Making better decisions on public health spending: A Scottish perspective
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Transcript of Making better decisions on public health spending: A Scottish perspective
Making better decisions on public health spending: A
Scottish perspectiveNeil Craig
NHS Health Scotland
Making better decisions on public health spending: Getting to grips with value for money
The King’s Fund18th September 2014
Outline
• The context for public health spending in Scotland?
• The role of NHSHS• The wider health system• How are these arrangements working in
practice? • Looking ahead
Context
• Improving health….• …..but persistent and widening health
inequalities• Financial pressures• Emphasis on prevention
What is NHS Health Scotland?
• NHS Special Health Board• Role: national agency for health improvement• Priority: reducing health inequalities• Aim: to improve Scotland’s overall health
record by focusing on the persistent inequalities that prevent health being improved for all
Local delivery…..• Delivered by Community Planning Partners• Configured in Community Planning
Partnerships • Expressed in Single Outcome Agreements
…… National direction • Directed by Scottish Government through
- statement of ambition and community planning guidance- National Community Planning Group- broad priorities
Priorities - strategic
• Faster shift to prevention• More joint resourcing• Co-production and assets-based approaches
Priorities - specific
• Early Years• Outcomes for Older People (including health
and social care)• Safer Communities and Offending• Health Inequalities (including physical activity
opportunities)• Economic Growth and Recovery• Employment (especially youth employment)
In practice?
• Community planning: a work in progress• National steer vs local freedoms: is the
balance right? • Multiple objectives of prevention:
- are they shared?- are they mutually compatible?
Cost-effective/VFM Likely to reduce health inequalities
Potential savings from reduced ‘failure demand’
Building relationships
• With SGs, CPPs and 3rd sector• With COSLA e.g. through an Inequalities Action
Group• Through a knowledge-into-action strategy• Through a SG-sponsored Health Economics
Network for Scotland
=> Early days
Themes
• Balance between central guidance and local autonomy?
• Local implications of national (or international) evidence?
• Complexity vs accessibility
“Tell us, clearly, what the evidence says we should be doing but don’t tell us what to do…..”