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1/10

Disinvestment: some personalviews

David Parkin, Chief Economist

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2/10

How the Indian Government does it .

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3/10

What is disinvestment?

Disinvestment suggests the opposite of investment Investment means resources are used to create future

benefits instead of being used to obtain benefits now So does disinvestment mean obtaining benefits now instead

of creating future benefits?

OF COURSE NOT! It is a euphemism for notusing resourcesfor a particular purpose, whether the benefits are obtainednow, in the future or never

We could more accurately refer to it as deprioritisation, butthat is an even worse euphemism

This matters: the lack of a proper language inhibits discussionof processes for dealing with it; they may not simply be themirror image of those used for investment

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4/10

Is disinvestment being takenseriously?

Next stage review and QIPP

PLUS

A period of significant financial challenge

=

Disinvestment being taken seriously

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5/10

WCC disinvestmentcompetencies (1)

Competency 6: Prioritise investment of all spend in linewith different financial scenarios and according to localneeds, service requirements and the values of the NHS

Sub competency 6B: Prioritisation of investment anddisinvestmentto improve populations health

Sub competency 6C: Incorporation of priorities into

strategic investment plan to reflect different financialscenarios

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6/10

Competency 6

The PCT has defined criteria for evaluating andprioritising investment and disinvestment (B Level 2)

The PCT actively monitors what has happened as a

result of past investment and disinvestment (B Level3)

Mature programme budgeting or equivalent methodologyfor all key priority care pathways/disease groups with

integrated investment and disinvestment plans of upto ~10 years are in place (C Level 4)

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7/10

WCC disinvestmentcompetencies (2)

Competency 7: Effectively stimulate the market to meetdemand and secure required clinical and health andwell-being outcomes

Sub competency 7C: Creation of effective choices forpatients

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8/10

Competency 7

The PCT uses its understanding of the market, andpatient feedback and input to make decisions oninvestment and disinvestment to create more effective

choice(C Level 3) The PCT has clear investment and disinvestment

processes which lead to a mix of providers based onclinically defined cost/quality trade-off (C Level 4)

NB these are the only mentions

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9/10

WCC Governance criteria -Green

Initiatives to ensure delivery of strategic goals and thePCTs programme of change

Initiative investment or disinvestment requirementsare:

Explicit Selected using clear and articulated criteria

Sufficiently developed

The PCT articulates how investments and

disinvestments will change in multiple financial scenarioswith clear rationale considering and stating widerimplications (e.g. for services provided)

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10/10

WCC Governance criteria -Red

Consistency of financial plan with the strategy

The link between investment/ disinvestment decisionsand health outcomes, reduced inequalities, andefficiency and effectiveness of health services is unclear

Investment or disinvestment against each initiative is:

Not explicit by year

Not modelled

Timelines for investment or disinvestment are unclear