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

Jo Tyler Engagement Manager NHS Leicester City Quiz time

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? 1Male 2Female 3Prefer not to say 10

What age range are you? If you prefer not to say, please dont vote 1Under

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

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

Quiz

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

Local NHS has £1,600 to spend per person, per year. To pay for: Treatments Medicines Equipment Management of buildings Running vehicles Employing staff

What do you think the cost per treatment is for....

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

£700

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

£1,044

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

£5,459

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

£5,456

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

£748

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

£972

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

£250

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

£52 up to £188

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

£1.85

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

£ 24.64

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

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

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

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/ To be transferred to Local Authorities for investment in re-ablement -£11.0Growth in demand expected in 2011/ Realignment of expenditure budgets to release additional resource +£10.4The full impact of services that started in 2010/ Investment in new priorities outlined in the operating framework ADDITIONAL MONEY AVAILABLE IN 2011/12 £16.3EXCESS OF COSTS OVER ADDITIONAL MONEY AVAILABLE -£45.6

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

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 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?

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

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

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

Principles Rational Fair Consistent Transparent Legal

Where does health care take place?

What are the main causes of death in Leicestershire?

Effective heart disease prevention What is the most effective prevention in reducing deaths from heart disease? Deaths from heart disease halved from 1981 to ,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

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 Sep 17;331(7517):614. Epub 2005 Aug 17 Effective heart disease prevention

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

Death rates from heart disease in Leicestershire

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

Life expectancy for males in Leicestershire

Life expectancy of females in Leicestershire

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)

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?

Thank you

Refreshment Break

Jo Tyler Engagement Manager NHS Leicester City Workshop 1

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

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

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

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

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

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

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

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

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

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

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

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?

Thank you and closing remarks