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