NHS Spending Priorities

1. NHS Spending Priorities Sue Bishop, Tim Daniel, Sue Cavill and Jo Tyler

2. Sue CavillAssociate Director Communications and EngagementNHS Leicestershire County and Rutland Introductions

3. Housekeeping • Refreshments • Toilets • Fire Escape • Introductions • Note paper • Questions • Blue Card

4. Jo TylerEngagement ManagerNHS Leicester City Quiz time

5. 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.

6. What gender are you? • Male • Female • Prefer not to say 10 You have seconds

7. What age range are you?If you prefer not to say, please don’t vote • Under 16 • 16-19 • 20-29 • 30-39 • 40-49 • 50-59 • 60-69 • 70-79 • 80+ 10 You have seconds

8. Do you consider yourself to have a disability? • Yes • No • Prefer not to say seconds 10 You have

9. What ethnicity are you? • Asian or Asian British • Black or Black British • Dual or Mixed Heritage • Chinese • White • Other • Prefer not to say 10 You have seconds

10. Quiz

11. How much do you think the local NHS spends per person, per year? • £1,600 • £8,000 • £20,000 10 You have seconds

12. Local NHS has £1,600 to spend per person, per year. To pay for: • Treatments • Medicines • Equipment • Management of buildings • Running vehicles • Employing staff

13. What do you think the cost per treatment is for....

14. Minor ear operation per operation (such as Grommets) • £200 • £400 • £700 10 You have seconds

15. £700

16. Tonsillectomy per operation • £575 • £1,044 • £2,875 10 You have seconds

17. £1,044

18. Hip replacement per operation • £5,459 • £6,789 • £7,773 10 You have seconds

19. £5,459

20. Knee replacement per operation • £4,238 • £5,456 • £748 10 You have seconds

21. £5,456

22. Cataracts cost for each eye • £202 • £512 • £748 10 You have seconds

23. £748

24. Varicose veins per operation • £390 • £972 • £1,632 10 You have seconds

25. £972

26. The average cost of an overnight stay in hospital • £120 • £250 • £480 10 You have seconds

27. £250

28. The minimum cost of being seen in the emergency department • Free • £35 • £52 10 You have seconds

29. £52 up to £188

30. The NHS to give you a prescription of 32 Aspirin tablets? • 70p • £1.85 • £2.50 10 You have seconds

31. £1.85

32. 28 tablets of 20mg Atorvastatin, a common cholesterol lowering drug • £5.89 • £10.52 • £24.64 10 You have seconds

33. £ 24.64

34. Sue BishopDirector of Finance NHS Leicestershire County and Rutland A snapshot of NHS finances

35. How much do we have to spend in 2010/11?

36. What are we spending it on?

37. How will the money change in 2011/12?

38. 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

39. What might this mean? Shared Back Office Services in IM&T and FM £400k Review of service developments 2008-2012 and other 2011/12 proposals for price and volume savings, service redesign and efficiencies £12.994m 30% management cost reduction £7.187m Primary Care £2.662m 5 High Impact QIPP schemes £12.472m Prescribing – LLR formulary part of £5.706m Prescribing other - balance of £5,706k Transforming Community Services £2.764m £45.611m productivity & savings programme LLR Estates £500k Mental Health savings £926k

40. Dr Tim DanielConsultant in Public Health MedicineNHS Leicestershire County and Rutland How we make our spending choices

41. 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’

42. 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

43. Principles • Rational • Fair • Consistent • Transparent • Legal

44. Where does health care take place?

45. What are the main causes of death in Leicestershire?

47. 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

48. Effective heart disease prevention • 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

50. Services providing the most health benefit per pound spent The cost to save one year of life for patients with heart disease: Aspirin £30-£50 Stop smoking £50-£300 ‘Clot buster’ drugs £3,000 Statin drugs £7,000 Angioplasty £33,000 Implantable Defibrillators £110,000