NHS Budgets 2011/12

Alan Campbell – NHS Salford

Introduction National Policy for Health

Organisational change

Quality Innovation Productivity and Prevention (QIPP)

Salford Service impact

National Policy for NHS

April 2011 > PCTs merged into Clusters (10>1 GM)

April 2011 > GP Commissioning Pathfinders active

April 2012 > SHA abolished

April 2012 > Health & Well Being Boards

April 2012 > National Commissioning Board

April 2013 > PCTs abolished

April 2013 > Public Health statutorily LG responsibility

April 2013 > GP Commissioners statutory Orgs

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Challenge for PCTs

Reducing Real Time Resources - £

Technology & New Drugs Emerging

Population Health issues— Tobacco

— Alcohol & Drugs

— Obesity

— Lifestyle

Consumer access ‘free service’ issues— Eg Bariatric Surgery

National Context

Funding Growth — ‘c. 0.1% growth next 3 years v 5.2% 10/11

Uniqueness of Health Care inflation

Reducing Management Capacity

Developing GP Consortia

Local Government Funding Reductions

State of The Local Health System

HealthSlow improvement to mortality/morbidity indicesPoor Cancer outcomesThe IndicatorsA&E attendances increasingOutpatient (new) slowingOutpatient (F/up) acceleratingUrgent Admissions increasing (fast!)Elective work volumes stablePrescribing – High volumes but improving cost effectivenessThe system approachIntegrated (Urgent) Care WorkCommunity Services TransformationGP Commissioning now well under wayFinancesRelatively stable now But Pressure Building!!

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Specific Areas For Cost Reductions Hospital Services - £16M annually for 4 years (£64M) Urgent / Unscheduled Care - £7.2M in 3 years Community Services – c£5M in 4 years Drug Budgets - £8M in 4 years Management Costs - £5M in 3 years Total c £90M in 4 years

What it means for patients C 15% real terms reduction in NHS expenditure Greater choice over treatment ‘no decision about me without me’ Greater involvement (co-production) with the public including

determining priorities Leaner ‘back office’ More focus on prevention & early intervention Supporting individuals & communities to manage own health better Health promotion and education at every opportunity Doing what's most cost effective (Prevention is a better investment

than treatment)

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Economics of Health Care Techniques to measure health benefit Quality Adjusted Life Years (QALY)

— Treatment of end stage Diabetes Very expensive— Need to understand cost effectiveness of:— Prevention:

— Lifestyle interventions c £11,600 QALY— Metformin c £15,000 QALY

— Screening— Blood Lipid Secondary Prevention c £22,000 QALY— Retinopathy screening c £17,000 QALY

— Hospital Treatment— Hospital Dialysis c £30,000 QALY— Erythropoietin (EPO) c £50,000 QALY

— Disability and Social Economic Costs !

Questions?