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NHS Spending Priorities. Sue Bishop, Tim Daniel, Sue Cavill and Jo Tyler. Sue Cavill Associate Director Communications and Engagement NHS Leicestershire County and Rutland. Introductions. Housekeeping. Refreshments Toilets Fire Escape Introductions Note paper Questions Blue Card.

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Nhs spending priorities

NHS Spending Priorities

Sue Bishop, Tim Daniel, Sue Cavill and Jo Tyler


Sue cavill associate director communications and engagement nhs leicestershire county and rutland

Sue CavillAssociate Director Communications and EngagementNHS Leicestershire County and Rutland

Introductions


Housekeeping
Housekeeping

  • Refreshments

  • Toilets

  • Fire Escape

  • Introductions

  • Note paper

  • Questions

  • Blue Card


Jo tyler engagement manager nhs leicester city

Jo TylerEngagement ManagerNHS Leicester City

Quiz time


Some test questions
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
What gender are you?

  • Male

  • Female

  • Prefer not to say

10

You have

seconds


What age range are you if you prefer not to say please don t vote
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


Do you consider yourself to have a disability?

  • Yes

  • No

  • Prefer not to say

seconds

10

You have


What ethnicity are you
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



How much do you think the local nhs spends per person per year
How much do you think the local NHS spends per person, per year?

  • £1,600

  • £8,000

  • £20,000

10

You have

seconds


Local nhs has 1 600 to spend per person per year
Local NHS has £1,600 to spend per person, per year. year?

To pay for:

  • Treatments

  • Medicines

  • Equipment

  • Management of buildings

  • Running vehicles

  • Employing staff



Minor ear operation per operation such as grommets
Minor ear operation per operation (such as Grommets) year?

  • £200

  • £400

  • £700

10

You have

seconds


£700 year?


Tonsillectomy per operation
Tonsillectomy per operation year?

  • £575

  • £1,044

  • £2,875

10

You have

seconds


1 044
£1,044 year?


Hip replacement per operation
Hip replacement per operation year?

  • £5,459

  • £6,789

  • £7,773

10

You have

seconds


5 459
£5,459 year?


Knee replacement per operation
Knee replacement per operation year?

  • £4,238

  • £5,456

  • £748

10

You have

seconds


5 456
£5,456 year?


Cataracts cost for each eye
Cataracts cost for each eye year?

  • £202

  • £512

  • £748

10

You have

seconds


£748 year?


Varicose veins per operation
Varicose veins per operation year?

  • £390

  • £972

  • £1,632

10

You have

seconds


£972 year?


The average cost of an overnight stay in hospital
The average cost of an overnight stay in hospital year?

  • £120

  • £250

  • £480

10

You have

seconds


£250 year?


The minimum cost of being seen in the emergency department
The minimum cost of being seen in the emergency department year?

  • Free

  • £35

  • £52

10

You have

seconds



The nhs to give you a prescription of 32 aspirin tablets
The NHS to give you a prescription of 32 Aspirin tablets? year?

  • 70p

  • £1.85

  • £2.50

10

You have

seconds


£1.85 year?


28 tablets of 20mg atorvastatin a common cholesterol lowering drug
28 tablets of 20mg Atorvastatin, a common cholesterol lowering drug

  • £5.89

  • £10.52

  • £24.64

10

You have

seconds


24 64
£ 24.64 lowering drug


Sue bishop director of finance nhs leicestershire county and rutland

Sue Bishop lowering drugDirector of Finance NHS Leicestershire County and Rutland

A snapshot of NHS finances





How will we address the gap
How will we address the gap? lowering drug

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


What might this mean? lowering drug

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


Dr tim daniel consultant in public health medicine nhs leicestershire county and rutland

Dr Tim Daniel lowering drugConsultant in Public Health MedicineNHS Leicestershire County and Rutland

How we make our spending choices


Key considerations
Key Considerations lowering drug

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
Rule of Rescue lowering drug

  • 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
Principles lowering drug

  • Rational

  • Fair

  • Consistent

  • Transparent

  • Legal




Effective heart disease prevention
Effective heart disease prevention lowering drug

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


Effective heart disease prevention lowering drug

  • 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


Services providing the most health benefit per pound spent
Services providing the most health benefit per pound spent lowering drug

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



There are big differences
There are big differences.... lowering drug

  • 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




There are big differences1
There are big differences… lowering drug

  • 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
A Framework for Prioritisation lowering drug

  • 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 lowering drug


Refreshment break

Refreshment Break lowering drug


Jo tyler engagement manager nhs leicester city1

Jo Tyler lowering drugEngagement ManagerNHS Leicester City

Workshop 1


Treatments to discuss
Treatments to discuss lowering drug

  • Wisdom tooth extraction

  • Stop smoking service

  • Alcohol Harm Reduction

  • Hip Replacement surgery

  • Bowel Cancer screening programme

  • New cancer drug for bowel cancer (Avastin)

  • Kidney Transplant

  • Improving Access to Psychological Therapies


Sue cavill associate director communications and engagement nhs leicestershire county and rutland1

Sue Cavill lowering drugAssociate Director Communications and EngagementNHS Leicestershire County and Rutland

Findings from workshop


Agree or disagree

Agree or Disagree lowering drug

Please select whether you agree, disagree or don’t know for each of the following statements


If you live a healthy lifestyle you have more right to treatment than someone who doesn t
If you live a healthy lifestyle you have more right to treatment than someone who doesn’t

  • Agree

  • Disagree

  • Don’t know

10

You have

seconds


The treatments and services you receive have been used by patients before, are very effective and have been proved to work

  • Agree

  • Disagree

  • Don’t know

10

You have

seconds


People who are ill because they are poor should have earlier treatment than those who are not poor
People who are ill because they are poor should have earlier treatment than those who are not poor

  • Agree

  • Disagree

  • Don’t know

10

You have

seconds


Drugs that are cheaper should be used whenever possible
Drugs that are cheaper should be used whenever possible treatment than those who are not poor

  • Agree

  • Disagree

  • Don’t know

10

You have

seconds


I might be willing to wait for a minor operation if it meant someone could have life saving surgery
I might be willing to wait for a minor operation if it meant someone could have life-saving surgery

  • Agree

  • Disagree

  • Don’t know

10

You have

seconds


Dr tim daniel public health consultant nhs leicestershire county and rutland

Dr Tim Daniel someone could have life-saving surgeryPublic Health ConsultantNHS Leicestershire County and Rutland

More information about the eight treatments


Workshop 2
Workshop 2 someone could have life-saving surgery

  • 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
Treatments someone could have life-saving surgery

  • Wisdom tooth extraction

  • Stop smoking service

  • Alcohol Harm Reduction

  • Hip Replacement surgery

  • Bowel Cancer screening programme

  • New cancer drug for bowel cancer (Avastin)

  • Kidney Transplant

  • Improving Access to Psychological Therapies


A framework for prioritisation1
A Framework for Prioritisation someone could have life-saving surgery

  • 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

Thank you and closing remarks someone could have life-saving surgery


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