Post on 30-May-2015
Financially challenged
Dr Jennifer Dixon
Nuffield Trust
1
Sources: HM Treasury (Roger Bootle)
Government Spending by Department (FY2007/08)
Social Security
27%
Health16%
Education13%
Scotland, Wales and NI
9%
Defence7%
Local Govt6%
Home Office3%
Debt Interest5%
Other 14%
2
Planned Increases in Government Spending by Department (Nominal, £bn, FY2007/08-2010/11)
Social Security 29
Health 19
Other 14
Education 13
Debt Interest 10
Scotland, Wales and NI 6
Local Govt. 4
Defence 2
Home Office 2
Total 98Sources: HM Treasury 3
Reasons to be cheerful (1)
4
Use of Resources05/06-07/08
Source: Annual Health check 2007/8, Healthcare Commission 5
Financial Performance of Strategic Health Authorities
Financial Management in the NHS: Report on the NHS Summarised Accounts 2007-08
2007-08
6
2006-07
Financial Performance of Primary Care Trusts
2007-08
Financial Management in the NHS: Report on the NHS Summarised Accounts 2007-08
2006-07
7
Financial Performance of NHS Trusts
8
2007-08
Financial Management in the NHS: Report on the NHS Summarised Accounts 2007-08
2006-07
Financial position of NHS (England) 2008/9 Quarter 3
Source: The Quarter, DH9
2005
/06
to 2
009/
9 (Q
3 Fo
reca
st)
Reasons to be cheerful (2)
10
Annual Health Check: Quality of services
Healthcare Commission
Source: annual health check11
Reasons to be not so cheerful…
• Financial regime tighter• Demand rising
12
Demand rising: inpatientSummary HES inpatient data by month of activity*
Source: NHS Information Centre * 2008-09 data provisional 13
Summary HES outpatient data by month of activity*
Source : NHS Information Centre
Demand rising: outpatients
* 2008-09 data provisional14
Demand rising: consultations in general practice
0
50,000,000
100,000,000
150,000,000
200,000,000
250,000,000
300,000,000
350,000,00019
95
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
Con
sulta
tions
Financial Year
Number of consultations in general practice 1995-2006
Total GP
Total
Source: NHS Information Centre15
Demand rising: drugsExpenditure on prescription drugs has increased over
the last decade
16From: National Audit Office report: Prescribing costs in primary care, 2007.
The answer?
17
Source: King’s Fund
18
NHS Production Pathway
Areas for scrutiny
• Budget areas
1919
Source: King’s Fund 20
Number of NHS activity categories and estimates shares of NHS spending, 2005/6
Local variations in NHS spending prioritiesFigure 1: Total spending* by PCTs on programmes in 2004/5
21* An additional category, 'Other', is not included in the figure. This captures around £15.5 billion of spending out of the £53 billion for 2004/5. Source: King’s Fund
Areas for scrutiny
• Budget areas• Productivity
22
23
Trends in Emergency and Elective admissions per Consultant (FTE*) 1999 /2000 to 2005/6
•Full time equivalent•Source: King's Fund analysis; Hospital Episode Statistic 2007; Information Centre 2007
24
Ranked Activity (case mix adjusted)* per consultant in General Surgery, 2004/5 data
ANONYMOUS HOSPITAL NHS TRUST
Source: Delivering Quality and Value: Consultant Clinical Activity - University of York and Department of Health
25
Potential prescribing efficiency savings in primary care, by PCT (England) 2007
Areas for scrutiny
• Budget areas• Productivity• Outcomes
26
27
Age-sex standardised admission rate for COPD (ICD-10 J40 to J44) by PCT – emergency admissions only – 2000/01 to 2001/02
28
Preventable admissions
LOS ICD10 Diagosis AcuteTrust
APR 2002 11 J440 Chronic obstruct pulmonary dis with acute lower resp infec Hospital EMAY 2002 4 J441 Chron obstruct pulmonary dis wth acute exacerbation unspec Hospital EJUL 2002 8 J440 Chronic obstruct pulmonary dis with acute lower resp infec Hospital EAUG 2002 3 I500 Congestive heart failure Hospital FAUG 2002 2 J449 Chronic obstructive pulmonary disease unspecified Hospital FOCT 2002 3 J440 Chronic obstruct pulmonary dis with acute lower resp infec Hospital FOCT 2002 2 J441 Chron obstruct pulmonary dis wth acute exacerbation unspec Hospital GOCT 2002 2 J441 Chron obstruct pulmonary dis wth acute exacerbation unspec Hospital GNOV 2002 4 J441 Chron obstruct pulmonary dis wth acute exacerbation unspec Hospital FDEC 2002 4 J441 Chron obstruct pulmonary dis wth acute exacerbation unspec Hospital GDEC 2002 5 J441 Chron obstruct pulmonary dis wth acute exacerbation unspec Hospital GJAN 2003 1 J441 Chron obstruct pulmonary dis wth acute exacerbation unspec Hospital GFEB 2003 3 J441 Chron obstruct pulmonary dis wth acute exacerbation unspec Hospital G
Month ofAdmission
Where and how to act?
System
Organisation
Team
Practitioner
Piecemeal Comprehensive
29
Where and how to act?
System
Organisation
Team
Practitioner
Piecemeal Comprehensive
Guidance
30
Where and how to act?
System
Organisation
Team
Practitioner
Piecemeal Comprehensive
Guidance On ground help
31
Where and how to act?
System
Organisation
Team
Practitioner
Piecemeal Comprehensive
Guidance On ground help Motivators
32
Where and how to act?
System
Organisation
Team
Practitioner
Piecemeal Comprehensive
Guidance On ground help Motivators
Central directiveRegulationFinancial incentives(threat)
33
Where and how to act?
System
Organisation
Team
Practitioner
Piecemeal Comprehensive
Guidance On ground help Motivators
IT infrastructure
34
Individualised data to guide appropriate intervention
Ongoing, individualised, real time data analysis to guide intervention:
Utilisation and demand management
Care coordination
Risk factor reduction
Source: Humana UK35
Proactive Care Gap ChecklistGaps in the patients care are identified through the use of flags.
If there is a “Y”, an action is needed.
Member Information
36
Source: Kaiser Permanente, SC
What would be evidence of not coping?
• Deficit• Reduced access (geographic,
socioeconomic)• More preventable ill health and mortality
37