nhs spending priorities
DESCRIPTION
NHS Spending Priorities. Sue Bishop, Tim Daniel, Sue Cavill and Jo Tyler. Sue Cavill Associate Director Communications and Engagement NHS Leicestershire County and Rutland. Introductions. Housekeeping. Refreshments Toilets Fire Escape Introductions Note paper Questions Blue Card. - PowerPoint PPT PresentationTRANSCRIPT
NHS Spending Priorities
Sue Bishop, Tim Daniel, Sue Cavill and Jo Tyler
Sue Cavill Associate Director Communications and
EngagementNHS Leicestershire County and Rutland
Introductions
Housekeeping
Jo TylerEngagement Manager
NHS Leicester City
Quiz time
Some Test Questions
We are going to practice using the vote pads, we will ask some questions and would like you to select which of the following you consider yourself to be.
What gender are you?
1 Male2 Female3 Prefer not to say
10
10
What age range are you?If you prefer not to say, please don’t
vote
1 Under 162 16-193 20-294 30-395 40-496 50-597 60-698 70-799 80+
1 Yes2 No3 Prefer not to say
Do you consider yourself to have a disability?
10
10
What ethnicity are you?
1 Asian or Asian British2 Black or Black British3 Dual or Mixed Heritage4 Chinese5 White6 Other7 Prefer not to say
Quiz
10
How much do you think the local NHS spends per person, per year?
1 £1,6002 £8,0003 £20,000
Local NHS has £1,600 to spend per person, per year.
What do you think the cost per treatment is for....
10
Minor ear operation per operation (such as Grommets)
1 £2002 £4003 £700
£700
10
Tonsillectomy per operation
1 £5752 £1,0443 £2,875
£1,044
10
Hip replacement per operation
1 £5,4592 £6,7893 £7,773
£5,459
10
Knee replacement per operation
1 £4,2382 £5,4563 £748
£5,456
10
Cataracts cost for each eye
1 £2022 £5123 £748
£748
10
Varicose veins per operation
1 £3902 £9723 £1,632
£972
10
The average cost of an overnight stay in hospital
1 £1202 £2503 £480
£250
10
The minimum cost of being seen in the emergency department
1 Free2 £353 £52
£52 up to £188
10
The NHS to give you a prescription of 32 Aspirin tablets?
1 70p2 £1.853 £2.50
£1.85
10
28 tablets of 20mg Atorvastatin, a common cholesterol lowering drug
1 £5.892 £10.523 £24.64
£ 24.64
Sue BishopDirector of Finance
NHS Leicestershire County and RutlandA snapshot of NHS finances
How much do we have to spend in 2010/11?
NHS LEICESTER CITY (NHSLC)
£M
NHS LEICESTERSHIRE COUNTY & RUTLAND
(NHSLCR)£M
TOTAL LLR £M
Money received in 2010/11
£553.4 £945.1 £1,498.5
Investment in healthcare services
£547.3 £934.7 £1,482.0
Surplus at year end £6.1 £10.4 £16.5
What are we spending it on?
NHS Leicester
City£M
NHS Leicestershire
County and Rutland £M
Total (LLR)£M
Acute hospitals - UHL £210.2 £282.6 £492.8
Acute hospitals - other £20.6 £112.3 £132.9
Non Acute – mental health, community services, learning disabilities, ambulance
£139.7 £226.2 £365.9
Continuing healthcare £17.7 £35.7 £53.4
Primary Care £76.4 £141.5 £217.9
Prescribing £49.2 £93.4 £142.6
Corporate costs £33.5 £43.0 £76.5
TOTAL INVESTMENT £547.3 £934.7 £1,482.0
How will the money change in 2011/12?
CHANGES IN MONEY AVAILABLE £m EXTRA COSTS THAT WILL OCCUR £m
Additional funding from the government +45.1 Inflation (2.5% less 4%) +3.7
To be put aside in accordance with DH requirements
-£28.2 Growth in demand seen in 2010/11 -12.8
To be transferred to Local Authorities for investment in re-ablement
-£11.0 Growth in demand expected in 2011/12 -22.5
Realignment of expenditure budgets to release additional resource
+£10.4 The full impact of services that started in 2010/11
-16.2
Investment in new priorities outlined in the operating framework
-14.1
ADDITIONAL MONEY AVAILABLE IN 2011/12
£16.3 EXCESS OF COSTS OVER ADDITIONAL MONEY AVAILABLE
-£45.6
How will we address the gap?
• Look to reduce the price we pay• Find ways to reduce demand for services• Change the way services are delivered so that they
can be provided at a reduced cost• Reduce expenditure on “back office” costs• Target investment at those areas where there is
most health gain• Reduce investment in areas where there is little or
no clinical evidence to support the continuation of services
5 High Impact QIPP
schemes£12.472m
£45.611m productivity & savings
programme
TransformingCommunity Services
£2.764m
Mental Health savings£926k
30% management cost reduction
£7.187m
Prescribing – LLR formulary part
of £5.706m
Review of service developments 2008-2012 andother 2011/12 proposals for price and volume savings,
service redesign and efficiencies £12.994m
Prescribingother - balance
of £5,706k
Primary Care
£2.662m
LLREstates £500k
Shared Back Office Services in
IM&T and FM £400k
What might this mean?
Dr Tim DanielConsultant in Public Health Medicine
NHS Leicestershire County and Rutland
How we make our spending choices
Key Considerations
All Choices:• Are difficult but have to be made• Are complex, you’re not comparing ‘like with like’• Based on reliable evidence – where available• Always involve value judgements• Use the same budget, so the best alternative
needs to be considered• Must avoid the ‘rule of rescue’
Rule of Rescue
• A natural human response• E.g. Air sea rescue/Chilean miners• The tendency is to offer health care to
identifiable people in life threatening situations over others who are unseen and who have less urgent needs e.g. Cancer drugs vs. prevention
Principles
• Rational• Fair• Consistent• Transparent• Legal
Where does health care take place?
What are the main causes of death in Leicestershire?
Effective heart disease prevention
What is the most effective prevention in reducing deaths from heart disease?• Deaths from heart disease halved from 1981 to 2000 • 1,200 fewer deaths per year in Leicestershire• 80% of this reduction was in people not known to
have heart disease• 20% in those with heart disease
• For those with heart disease:– 2/3 through lifestyle changes – only 1/3 through medical treatment
• Overall, 24 out of every 25 deaths prevented was due to changes made outside a hospital
Capewell S BMJ. 2005 Sep 17;331(7517):614. Epub 2005 Aug 17
Effective heart disease prevention
Services providing the most health benefit per pound spent
The cost to save one year of life for patients with heart disease:Aspirin £30-£50Stop smoking £50-£300‘Clot buster’ drugs £3,000Statin drugs £7,000Angioplasty £33,000Implantable Defibrillators £110,000
Death rates from heart disease in Leicestershire
There are big differences....
• You are twice as likely to die from heart disease before age 75 in Coalville than you are in Rutland
• You are twice as likely to die from heart disease before age 75 in Stoneygate than you are in Knighton
Life expectancy for males in Leicestershire
Life expectancy of females in Leicestershire
There are big differences…
• A woman will live 10 years longer in Oakham (87) than in Coalville (77)
• A man will live 5 years longer in Knighton (79) than in Stoneygate (74)
A Framework for Prioritisation
• Does the treatment deliver a health benefit?– Improving life expectancy– Improving or maintaining quality of life
• How much does it cost for that health benefit?• Is the benefit targeted at those in greatest
need?• How many people will benefit?
Thank you
Refreshment Break
Jo TylerEngagement Manager
NHS Leicester City
Workshop 1
Treatments to discuss
1. Wisdom tooth extraction2. Stop smoking service3. Alcohol Harm Reduction4. Hip Replacement surgery5. Bowel Cancer screening programme6. New cancer drug for bowel cancer (Avastin)7. Kidney Transplant8. Improving Access to Psychological Therapies
Sue CavillAssociate Director Communications and
EngagementNHS Leicestershire County and Rutland
Findings from workshop
Agree or Disagree
Please select whether you agree, disagree or don’t know for each of the following
statements
10
If you live a healthy lifestyle you have more right to treatment than someone
who doesn’t1 Agree2 Disagree3 Don’t know
10
The treatments and services you receive have been used by patients before, are very
effective and have been proved to work1 Agree2 Disagree3 Don’t know
10
People who are ill because they are poor should have earlier treatment
than those who are not poor1 Agree2 Disagree3 Don’t know
10
Drugs that are cheaper should be used whenever possible
1 Agree2 Disagree3 Don’t know
10
I might be willing to wait for a minor operation if it meant someone could
have life-saving surgery1 Agree2 Disagree3 Don’t know
Dr Tim DanielPublic Health Consultant
NHS Leicestershire County and Rutland
More information about the eight treatments
Workshop 2
• 8 treatments to consider but only a limited budget ( fixed no. of counters to ‘spend’)
• For each treatment:– Brief description– The relative cost to treat one person – The relative health benefit for one person-either
increased life expectancy, or quality of life, or both
• Discuss on your table and decide which treatments will receive your counters now
Treatments
1. Wisdom tooth extraction2. Stop smoking service3. Alcohol Harm Reduction4. Hip Replacement surgery5. Bowel Cancer screening programme6. New cancer drug for bowel cancer (Avastin)7. Kidney Transplant8. Improving Access to Psychological Therapies
A Framework for Prioritisation
• Does the treatment deliver a health benefit?– Improving life expectancy– Improving or maintaining quality of life
• How much does it cost for that health benefit?• Is the benefit targeted at those in greatest
need?• How many people will benefit?
Thank you and closing remarks