1. Gateshead Local Strategic Partnership Shifting Resources Upstream

2. JSNA aim Shift from acute to preventive/community care

3. 2008 Gateshead JSNA “…strategic commissioning intention expressed by the JSNA…a reallocation of resources…of 5% from acute care to prevention or community based care.” “to aim for at least 1% transfer in 08-09, leading up to at least 3% by 10-11.” “reviewed in terms of best outcomes for the health of the population as well as…resource allocation.” (ref. “Our Health, Our Care, Our Say”)

4. Why “shift resources upstream ”? e.g. Chapter 6: Care Closer to Home e.g. Primary Care Centres, outpatient clinics into community settings, health checks e.g. “Helping People to Stay Healthy”

5. Focus of project Tracking expenditure from acute to preventive or community care Data identification, access and presentation Circulatory disease (similar work also on mental health and musculo- skeletal conditions)

6. Why track expenditure? Lack of evidence showing how JSNA is influencing commissioning How do we know JSNA is making a difference? To demonstrate that JSNA is a cost- effective exercise

7. Challenges (1) Identifying appropriate data –Definitions of ‘acute’ Secondary care – hospital-employed nurses in the community –Acute to preventive/community care is a continuum E.g. care in outpatients is more ‘community-based’ than care as an inpatient –Cross-over effects Preventive measures affect several conditions e.g. weight management – heart disease, diabetes etc.

8. Challenges (2) obtaining appropriate data –General Information staff and public health staff unavailable to provide or discuss (swine flu management) –Non-routine data JSNA is not everybody’s priority –Routine data Timeliness Appropriate level LA service data and health data not categorised in same way

9. Challenges (3) Programme budgeting PCT not LSP Levels of standard breakdown inappropriate – (lowest level = circulatory disease subcategories) Not even split into secondary/primary care Standard format is spend per 100,000 weighted head of population – less impact than actual £ total

10. Challenges (4) Actual spend or percentage of total? How to account for injections of funding, as opposed to transferred money Displaying data Questions include –where do prescribing data go? –Is outpatients ‘more community-based’ than LA day care? What do data NOT show? –Was expenditure actually transferred? –Were the relative changes coincidental?

11. Addressing challenges (1) Aim to use routinely available data –LA – Personal Social Services Expenditure (PSSEX) but hope for more on specific long- term conditions (e.g. stroke expenditure) –Drugs expenditure – prescription costs AND number of items –Secondary care Cardiology –attendances and costs –Elective, non-elective –Inpatient, outpatient

12. Addressing challenges (2) Primary care - Programme budgeting –Continue work with finance colleagues Identify useful drilling down approaches Ongoing (local) work to show –by setting and –by sector –Use and disseminate use of approach –Obtain £ actual not £ per 100k population –Press for national drilling-down requirements

13. Addressing challenges (3) Make assumptions – even if we get it ‘wrong’ but use the same next time, we can still draw year-on-year comparisons E.g. retain standard classification of hospital heart nurses as secondary care (far from ideal)

14. Displaying information (1) Even if chosen approach not ideal, consistency allows comparison aim

15. Displaying information (2) Even if chosen approach not ideal, consistency allows comparison aim – non-elective aim – outpatients aim –elective aim – health improvement

16. Comparing expenditure across all sectors Data not yet available for 2008/09 – chart not based on actual figures Displaying information (3)

17. What has gone well (1) JSNA steering group multi-agency Others invited and informed Multi-level – Directors Information staff Others invited and informed

18. What has gone well (2) Programme budgeting –Finance colleagues very helpful –Pilot site for local implementation of “Programme Budgeting” approach –Additional work ongoing Other information supply –Colleagues willing to discuss requirements

19. What has gone well (3) Linkage with other strategies and plans Results will link with forecasting for PCT strategies Provides evidence for World Class Commissioning competency 5 –evidence for investment and disinvestment decisions Results expected to influence LA and LSP plans, e.g. –Adult Care Commissioning Strategy –Housing strategy – needs for people with long-term conditions –mental health work will influence plans for mental health services

20. What to do next? Await further data/information Continue similar work with musculo-skeletal and mental health conditions Circulate proposed outputs for comment Use results as levers: –to push for changes to ensure resources are shifted upstream –to push for additional drilling down in programme budgeting –to link JSNA with other strategies