Post on 29-May-2015
description
transcript
John Matheson & Stephen Gallagher
Quality Driven Financial Performance
Scottish Government
1
2
3
Economic Overview
Quality and Efficiency
Current Perspective
Horizon Scan
SCENENHSScotland Event
NHSScotland Event
Economic
Overview
Total Managed Expenditure vs Current Receipts
30
35
40
45
50
5519
48-4
9
1953
-54
1958
-59
1963
-64
1968
-69
1973
-74
1978
-79
1983
-84
1988
-89
1993
-94
1998
-99
2003
-04
2008
-09
2013
-14
Perc
enta
ge o
f nati
onal
inco
me
Total Managed Expenditure
Current receipts
Public Sector net borrowing
30
50
70
90
110
130
150
170
£bn
0'8-09 09-10 10-11 11-12 12-13 13-14 14-15
Financial year
Public Sector net borrowing
March 2010 Budget
June 2010 OBR prebudget reportJune 2010 OBRbudget forecast
Two-Speed Recovery
Two-Speed Recovery
Annual GDP % Change
IMF GDP Forecasts for Advanced and Emerging & Developing Economies
Advanced economies Emerging & Developing Economies
Source: Reuters EcoWin
05 06 07 08 09 10 11 12 13
Perc
ent
-4
-3
-2
-1
0
1
2
3
4
5
6
7
8
9
Forecast
Average Growth 1998 - 2007
International GDP Growth - Update
United States United Kingdom Japan Euro Zone
Source: Eurostat
Q3 Q4 Q1 Q2
10 11
Pe
rcen
t
-1.00
-0.75
-0.50
-0.25
0.00
0.25
0.50
0.75
1.00
‘On the road from the City of Skepticism, I had to pass
through the Valley of Ambiguity’
Adam Smith
‘On the road from the City of Skepticism, I had to pass
through the Valley of Ambiguity’
Adam Smith
SCENE
-6%-5%-4%-3%-2%-1%0%1%2%3%4%5%6%7%8%9%
10%11%12%13%14%
00-01 01-02. 02-03. 03-04. 04-05. 05-06. 06-07. 07-08. 08-09. 09-10. 10-11. 10-11.Health
'11-12 '12-13 13-14
Since Devolution SR2007 Next SR
% Annual Real Growth Rate in Scottish DEL Budgets
•IFS predictions – Dec 2009
•Reflects current use of EYF
Estimated Scottish Government DEL Expenditure – June 2010 Budget Results (2010/11 Prices)
20,000
22,000
24,000
26,000
28,000
30,000
32,000
£ M
illio
ns
(20
10
-11
Price
s)
2009-10 2025-2616 years
£42 billion£39
UK Comprehensive Spending Review 2010UK Comprehensive Spending Review 2010
Scottish Government DEL Settlement 2011-12 to 2014-15
Change
2010-112011-
122012-
132013-
142014-
152010-11to 2014-15
£bn £bn £bn £bn £bn £bn %
Cash terms
Resource 25.9 25.4 25.8 26.0 26.1 0.2 0.8%
Capital 3.3 2.5 2.5 2.2 2.3 -1.0 -30.3%
Total DEL 29.2 27.9 28.3 28.2 28.4 -0.8 -2.7%
NHSScotland Event
Efficiency is a dimension Quality. It can be safer care, more timely and can offer better patient experience.
Quality & Efficiency – Two sides of the coin
“To improve the overall quality and efficiency of NHSScotland while
ensuring good value for money and achieving financial targets.”
Case study: NHS Tayside Older Peoples Services
Project established to realise significant improvements, both qualitative and financial. By focusing on the patient and removing waste, NHS Tayside is delivering:
Reduced inappropriate admissions, Reduced length of stay through focus on patient goal
setting and partnership working (from 27 to 18 days), Lower readmissions by shifting the balance of care, Capacity and capability in staff to proactively manage and
support more effective and efficient patient pathways, and Potential to save £1.4m p.a. in net savings from service
reconfiguration.
Case study: NHS Borders Enhanced Recovery
Enhanced Recovery focuses on improving patient outcomes and speeding up a patient’s recovery after surgery. NHS Borders has successfully adopted and implemented this model of care for patients receiving planned major orthopaedic operations, resulting in a reduction in the length of stay in hospital for patients from an average of 7.7 days to a new average of 3.5 days.
This reduction not only represents a long-term productive opportunity for NHS Borders but also provides improved patient outcomes by reducing variability, decreasing the risk of infection, and ensuring that patients are active participants in their own recovery process.
We have a record of achievement….
NHS Scotland’s Health Boards delivered £262m of local efficiency savings in 2010/11, equivalent to 3.1% of baseline funding made available to NHS Boards.
This exceeded the minimum level of savings required by £61m and made it the third year in a row that NHS Boards have exceeded their efficiency targets
NHS Scotland Productivity
No. of inpatient & day cases has increased every year since 2002/03 (1.41m in 2010/11)
No. of WTE has increased at similar rate but decreased last year
Number of staffed acute beds has reduced every year since 2006/07 (2009/10 average 17,099 beds); day case surgery up by 4.6% over the same period
ALOS for emergency inpatients from 4.2 days (06/07) to 3.7 days (09/10)
NHS Scotland Performance
Scotland has lowest median waiting time for 7 of 11 procedures (UK Health Stats comparisons)
Scotland has lowest 90th percentile waiting time for 7 of 11 procedures
99.9% patients waiting 12 weeks or less for 1st outpatient consultation
99.6% of patients waited 6 weeks or less for key diagnostic tests
HAI – Since 2007, c.diff cases reduced by 73%
HAI - Since 2007, MRSA bacteraemias reduced by 61%
Scottish Patient Safety ProgrammeScottish Patient Safety Programme
72% reduction in critical care
c.diff
14% increase in ward hand
hygiene
58% decrease in ward c.diff
23% increase in
surgical briefings
15% increase in on-time antibiotics`
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Efficiency and Productivity Framework
How? Support – supporting our
workforce through engagement, partnership and placing quality at the centre.
Cost reductions – using the data to identify potential based on variability of care
Enablers – identifying, testing sharing and sustaining good practice.
Focussed Approach:
Work-streams identified and links made to QAB and Delivery Groups
Portfolio Board established to identify priority projects
Return on Investment
Collective approach to implementation of what works.
“To improve the overall quality and efficiency of NHSScotland while ensuring good value for money and achieving financial targets.”
• Primary Care & Community
• Patient Flow & Acute Services
• Workforce Productivity
• Evidence Based Care
• Prescribing, Procurement & Shared Services
• Service Redesign & Innovation
Service Redesign
Work-streams: Reducing Variation, Waste and Harm
Three Phases of Activity
1. Estimate Potentials based on variability Meaningful comparison Understanding blend of productivity, cash efficiency Building the quality as well as efficiency case for redesign
2. Agree Priorities Best practice actions Case studies Pilot/Project based activity with clear ROI Agree what support required to deliver to scale
3. Benefits realisation and reporting, challenge to adopt, re-examine potential
Emerging portfolio 2011/12
What seems to make a difference?
Strong CEO leadership Clear Organisational Narrative linking Quality, Efficiency and Productivity Good use of information to identify opportunities and drive improvement Dedicated and rigorous Project Management Clinical Leadership and Engagement Clear system rules/norms (based on quality) and aligning incentives/sanctions Delegated budgetary responsibility and bottom up idea generation Directors focus on delivery of critical projects Ownership of benefits realisation (quality and efficiency) across organisation Agile, targeted improvement support to realise benefits within portfolio
Clear link to strategic objectives Clear articulation of the place of continuous improvement in delivering
significant quality and efficiency gains for the organisation Evidence of triangulation in organisation between operational
management, finance and improvement/modernisation teams Table outlining projects, link to E&P themes, quality and capability
benefits and the efficiency and productivity benefits
Scheme E&P quality themes Quality and capability benefit
Efficiency and productivity benefit
Implementation of self management – COPD
Out-patients, community and primary care
Person-centred approach, staff skills development
HEAT T10
Savings of £460k pa expected; 2,200 em adm avoided
Targeted Improvement – Case Study: NHS Lothian
NHSScotland Event
Current
Perspective
Five Year PerspectiveFive Year Perspective
SCENE
– Development of Strategic Narrative detailing Five Year Vision
– Recognition of challenges facing NHSScotland State of Scotland’s Health Demographic Profile Challenge of UK Finances
– UK Barnett Consequentials will be passed on to NHS
– Service change to be described in the context of quality improvement
– Different service delivery approaches required at a local, regional and national level
Health Manifesto CommitmentsHealth Manifesto Commitments
SCENE
– Delivery on Manifesto Commitments – Low in number
Alcohol Minimum Pricing Policy Health and Social Care Integration Family Nurse Partnerships Early Detection of Cancer Further Investment in Dementia Services Ring-fenced Support for Carers
Spending ReviewSpending Review
SCENE
– Identify and Prioritise the spending policies which:
maximise economic recovery and increase sustainable economic growth
protect services for the most vulnerable prioritise the most effective preventative spend deliver actions to meet statutory targets on
reducing greenhouse gas emissions
Spending ReviewSpending Review
SCENE
– Exploring scope for
further integration; new funding mechanisms; reducing duplication; and reflecting on the key messages from the Christie
Commission.
Spending ReviewSpending Review
SCENE
– Specific focus on the following areas:-
– Work to reduce carbon emissions
– Early Years – Post-16 Education – Employability – Adult and Social Care
– Support for Business – Assets & Infrastructure – Offending & Community
Safety – Delivering Services in Rural
Areas
Spending ReviewSpending Review
SCENE
– Timetable
two months shorter than normal Cabinet meeting 28th July further Cabinet discussion 9th / 23rd / 30th August Cabinet final sign-off 6th September Spending Review and Draft Budget Announcement
21st September
Implications for Leaders (1)Implications for Leaders (1)
SCENE
– The evidence base for what improves quality is clearer than for what reduces costs
– The two agendas are related and leaders must connect them
– Taking a broad and balanced approach to quality may improve clinical engagement
– Increasing reliability and reducing variation matters
– Have to do this with people and not to them
Implications for Leaders (2)Implications for Leaders (2)
SCENE
– Greater efficiency alone won’t be sufficient
– Needs both short term and long term approaches (low hanging fruit and culture shift required)
– A requirement not a choice to connect quality and cost given what we know about demography and demand.
“We look to Scotland for all our ideas of civilisation”
Voltaire(1694-1778)
“We look to Scotland for all our ideas of civilisation”
Voltaire(1694-1778)
SCENE