Scottish Public Health Network

Update of 2007 literature review on disinvestment

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Scottish Public Health Network

• undertake prioritised national pieces of work where there is a clearly identified need;

• facilitate information exchange between public health practitioners, link with other networks and share learning;

• create effective communication amongst professionals and the public to allow efficient co-ordination of public health activity; and

• support and enhance the capabilities and functionality of the Scottish Directors of Public Health Group.

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New Ways of Working - Background

• Public sector financial restructuring• NHSScotland Quality Strategy - emphasis on quality (and

cost-efficiency)

• Public health Directorate must meet competing demands: – ensuring further progress in delivering health

improvement and health inequality reduction against national targets;

– refocusing resources on effectiveness in health service planning and development; and

– maintaining appropriate health protection capacity to meet demands such as that exemplified by the H1N1 Pandemic.

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New Ways of Working – ProjectAIMS:• establish the baseline of public health activities across

Scotland to meet challenges; • explore new ways of working which will maintain the

necessary capacity within the public health function in Scotland;

• exemplify the contribution of public health in areas such as:– promoting efficiency in health improvement

interventions;– health services disinvestment; and

• finding a way of modelling the impacts of future change on public health functional capacity.

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Disinvestment

Elshaug et al. (2007) defined disinvestment as:‘The process of partially or completely withdrawing health resources from any existing health care practices, procedures, technologies or pharmaceuticals that are deemed to deliver little or no health gain for their cost, and thus are not efficient health resource allocations’.”

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Disinvestment strand - Objectives• To update previous work from 2007• To understand and promote public

health contribution to disinvestment • To understand and promote

contribution to wider national planning agenda

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Previous work• 2007 case study (Sheila Scott, Director of

Public Health, NHS Western Isles) including a literature review of disinvestment (Ann Lees, NHS Greater Glasgow & Clyde) - four sentinel surgical procedures

• NICE programme – the ‘don’t dos’ lists• NHS Healthcare Improvement Scotland

(SHTG)

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MethodSOURCES:• BMJ Best Practice• EBM database• DARE/HTA/NHS EED• NICE programme:

– don’t do’s’ list– Optimal Reviews: Recommendation Reminders– Cost saving guidance

• Request to Directors of Public Health regarding local disinvestment work (2011)

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Literature review - resultsIneffective Healthcare Interventions by Type

Total

Surgery 21

Treatment (inc. drugs, tests etc.) 232

Therapy (inc. psychotherapy and devices) 21

Model of care 12

Screening 5

Total 291

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Examples of interventions for possible disinvestment include: • coronary artery stenting in ischaemic heart disease;• the use of many classes of drugs in the treatment of

anxiety and depressive states;• oxygen therapy in certain presentations of chronic

obstructive pulmonary disease;• the use of alcohol brief interventions in hospital inpatient

settings; or• several categories of clinical tests used in conditions such

as chronic obstructive pulmonary disease, dyspepsia, epilepsy, familial breast cancer, fertility, growth hormone deficiency, hypertension, lung cancer, and Parkinson’s disease.

Literature review - results

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How to implement?• Not actually easy to disinvest – also much of it happens without

any resource release! (cf NHS Greater Glasgow & Clyde review)• Approaches to benefits realisation with disinvestment which

include:– service redesign: using disinvestment to allow service

redesign/ reconfiguration to be progressed beyond LEAN approaches;

– substitution: within service disinvestment to allow reinvestment to address service pressure or allow limited service development;

– resource release: managed service removal or closure.• Good old fashioned “public health” (e.g. HCNA)!

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Way forward• Disinvestment strand to be carried forward as

part of the CMO Models of Care work-stream under the Efficiency and Delivery strand of the NHSScotland Quality Strategy.

• Wider NPF support to be routed through the regional planning teams for initial discussion. Further discussion on necessary mechanism(s).

• Public Health Directorates will be supporting this work, locally, regionally and nationally.

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ScotPHN

Phil Mackie, Lead Consultant(phil.mackie@nhs.net / 0141 354

2978)

www.scotphn.net

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