Making better decisions on public health spending: A

Scottish perspectiveNeil Craig

NHS Health Scotland

Making better decisions on public health spending: Getting to grips with value for money

The King’s Fund18th September 2014

Outline

• The context for public health spending in Scotland?

• The role of NHSHS• The wider health system• How are these arrangements working in

practice? • Looking ahead

Context

• Improving health….• …..but persistent and widening health

inequalities• Financial pressures• Emphasis on prevention

What is NHS Health Scotland?

• NHS Special Health Board• Role: national agency for health improvement• Priority: reducing health inequalities• Aim: to improve Scotland’s overall health

record by focusing on the persistent inequalities that prevent health being improved for all

Local delivery…..• Delivered by Community Planning Partners• Configured in Community Planning

Partnerships • Expressed in Single Outcome Agreements

…… National direction • Directed by Scottish Government through

- statement of ambition and community planning guidance- National Community Planning Group- broad priorities

Priorities - strategic

• Faster shift to prevention• More joint resourcing• Co-production and assets-based approaches

Priorities - specific

• Early Years• Outcomes for Older People (including health

and social care)• Safer Communities and Offending• Health Inequalities (including physical activity

opportunities)• Economic Growth and Recovery• Employment (especially youth employment)

In practice?

• Community planning: a work in progress• National steer vs local freedoms: is the

balance right? • Multiple objectives of prevention:

- are they shared?- are they mutually compatible?

Cost-effective/VFM Likely to reduce health inequalities

Potential savings from reduced ‘failure demand’

Building relationships

• With SGs, CPPs and 3rd sector• With COSLA e.g. through an Inequalities Action

Group• Through a knowledge-into-action strategy• Through a SG-sponsored Health Economics

Network for Scotland

=> Early days

Themes

• Balance between central guidance and local autonomy?

• Local implications of national (or international) evidence?

• Complexity vs accessibility

“Tell us, clearly, what the evidence says we should be doing but don’t tell us what to do…..”