nick hex, associate director, york health economics consortium
TRANSCRIPT
Providing Consultancy &
Research in Health Economics
Providing Consultancy &
Research in Health Economics
Nick Hex
Associate Director
York Health Economics Consortium
Closing the funding gap
Providing Consultancy &
Research in Health Economics
The NHS success story…
Reductions in premature deaths from heart disease, cancer,
strokes and respiratory disease
People living longer
Previously life-threatening conditions can be managed
Reduced risk factors (smoking)
Medical advances (drugs, surgical procedures & diagnostic
techniques)
Providing Consultancy &
Research in Health Economics
…leads to increasing demand
Growth in older population
Increased life expectancy equates to increased years of ill health
Increase in LTCs and multi-morbidities
Increased risk factors (obesity, alcohol)
Higher expectation among patients and greater choice
Providing Consultancy &
Research in Health Economics
The need for change
Source: The King’s Fund
Providing Consultancy &
Research in Health Economics
What does the NHS need?
Source: The King’s Fund
Providing Consultancy &
Research in Health Economics
Closing the funding gap
Opportunities include:
Improving productivity within existing services
Delivering the right care in the right setting
Developing new ways of delivering care
Allocating spending more rationally
Monitor (Oct 2013): Closing the NHS funding gap: how to get better value healthcare for patients
Providing Consultancy &
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Five year forward view
“How can we get there”:
Diverse solutions and local leadership
Aligned national NHS leadership
Support for a modern workforce
Exploit the information revolution
Accelerate useful health innovation
Drive efficiency and productive investment
Providing Consultancy &
Research in Health Economics
What is productivity?
“Productivity measures the ratio of the amount of output produced to the amount of input used to produce the output. The fewer inputs used for a given amount of output, the higher is productivity.The amount of NHS output comprises the number and type of patients treated in different healthcare settings, the quality of the care received and measures of the success of treatment. NHS input includes NHS and agency staff, equipment and supplies, and buildings.”
Source: University of York,
Centre for Health Economics
Providing Consultancy &
Research in Health Economics
Productivity savings 12-13
Source: King’s Fund
Tariff efficiency, £2,400m
Admin, £163m
Pay freeze, £850m
Prescribing, £472m
Primary care, £194m
Other, £757m
£5.04bn QIPP
saving
Demand mgmt,
£200m
Providing Consultancy &
Research in Health Economics
Productivity change 1996-2009
Source: Hardie et al. 2011
-2.5
-2
-1.5
-1
-0.5
0
0.5
1
1.5
2
96 97 98 99 00 01 02 03 04 05 06 07 08 09
An
nu
al
% c
ha
ng
e
Providing Consultancy &
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BHBV indicators 13-14
Source: NHS Improving Quality
0 200 400 600 800 1000 1200 1400
Pre-procedure elective bed days
Increasing day surgery rates
Managing surgical thresholds
Pre-procedure non-elective bed days
Outpatient appointment DNA
Emergency readmission (14 days)
Reducing emergency admissions
Managing first follow up
Reducing length of stay
Reducing outpatient appointments
£ millions
Total: £5.6bn
Providing Consultancy &
Research in Health Economics
Productivity ideas
“Evidenced ideas”:
DescriptionExamples of
improvements
Self-management
Patient-led support for
sufferers of chronic
diseases
Improved health
outcomes; financial
savings
Telehealth/telecare
Broad range of telehealth/
telecare interventions for
older frail people
69% reduction in A&E
attendances; reduced
length of inpatient stay for
nursing home patients
Case management and
coordinated care
Integrated care pilots using
case management
Reduced secondary care
useSource: King’s Fund (adapted from NHS England ‘Any town’)
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Productivity ideas
“Promising ideas”:
DescriptionExamples of
improvements
Cancer screening
Increase public awareness
of cancer to encourage
earlier presentation
Better health outcomes
GP consultationTelephone consultations
with a GP
Reduced A&E attendances;
reduced work pressure on
GPs
Acute visiting serviceRapid access doctor for
acute care at home
Reduced emergency
admissions; improved
patient satisfaction
Source: King’s Fund (adapted from NHS England ‘Any town’)
Providing Consultancy &
Research in Health Economics
Productivity ideas
“Transformational ideas”:
DescriptionExamples of
improvements
Urgent and emergency
care networks
Consolidation of
emergency care onto
fewer sites
Reduced patient
complaints; improved
patient safety
Elective servicesSingle specialty treatment
centres
Higher consultant
productivity; reduced LOS
and waiting times
Interoperability of systems
and patient records
Cross-sector sharing of
patient records
Time savings for GPs;
better resource planning
Source: King’s Fund (adapted from NHS England ‘Any town’)
Providing Consultancy &
Research in Health Economics
Forward View forecast
A mismatch of £30bn by 2020/21
Demand is rising – can it be moderated?
Efficiency achievement around 0.8% per annum
1.5% should be achievable but aim is for 2% or even 3% per
annum
But it needs productive investment to support new models of care
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Research in Health Economics
3 scenarios
Based on a flat budget for the next 5 years:
0.8% efficiency achieved – shortfall of £21bn remains by 2020/21
1.5% efficiency achieved – shortfall of £16bn remains by 2020/21
Productive investment in new care models supports demand
reduction and allows efficiency gains of 2-3% per annum –
funding gap is closed
Providing Consultancy &
Research in Health Economics
Providing Consultancy &
Research in Health Economics
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