The Kings Fund
2012 Conference
Derek Feeley
Director General Health and Social Care
and Chief Executive of NHS Scotland
NHS Scotland
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c. 5.1 million population
Devolved (since 1999)
14 Regional Boards
Integrated system ( e.g. no
purchaser/ provider split)
Integration of health and
social care underway
Tax funded/ cash limited
Equal access on basis of
need
Free at the point of care
HEALTH BUDGET REAL TERMS SUMMARY
00-01
£m
01-02
£m
02-03
£m
03-04
£m
04-05
£m
05-06
£m
06-07
£bn
07-08
£bn
08-09
£bn
09-10
£bn
10-11
£bn
11-12
£bn
12-13
£bn
13-14
£bn
14-15
£bn
overall
Increase
£bn
Overall
Increase
%
Health Budget (Cash)
5.521
6.162
6.474
7.227
8.048
8.790
9.531
10.215
10.642
11.058
11.182
11.369
11.583
11.803
11.946
6.425
116.4%
Health Budget
(Real at 2000-01 prices)
5.521
6.047
6.198
6.769
7.322
7.818
8.255
8.632
8.754
8.962
8.812
8.751
8.682
8.631
8.522
3.001
54.4%
Health Budget Cash and Real Terms Summary 2000-01 to 2014-15
12
11
10
Budget
£bn
9
Cash
Real
8
7
6
5
'0001
'0102
'0203
'0304
'0405
'0506
'0607
'0708
'0809
Financial Year
Note: This presentation provides a high level position based on
published budget figures. It should be noted that budgets between
years are not directly comparable due to transfers between portfolios
and other budgetary and accounting adjustments (e.g. HM Treasury
cost of capital removal)
'0910
'1011
'1112
'1213
'1314
'1415
Health Spend – 4 Nations
Identifiable Expenditure per capita on Health, UK and countries, £
2,500
2,000
England
Scotland
1,500
Wales
Northern
Ireland
1,000
UK identifiable
expenditure
500
0
2007-08
Source: HM Treasury Oct 2012
2008-09
2009-10
2010-11
2011-12
Health Spend – Scotland and English regions
Identifiable spend per capita on health, Scotland and English Regions, £
2,500
North East
North West
2,000
Yorkshire and
the Humber
East Midlands
West Midlands
1,500
East
London
1,000
South East
South West
Scotland
500
Identifiable Expenditure per head
on health, £ 2011-12
London 2,102
North East 2,095
North West 2,029
Yorkshire and the Humber 1,905
West Midlands 1,865
South West 1,771
East Midlands 1,728
East 1,711
South East 1,702
England 1,874, Scotland 2,091,
Source: HM Treasury, Oct 2012
0
2007-08
Source: HM Treasury Oct 2012
2008-09
2009-10
2010-11
2011-12
4 Key Challenges
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Economic
Demographic
Population Health
Changing Expectations
Triple Aim
The Triple Aim
Health of the
Population
Integration
Experience of
Care
Best Value
for Money
3 Quality Ambitions
• Mutually beneficial partnerships between patients, their families
and those delivering healthcare services. Partnerships which
respect individual needs and values and which demonstrate
compassion, continuity, clear communication and shared
decision-making.
• No avoidable injury or harm from the healthcare they receive,
and that they are cared for in an appropriate, clean and safe
environment at all times.
• The most appropriate treatments, interventions, support and
services will be provided at the right time to everyone who will
benefit, with no wasteful or harmful variation.
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HSMR
HSMR: Scotland
Jan. ’08  Mar. ‘12
1.05
1.03
1.00
0.95
0.90
0.89
0.85
6640 less than expected deaths
0.80
Hospital Standardised Mortality Ratios (Seasonally Adjusted)
Scotland: Oct-Dec 2002 to Jan-Mar 2012
1.2
1.1
Smoothed
SMR
1.0
0.9
1.4%
average yearly
reduction
0.8
0.7
average yearly reduction
4.2%
(Oct 2002 to Jan 2010)
(Apr 2010 to Mar 2012)
0.6
1
2
3
4
5
6
7
8
9
10 11
12 13
14 15
16 17
18 19
20 21
Quarters
22 23
24 25
26 27
28 29
30 31
32 33
34 35
36 37
38
Implications for Costs – what do we
know?
• Poor quality is costly
• Costs and benefits are
spread over time and
between stakeholders
• The context matters
• Better data would help
Quality and Cost - It’s
complicated….
Too bad all the people who know how to run
the country are busy driving cabs and
cutting hair.
-- George Burns
Why Quality?
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Waste, harm and variation
Poor quality costs more
Clinical engagement
Thrive or survive?
Route to longer term sustainability
What is the alternative?
The alternative?
Or this…..?
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Harm - General ward C.Difficile rate
(per thousand patient days)
2.5
1.15
90% reduction
2
1.5
1
0.12
0.5
0
Cost of Infection
Cost of infection (Pennsylvania)
Tackling Variation –
high cost, high volume services
Bedday rate for patients aged 75+,
emergency admissions
Bedday rate per 1000 aged 75+
6500
6000
Borders
Lothian
5500
~550 beds
5000
Board
average
Highland
4500
Ayrshire &
Arran
Tayside
Re-shaping Care
Prog/LTC Prog
4000
rMa
06
rMa
07
rMa
08
rMa
09
rMa
10
rMa
11 Sept-11
Year ending
Prepared by Peter Knight JIT June12
Sustainability - Quality and Efficiency
Improving Quality and
Reducing Costs
Our Choice
Surviving – the 3%
Thriving – the 97%
The future - Getting to the third curve
Co-production
& assets
Performance
Improvement
Performance
Time
"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.”
1941, William A. Foster