Derek Feeley, Chief Executive at NHS Scotland, gives an overview of health care in Scotland, including the economic, demographic and population health challenges.
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Derek Feeley: Scotland - why quality is the best response to the financial challenge
1. The King’s Fund
2012 Annual Conference
Derek Feeley
Director General Health and Social Care
and Chief Executive of NHS Scotland
2. NHS Scotland
• 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
3. Health Budget Real Terms Summary
overall Overall
00-01 01-02 02-03 03-04 04-05 05-06 06-07 07-08 08-09 09-10 10-11 11-12 12-13 13-14 14-15 Increase Increase
£m £m £m £m £m £m £bn £bn £bn £bn £bn £bn £bn £bn £bn £bn %
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 9 Cash
£bn
Real
8
7
6
5
'00- '01- '02- '03- '04- '05- '06- '07- '08- '09- '10- '11- '12- '13- '14-
01 02 03 04 05 06 07 08 09 10 11 12 13 14 15
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)
4. Health spend – 4 nations
Identifiable Expenditure per capita on Health, UK and countries, £
2,500
2,000
England
1,500 Scotland
Wales
Northern
Ireland
1,000
UK identifiable
expenditure
500
0
2007-08 2008-09 2009-10 2010-11 2011-12
Source: HM Treasury Oct 2012
5. Health spend – Scotland and
English regions
Identifiable spend per capita on health, Scotland and English Regions, £ Identifiable Expenditure per head
2,500 on health, £ 2011-12
North East
London 2,102
North West
North East 2,095
2,000
Yorkshire and
North West 2,029
the Humber
East Midlands
Yorkshire and the Humber 1,905
1,500 West Midlands
West Midlands 1,865
East
South West 1,771
London
East Midlands 1,728
1,000 South East
East 1,711
South West
South East 1,702
Scotland
England 1,874, Scotland 2,091,
500
Source: HM Treasury, Oct 2012
0
2007-08 2008-09 2009-10 2010-11 2011-12
Source: HM Treasury Oct 2012
6. 4 key challenges
• Economic
• Demographic
• Population health
• Changing expectations
7. Triple Aim
The triple aim
Health of the
Population
Integration
Experience of Best Value
Care for Money
8.
9. 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.
10. HSMR
Ja
n-
M
ar
0.80
0.85
0.90
0.95
1.00
1.05
A 20
pr
-J 0
un 8
Ju 2
l-S 00
ep 8
O 2
ct 1.03
-D 008
ec
Ja
n- 200
M 8
ar
A 20
pr
-J 0
un 9
Ju 2
l-S 00
ep 9
O 20
ct
-D 0
ec 9
Ja
n- 200
M 9
ar
A 20
pr
1
10.6%
-J
un 0
Ju 2
l-S 01
ep 0
O 2
ct
redu
-D 010
c
ec
Ja
n- 201
M 0
ar
A 20
tion
pr
HSMR: Scotland
-J 1
un 1
Ju 2
Jan. ’08 Mar. ‘12
l-S 01
ep 1
O 2
ct
6640 less than expected deaths
-D 011
Ja ec
n- 20
M 11
ar
20
12
p
0.89
12. 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
13. 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
14. Why quality?
• Waste, harm and variation
• Poor quality costs more
• Clinical engagement
• Thrive or survive?
• Route to longer term sustainability
• What is the alternative?
17. Ja
0
1
2
0.5
1.5
2.5
n-
08
Ap
r- 0
8
Ju
l-0
8
O
1.15
ct
-0
8
Ja
n-
09
Ap
r- 0
9
Ju
l-0
9
O
ct
-0
9
Ja
n-
10
Ap
r- 1
0
Ju
l-1
0
O
ct
-1
0
(per thousand patient days)
Ja
n-
11
Ap
r- 1
1
90% reduction
Ju
l-1
1
O
ct
-1
1
0.12
Harm - General ward C.Difficile rate
23. Improving quality and reducing costs
Our choice
Surviving – the 3%
Thriving – the 97%
24. The future - getting to the third curve
Co-production
& assets
Performance
Improvement
Performance
Time
25. "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
Notes de l'éditeur
Quality Strategy launched May 2010 Quality Alliance Board to challenge and ensure implementation to achieve aim of being a world leader Commitment to prioritise, align and ensure a coherent programme of local and national work underpinning Quality Strategy Ambitions Quality Outcomes and related measures, with national targets embedded Quality Strategy launched May 2010 Quality Alliance Board to challenge and ensure implementation to achieve aim of being a world leader Commitment to prioritise, align and ensure a coherent programme of local and national work underpinning Quality Strategy Ambitions Quality Outcomes and related measures, with national targets embedded Quality Strategy launched May 2010 Quality Alliance Board to challenge and ensure implementation to achieve aim of being a world leader Commitment to prioritise, align and ensure a coherent programme of local and national work underpinning Quality Strategy Ambitions Quality Outcomes and related measures, with national targets embedded
Smoothed the seasonal effect . Fit regression line: shows a marked acceleration over the most recent two year period. Why is this ? We cant say for certain – but one explanation is the cumulative additive effect of the many many small changes and improvements made across a nation. Made by you and the people you work with The so called aggregation of marginal gains The sum is greater than the whole- there is probably a synergistic effect beyond the simple addition or cumulation- achieving a critical mass. Fits with our thinking- focus on processes – and outcomes will follow – often after a delay or lag