Scottish Healthcare Conference

7th November 2013

John Matheson Director of Health Finance, eHealth and

Pharmaceuticals Scottish Government

Economic Context

Economic Context

Public Finances – Fall in Government Expenditure

Mercer, Guthrie, Wyke: Scottish School of Primary Care

Multimorbidity

Demographic change for population aged 65+ ScotlandPotential impact on emergency bed numbers 2007-2031

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Projected2016

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Beds

9% 24%

41% 61%

84%

NHS Tayside +148 beds 2016 +517 beds 2031

Healthcare demand is growing

A new Ninewells Hospital by 2031!

Demographic Change

How are we responding to this challenge?

How are we responding to this challenge?

“Give me six hours to

chop down a tree and I will spend the

first four sharpening the axe”

Abraham Lincoln 1809-1865

Wealthier and Fairer

Smarter

Healthier Helping people to sustain and improve their health, especially in

disadvantaged communities, ensuring better, local and faster access to health care

Safer and Stronger

Greener

Scotland Performs: Strategic Objectives

Aims To deliver the highest

quality healthcare services to the people of Scotland For NHSScotland to be recognised as world-

leading in the quality of healthcare it provides

• Person-Centred - Mutually beneficial partnerships between patients, their families, and those delivering healthcare services which respect individual needs and values, and which demonstrate compassion, continuity, clear communication, and shared decision making.

• Effective - The most appropriate treatments, interventions, support, and services will be provided at the right time to everyone who will benefit, and wasteful or harmful variation will be eradicated.

• Safe - There will be no avoidable injury or harm to patients from healthcare they receive, and an appropriate clean and safe environment will be provided for the delivery of healthcare services at all times.

The Healthcare Quality Strategy for Scotland

EVERYONE IS ABLE TO LIVE LONGER HEALTHIER LIVES, AT

HOME, OR IN A HOMELY SETTING

Our ‘2020 Vision’

Triple Aim

Health of the Population

Experience of Care

Best Value

for Money

The IHI Triple Aim

ROUTE MAP TO THE 20:20 VISION

Primary Care

Quality of care

Integrated CareSafe CareUnscheduled & Emergency Care

Health of the Population

Prevention

Early YearsHealth Inequalities

Value & Financial Sustainability Efficiency & Productivity

Innovation

Workforce

12 PRIORITY AREAS FOR ACTION

11/02/13

Person Centred CareCare for Multiple & Chronic Illnesses

Time

Performance

Performance

Improvement

Co-production & assets

Getting to the third curve

Assets thinking •Strengths based •How can we create community spirit? •What can I do? •We’re all in this together •We’re getting there •Work with engaged people •People have the answers •People control their lives

Deficit thinking •Problem orientated •How to fix this problem? •Someone needs to sort this •Us versus them •Problems are embedded •Do things to people •People are a problem •People can’t be trusted to decide/be in control

Assets vs Deficits

• Need to continue to get basics right • Savings and efficiencies available in ‘back

of house’ functions • Meeting financial targets and KPIs key to

securing shareholder/ public confidence • Can’t really pursue quality and co-

production without this foundation

Why performance?

• Waste, harm and variation • Poor quality costs more • Clinical engagement • Thrive or survive? • Route to longer term sustainability • What is the alternative?

Why quality?

William A. Foster 1941

"Quality is never an accident; it is always the result of high intention, sincere effort,

intelligent direction and skillful execution; it represents the wise

choice of many alternatives.”

88

EinsteinEinstein’’s Definition of Insanitys Definition of Insanity

“Doing the same thing over and over again and expecting

different results.”

Quarterly Clostridium difficile Infection cases in Patients aged 65 and over

January – March 2007 to July-September 2012

Cases have decreased by 1,410 – 79.4% (from 1,775 cases in Jan-Mar 2007 to 365 in Jul-Sept 2012)

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Jan 07 - Mar 07

Jul 07 - Sep 07

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Jul 08 - Sept 08

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Jul 09 - Sept 09

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Jul 10 - Sept 10

Jan 11 - Mar 11

Jul 11 - Sept 11

Jan 12 - Mar 12

Jul 12 - Sept 12

The Early Years Collaborative - Ambition

To make Scotland the best place in the world to grow up in by improving outcomes, and reducing inequalities, for all babies, children, mothers, fathers and families across Scotland to ensure that all children have the best start in life and are ready to succeed.

• Establish and Oversee Specific System-Level Aims at the Highest Governance Level

• Develop an Executable Strategy to Achieve the System-Level Aims and Oversee Their Execution at the Highest Governance Level

• Channel Leadership Attention to System-Level Improvement: Personal Leadership, Leadership Systems, and Transparency

• Put Patients and Families on the Improvement Team • Engage Physicians • Build Improvement Capability

IHI Seven Leadership Leverage Points

Make the Estates and Facilities Teams Quality Champions • Learning about the potentially powerful role Asset & Facilities teams can

play in improvement once they see “reduce waste in core processes” as the primary driver of cost reductions rather than the traditional approach of “reduce inputs to (defective) core processes.

IHI Seven Leadership Leverage Points

Quality Driven Asset Performance

Infrastructure Investment 2013-14 and 2014-15

2013-14 £ million

2014-15 £ million

Net Capital Budget (including acceleration / additional Barnett consequentials) 400.5 239.0 Capital Receipts 14.0 7.0

Revenue to Capital Transfer up to 105.0 120.0

519.5 366.0 Less: New South Glasgow Hospitals and Other Legal Commitments (302.0) (116.0)

Formula Capital 217.5 250.0

Infrastructure Investment Investment Programme and NPD Context

• Use of NPD allows priority projects to be developed and delivered

• Programme of £750 million capital equivalent investment

• NPD £500 million - Sick Kids, SNBTS, North Ayrshire Community Hospital now in Procurement

• Hub DBFM £250 million all five hub companies now formed

• Aberdeen Health Village on site, North Bundle (Forres, Woodside and Tain) in procurement

• Pipeline of 38 projects

• Design and Build schemes on site – Lauder, Glenwood

• During the period 2008-09 to 2012-13 Health Boards delivered cumulative efficiency savings of £1.2 billion.

• In addition to the savings achieved locally by the Boards, NHSScotland delivered further national savings of £199 million e.g. procurement, prescribing.

• In total therefore, for the five year period, cumulative savings in excess of £1.4 billion

Efficiency History

Efficiency and Productivity Workstreams

Alignment of workstreams with the ‘20:20’ Vision

Prevention and Early

Intervention Health Behaviour Change Smoking Cessation Lifestyle Interventions

Evidence Based Care

Low Value Clinical Interventions

Evidence Based Clinical Thresholds NICE/ HIS Standards Patient Safety

Support and Enablers:

• Identify and share good practice

• Innovative approaches to data to identify productive opportunities

• Tools for demonstrating productive gain and benefits realisation

Outpatients, Primary and Community Care

Acute Flow and Capacity Management

Prescribing Shared Services Procurement

Productive GP

RTC Community

Reshaping Care

Outpatients

SAS Modernisation

PMS QoF Indicators

Ophthalmic Referrals

LTC eHealth

Demand and Capacity Planning

Day/ Short Stay Surgery/ Ambulatory Care

Enhanced Recovery

Inpatient Capacity and Flow

Orthopaedics

Theatres

National Therapeutic Indicators

PAPS, Formulary and Advisory Network

Secondary and Primary Care Interface

Repeats, Waste and Polypharmacy

Performance Management and Incentives

National Approach and Consistency

HR Services

Facilities

Finance

Social Work

Good Practice

Intensive Improvement Activity

National Contracts Review

Regional Consortia

Dashboards

Workforce Capacity and Modernisation Leadership and Capability Governance and

Engagement

Information and Analytics Benchmarking Baselining Productive

Opportunity Whole Systems

Analysis

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SCENE

– Health resource budget protected again in 2014-15 and 2015-16 with the Health Barnett consequentials of

£284 million and £202 million respectively passed on in full. – 2014-15 budget is in line with indicative figures provided at Draft Budget 2013-14 in September 2012 i.e.

3.1 per cent uplift for Territorial Boards in 2014-15 and a further 2.7 per cent in 2015-16. – Special Boards 1.0 per cent uplift and savings withdrawn for four Boards – Efficiency savings of three per cent in 2014-15. – Health’s position relative to other portfolios’ remains consistent. – Whilst Capital budget SG share is falling from 15.7 per cent to 5.0 per cent the formula allocation to

Boards is up from £117 million in 2013-14 to £134 million in 2014-15 and £145 million in 2015-16. Change in approach to funding the revenue consequentials of NPD Projects.

– Integration Fund replaces the Adult and Social Care Change Fund and increasing from £70 million to £100 million in 2015-16 with a further £20 million earmarked and held centrally for national initiatives.

– Agreement on Joint Working on Community Planning and Resourcing - we will work through how to best to incorporate this Agreement within the 2014-15 Local Delivery Planning process

– We will have a detailed financial planning with Directors of Finance at the meeting on 31 October

Spending Round 2013 and Draft Budget 2014-15

Key Messages: Health

Forward look – Known and Emerging Issues – Known and Emerging Issues

• Pay including Incremental

Progression

• Prices / Demographic Change

• Drugs and Prescribing

• Efficiency Savings

• Access to Medicines

• Health and Social Care Integration

• One Year Job Guarantee

• New and Extended Immunisations

• Police Custody Healthcare and

Forensic Medical Services

• Commonwealth Games 2014

• Unscheduled Care / Access / Treatment Times Guarantees

• Getting it Right for Every Child • Pensions / National Insurance

“Scotland has the safest healthcare system on the

planet.”

Don Berwick HFMA Conference, London, December 2012.

Questions?