Future: Data Strategy for the RUM and the Integrated Care Assessment Data Summary (RUM-ICADS). Your views are invited by 29 September 2003.
Context
Circular No 9/2002 of 24 September 2002 introduced the Report on the Development of a Resource Use Measure (RUM) for Scotland. The RUM is a standardised tool that will group individuals according to their level of relative need following a Single Shared Assessment (SSA). The "Next Steps" letter issued on 28 February 2003 on behalf of the Executive, COSLA and NHSScotland confirmed that implementation of the RUM had begun in 5 implementation sites. It set out the expectation that all partnerships will begin to use the RUM by end of 2003-04. The plan for full implementation assumes that all SSAs of people aged 65 and over in Scotland should have a RUM grouping assigned. The RUM appendix to the "Next Steps" letter stated that the ongoing work with the 5 sites and the RUM Information Sub-Group and RUM Reference Group included looking at how RUM scores could be combined with other information already collected. This would provide a data set that could inform planning locally and be made available for national collection.
What are we consulting on?
The consultation paper provides an overview of the development of the data summary for RUM-ICADS, which consists of RUM and associated data derived from the SSA process. The strategy has been produced in collaboration with the 5 implementation sites, the Care Assessment Group (CAG), and the RUM Reference Group. The CAG was set up to oversee the implementation of SSA and RUM. The RUM Reference Group oversees the development and implementation of the RUM and reports to the CAG.
The fundamental strategic purpose of the RUM development is to support the provision of better services for Scotland's older people. The RUM-ICADS development introduces for the first time the prospect of obtaining person based information on need and service provision for older people in a standardised format, with coverage extending over the whole of Scotland. It is a substantial step in the development of client level information collected across traditional NHS and local authority boundaries. It will therefore be useful to both health and social care interests, and will provide information across a range of levels from front-line practitioners to a Scotland-wide level. For example:
At local level:
support for strategic planning and the development of jointly delivered services, caseload management, benchmarking for best value and local resource allocation; and
the provision of a source of regularly updated information for local authorities and their health partners to use together.
At national level
a more complete insight into the needs characteristics of older people receiving services across the whole of Scotland;
a means for identifying and reviewing differences and similarities between different parts of Scotland by matching levels of service provision to need; and
supporting balance of care work and national benchmarking associated with best value approaches.
IT Considerations
From the outset the RUM development team has been considering methods of delivery of the RUM-ICADS information requirements by electronic means. With the emergence of the eCare Programme it is apparent that this technology would offer an effective means of sharing the RUM data between practitioners. Despite this it is acknowledged that the proposed data strategy will make significant demands on the IT systems being used within Councils and partnerships to support the assessment process. In parallel with the consultation, discussions will be held with Carenap/eCare project teams to explore ways of minimising the impact on local IT systems, for example, the possibility of incorporating the RUM into a Networked Carenap and developing a web front-end. This would enable the RUM to be integral to the assessment.
What are we asking?
We ask that you share this paper with your constituents and feed back comments to the Joint Future Unit by 29 September. We would particularly welcome your comments on:
1. The potential uses of the aggregated RUM-ICADS information
Locally
Nationally
2. The linkages across the RUM-ICADS data set and with other sources for effective local planning purposes (see paragraphs 10, 11 and 17-22 of the paper).
3. Whether the data set ( at appendix 1 of the paper):
is clear?
is feasible and useful to collect?
is useful for local planning?
4. Whether the proposed data set is seen as essential information to have locally within each partnership. This question is based on the principle that national information should be built upon the information required to manage and plan services at the local partnership level.
5. Phased introduction of data summary. It is recognised that all the data items in the proposed RUM-ICADS may not be readily available in the short term. For this reason, it will be necessary to consider the possibility of phasing the introduction of the data summary. Thus, for example, some of the information from data item 15-20 may need to be introduced at a later date. Please therefore indicate which elements of the data set (item 1-20, appendix 1) partnerships would consider essential locally for planning purposes and feasible to collect in the short term.
Where to send comments
Please could you send comments on the consultation paper by 29 September 2003 to:
Derick Wilson
Joint Future Unit
Scottish Executive Health Department
St Andrew's House
Regent Road
Edinburgh EH1 3DG
Email: Derick.J.Wilson@scotland.gsi.gov.uk
Questions on points of detail in the consultation paper should be addressed to Winona Samet on 0131-244 5317 ( Winona.Samet@scotland.gsi.gov.uk) or Brenda Kerr on 0131-244 3744 ( Brenda.Kerr@scotland.gsi.gov.uk).
Electronic copies of this letter and the consultation paper can be found at www.scotland.gov.uk/views/views.asp.
Comments will be assumed to be accessible publicly through a file held in the Scottish Executive's library unless you request otherwise.
Yours sincerely
Adam Rennie
J A RENNIE
JOINT FUTURE: DATA STRATEGY FOR THE RESOURCE USE MEASURE (RUM) 1 AND THE INTEGRATED CARE ASSESSMENT DATA SUMMARY (RUM-ICADS)
Introduction
1. This paper provides a strategic overview of the development of the Resource Use Measure Integrated Care Assessment Data Summary (RUM-ICADS), which consists of RUM and associated data derived from the Single Shared Assessment (SSA) process. The RUM is currently being implemented in 5 local area partnerships across Scotland, as a first stage towards full national coverage. This paper outlines the importance of RUM-ICADS information through its potential to inform decisions at different organisational levels, from front-line practitioners to national level. The paper also outlines some of the issues for collating RUM-ICADS information to enable its effective use in the immediate future and in the longer term.
2. The fundamental purpose of the RUM-ICADS development is to support the provision of better services for Scotland's older people. This paper begins the task of developing a comprehensive information strategy based around the RUM-ICADS dataset.
Background
3. The development of the Resource Use Measure (RUM) was led by professional staff at the Joint Future Unit of the Scottish Executive, working in partnership with information specialists in ISD Scotland and, crucially, with a range of local authority and health staff from across Scotland. A report on the development was accepted by Scottish Ministers and published on 24 September 2002. Subsequently the Joint Future Ministerial Group agreed on 23 January 2003 that the RUM should become a key element in the Joint Future programme for older people. Details were contained in the "Next Steps" letter recently issued by the Scottish Executive in February 2003.
4. The RUM is currently being implemented in 5 sites 2 across Scotland as part of an overall plan that all areas begin using the RUM by the end of 2003-04. The plan assumes that after full implementation all single shared assessments (SSA) of people aged 65 and over in Scotland should have a RUM grouping assigned. These assessments are usually carried out in conjunction with services being provided, and re-assessments made if clients' levels of need or circumstances change significantly. Clients should be re-assessed annually in any case. The assumption is that the RUM should be completed on each occasion, giving a score and relative need grouping.
5. The RUM should not be seen as a stand-alone application - from the outset of development it has been firmly embedded in the Single Shared Assessment (SSA) process and is an important component of the Joint Future Agenda for older people. Standardised information, collected uniformly across Scotland using agreed guidelines and positioned cohesively alongside the SSA requirements, will allow for better informed decision making at a variety of levels.
6. The strategy assumes that information will be collected on clients receiving support or care in a mixture of settings, from their own homes with informal carer input, through to supported housing and care homes.
7. It is envisaged that data requirements will be comprehensive, providing details on care setting (e.g. own home, sheltered housing, care home), type of service provided and details of the clients, including levels of need (i.e. the RUM score).
8. The RUM-ICADS development introduces for the first time the prospect of obtaining person based information on need and service provision for older people in a standardised format with coverage extending over the whole of Scotland. It is a substantial step in the development of client level information collected across both traditional NHS and local authority boundaries. It will therefore be useful across health and social care interests, and provide information across a range of levels from front-line practitioners to a Scotland-wide level.
Informing Service Teams
9. At service team level the RUM will provide a client level summary complementing the more detailed and descriptive information obtained through the SSA. The changing needs of a client over time will be documented in detail through the SSA and in a concise standardised format through the RUM. The data compiled from the RUM scores when linked to other key service information will become an important resource to assist local teams to monitor service effectiveness, review workload and plan for future service demand.
At Local Level
10. At local level (local authority, unified health boards and partnership bodies) data aggregated from the RUM-ICADS will provide an important source of information to support strategic planning and the development of jointly delivered services, caseload management, benchmark for best value and local resource allocation. This data will become an essential component in monitoring progress on joint working locally and in informing discussions about the balance of service provision in local areas.
11. The use of personal identifiers for records allows the possibility of the elimination of double counting of care episodes and hence the assembling of service users' care histories. This would contribute to the development of a more integrated care service in the longer term. A more detailed discussion on linkages across RUM-ICADS is included in paras 17-22.
At National Level
12. The potential uses of RUM-ICADS data at a national level will be subject to careful, measured discussion and dialogue with all key stakeholders. Nationally compiled information based on the RUM-ICADS has the potential to offer a number of distinct benefits. The national standardised approach contributes at both local level and national level to:
a more complete insight into the needs characteristics of older people receiving services across the whole of Scotland;
a means for identifying and reviewing differences and similarities between different parts of Scotland by matching levels of service provision to need;
supporting balance of care work and national benchmarking associated with best value approaches;
the provision of a source of regularly updated information for local authorities and their health partners to use together.
13. The RUM-ICADS information (see para. 22 and 23) would also support, for example, monitoring of the longer term impact of the Joint Future Agenda and would help inform the development of future policies for older people. Issues such as the variation in services provided and quality of access for people with similar needs may be explored using the RUM-ICADS data. Another possibility referred to in the original RUM report 1 is, over time, and with discussion and agreement from all the relevant stakeholders, the exploration of whether - and how - RUM-ICADS data may inform resource allocation.
Use of the RUM in Care Homes
14. The Scottish Commission for the Regulation of Care (the Care Commission) has expressed an interest in working with the Scottish Executive in using the RUM to inform staffing levels in care homes, although this is not the immediate priority for the implementation of the RUM. Further discussion is planned with the Care Commission to agree a possible timetable for this project.
15. It is acknowledged that there are overlaps with the interviewer-based dataset on Scottish Care Resource Utilisation Groups (SCRUGS) and ISD Scotland will review the possible harmonisation of RUM and SCRUGS data.
16. Note that the new Scottish Care Home Census return (introduced for period ending 31 March 2003), which will be conducted biannually by the Scottish Executive on a multi-agency basis, will also include a question about the RUM score for all long-stay residents on the census night. This will be used in a complementary way to the RUM-ICADS information to provide snapshot information about care home residents.
Linkages Across RUM-ICADS Data, and with Other Data Sources
17. When the needs of an individual change the person will require review or re-assessment. The linking of RUM-ICADS over time (internal linkage) offers the prospect of describing an individual's care history.
18. Important insights are also possible however from linking RUM-ICADS to other related information (external linkage). For example linkage to repeat emergency hospital admissions and/or delayed discharges from hospital, may provide information that can inform the development of strategies to avoid hospitalisation where this is not clinically necessary.
19. These potential uses, based on linked records, will only be possible if certain person-unique information is included in the national data set and it is essential that procedures for collection of such data must be consistent with the various legal and ethical requirements that apply.
20. Once the necessary confidentiality safeguards are in place it becomes possible to envisage, in the longer term, the prospect of the development of comprehensive care records for patients. Such data might describe the older person's journey of care from the community through the NHS and back into a care home or supported in the community.
21. The development of outcome and quality measures - e.g. waiting times, appropriateness of placement decisions, success in maintenance of independence, would also be facilitated by the availability of such data.
22. It is emphasised however that in addition to ensuring the safeguards mentioned above are in place, the complexity of linking data will require substantial development, testing and liaison with key stakeholders.
RUM-ICADS Draft Dataset
23. Detailed preparatory work has already been carried out to specify a possible common standard data set that could be used alongside the RUM scores to provide a comprehensive view of each client following a SSA. The content of the draft RUM-ICADS is the product of consultation with representatives from the five shadow implementation sites, 2 with supporting input from the Scottish Executive and ISD Scotland. The proposed content is listed at Appendix 1. It includes personal details (age, sex, postcode of residence), current situation (own home, sheltered housing, etc.), any underlying problems (e.g. dementia), details of services to be provided, carer details, and the RUM score.
24. It is recognised that all the data items in the proposed RUM-ICADS may not be readily available in the short term. For this reason, the possibility of phasing the introduction of the data summary will be necessary. Thus, for example, some of the information from data item 15 and higher may need to be introduced at a later date.
Electronic Processing of Data
25. From the outset the RUM development team has been considering methods of delivery of the RUM-ICADS information requirements by electronic means. With the emergence of the eCare Programme it is apparent that this technology would offer an effective means of sharing the RUM data between practitioners. Despite this it is acknowledged that the proposed data strategy will make significant demands on the IT systems being used within Councils and partnerships to support the assessment process. In parallel with the consultation, discussions will be held with Carenap/eCare project teams to explore ways of minimising the impact on local IT systems, for example, the possibility of incorporating the RUM into a Networked Carenap and developing a web front-end. This would enable the RUM to be integral to the assessment.
26. The mechanisms for the collection of RUM data should be integrated into local systems supporting case management and SSA. The assumption is that data will be held and extracted electronically for subsequent local, authority or national use. As part of their role in early implementation, South Lanarkshire, East Renfrewshire, Orkney, and Perth & Kinross are beginning to develop such systems. Data sharing between councils and NHS organisations, supported by the E-biz 2000 middleware, creates the potential for RUM-ICADS data to be available for automatic extraction and transmission for local and national information purposes.
Interim Arrangements
Alternative Electronic Systems
27. Because of the lengths of time often involved in developing new integrated systems, it may be necessary to consider other interim solutions if the RUM-ICADS information detailed in this paper is to be available in the shorter term. Collated information would depend on other arrangements being made to extract data pre-punched into local electronic systems (e.g. by writing and supporting extraction software) or, where data can only be collected on paper, by establishing arrangements for data entry of paper forms.
28. One possible example of a technical solution to capture RUM-ICADS scores electronically would be to develop a web-based system with reporting facilities built in for analytical output. Such a system properly supported would require local availability of PCs with internet access and a standard browser. One important advantage of this approach is that IT support costs would be minimised. It is also feasible using this kind of approach to develop an on - line programme to enable practitioners to complete and calculate the RUM scores and relative need groupings for individuals electronically.
Paper Systems
29. It is estimated that approximately 10,000 RUM "forms" will be completed per month, once the RUM is fully implemented across Scotland. In the absence of electronic systems at present it is worth considering whether, very much as an interim measure, a paper based method might be employed to gather the required dataset in some areas.
30. The use of optical character recognition (OCR) processing of paper forms is one possible solution. It is not without its problems and its viability would need to be tested. OCR has obvious benefits in that it does not require staff responsible for completing the RUM to have access to a PC. It minimises the cost of data entry and ensures speedy data processing.
The Development of Data Quality Assurance Arrangements
31. In accordance with normal arrangements for collecting data, responsibility for the quality of data lies at a local level. In line with best practice, establishing arrangements for occasional quality review is beneficial to both local staff and to other users of the data. It is proposed that the implementation of the RUM-ICADS should be supported by a programme of Data Quality Assurance (DQA), involving regular (perhaps annual) quality reviews to check consistency and maintain standards.
32. Initially, DQA might involve a dedicated group of staff who would visit local teams by arrangement and would compare the completed RUM-ICADS data against the SSA and other relevant sources. In the longer term it may be preferable to establish arrangements locally to carry out DQA checks internally. Less frequent National DQA data audit may still be required to assure that the RUM-ICADS is used consistently, in order to maintain confidence in the reliability of the data across Scotland.
1 see "Report on the development of a Resource Use Measure (RUM) for Scotland" (2002); Scottish Executive. http://www.scotland.gov.uk/health/jointfutureunit2 East Renfrewshire, Glasgow, Orkney, Perth and Kinross and South Lanarkshire
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