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

2. Sue Cavill Associate Director Communications and Engagement NHS Leicestershire County and Rutland Introductions

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

4. Jo Tyler Engagement Manager NHS 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? 1Male 2Female 3Prefer not to say 10

7. What age range are you? If you prefer not to say, please dont vote 1Under 16 216-19 320-29 430-39 540-49 650-59 760-69 870-79 980+

8. 1Yes 2No 3Prefer not to say Do you consider yourself to have a disability? 10

9. What ethnicity are you? 1Asian or Asian British 2Black or Black British 3Dual or Mixed Heritage 4Chinese 5White 6Other 7Prefer not to say

10. Quiz

11. 10 How much do you think the local NHS spends per person, per year? 1£1,600 2£8,000 3£20,000

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. 10 Minor ear operation per operation (such as Grommets) 1£200 2£400 3£700

15. £700

16. 10 Tonsillectomy per operation 1£575 2£1,044 3£2,875

17. £1,044

18. 10 Hip replacement per operation 1£5,459 2£6,789 3£7,773

19. £5,459

20. 10 Knee replacement per operation 1£4,238 2£5,456 3£748

21. £5,456

22. 10 Cataracts cost for each eye 1£202 2£512 3£748

23. £748

24. 10 Varicose veins per operation 1£390 2£972 3£1,632

25. £972

26. 10 The average cost of an overnight stay in hospital 1£120 2£250 3£480

27. £250

28. 10 The minimum cost of being seen in the emergency department 1Free 2£35 3£52

29. £52 up to £188

30. 10 The NHS to give you a prescription of 32 Aspirin tablets? 170p 2£1.85 3£2.50

31. £1.85

32. 10 28 tablets of 20mg Atorvastatin, a common cholesterol lowering drug 1£5.89 2£10.52 3£24.64

33. £ 24.64

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

35. How much do we have to spend in 2010/11? NHS LEICESTER CITY (NHSLC) £M NHS LEICESTERSHIRE COUNTY & RUTLAND (NHSLCR) £M TOTAL LLR £M Money received in 2010/11 £553.4£945.1£1,498.5 Investment in healthcare services £547.3£934.7£1,482.0 Surplus at year end£6.1£10.4£16.5

36. What are we spending it on? NHS Leicester City £M NHS Leicestershire County and Rutland £M Total (LLR) £M Acute hospitals - UHL£210.2£282.6£492.8 Acute hospitals - other£20.6£112.3£132.9 Non Acute – mental health, community services, learning disabilities, ambulance £139.7£226.2£365.9 Continuing healthcare£17.7£35.7£53.4 Primary Care£76.4£141.5£217.9 Prescribing£49.2£93.4£142.6 Corporate costs£33.5£43.0£76.5 TOTAL INVESTMENT£547.3£934.7£1,482.0

37. How will the money change in 2011/12? CHANGES IN MONEY AVAILABLE£mEXTRA COSTS THAT WILL OCCUR£m Additional funding from the government+45.1Inflation (2.5% less 4%)+3.7 To be put aside in accordance with DH requirements -£28.2Growth in demand seen in 2010/11-12.8 To be transferred to Local Authorities for investment in re-ablement -£11.0Growth in demand expected in 2011/12-22.5 Realignment of expenditure budgets to release additional resource +£10.4The full impact of services that started in 2010/11 -16.2 Investment in new priorities outlined in the operating framework -14.1 ADDITIONAL MONEY AVAILABLE IN 2011/12 £16.3EXCESS OF COSTS OVER ADDITIONAL MONEY AVAILABLE -£45.6

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

40. Dr Tim Daniel Consultant in Public Health Medicine NHS Leicestershire County and Rutland How we make our spending choices

41. Key Considerations All Choices: Are difficult but have to be made Are complex, youre 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. 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 Effective heart disease prevention

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

51. Death rates from heart disease in Leicestershire

52. There are big differences.... 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

53. Life expectancy for males in Leicestershire

54. Life expectancy of females in Leicestershire

55. There are big differences… 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)

56. A Framework for Prioritisation 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?

57. Thank you

58. Refreshment Break

59. Jo Tyler Engagement Manager NHS Leicester City Workshop 1

60. Treatments to discuss 1.Wisdom tooth extraction 2.Stop smoking service 3.Alcohol Harm Reduction 4.Hip Replacement surgery 5.Bowel Cancer screening programme 6.New cancer drug for bowel cancer (Avastin) 7.Kidney Transplant 8.Improving Access to Psychological Therapies

62. Sue Cavill Associate Director Communications and Engagement NHS Leicestershire County and Rutland Findings from workshop

63. Agree or Disagree Please select whether you agree, disagree or dont know for each of the following statements

64. 10 If you live a healthy lifestyle you have more right to treatment than someone who doesnt 1Agree 2Disagree 3Dont know

65. 10 The treatments and services you receive have been used by patients before, are very effective and have been proved to work 1Agree 2Disagree 3Dont know

66. 10 People who are ill because they are poor should have earlier treatment than those who are not poor 1Agree 2Disagree 3Dont know

67. 10 Drugs that are cheaper should be used whenever possible 1Agree 2Disagree 3Dont know

68. 10 I might be willing to wait for a minor operation if it meant someone could have life-saving surgery 1Agree 2Disagree 3Dont know

69. Dr Tim Daniel Public Health Consultant NHS Leicestershire County and Rutland More information about the eight treatments

70. Workshop 2 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

71. Treatments 1.Wisdom tooth extraction 2.Stop smoking service 3.Alcohol Harm Reduction 4.Hip Replacement surgery 5.Bowel Cancer screening programme 6.New cancer drug for bowel cancer (Avastin) 7.Kidney Transplant 8.Improving Access to Psychological Therapies

72. A Framework for Prioritisation 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?

73. Thank you and closing remarks