NHS Bedfordshire: Expenditure and Activity or Outcome relative to other PCTs in England in 2007-2008

Inf

Canc,Circ

Blood

End

MH,SocLD

Neuro Vision

Hear

Resp

Dent

Gastro,Skin,Musc,Pois

Trauma GU

Mat

Neo

Hlth

-2.5

-2.0

-1.5

-1.0

-0.5

0.0

0.5

1.0

1.5

2.0

2.5

-2.5 -2.0 -1.5 -1.0 -0.5 0.0 0.5 1.0 1.5 2.0 2.5

Spend Z Score

Hea

lth

Ou

tco

me

Z S

core

Lower Spend, Greater Activity or Better Outcome

Lower Spend,Lesser Activity or Worse Outcome

Higher Spend,Lesser Activity or Worse Outcome

Higher Spend,Greater Activity or Better Outcome

Dental Budget: Ring-fenced till April 2011

Learning Disability: Standalone 8-bedded inpatient unit with low occupancy decommissioned

Vision: Business case to increase use of High Street

Optometrists subject to adequate training

New Integrated Community Based Service for Sexual Health,

Pharmacy and GP LES

FOCUS ON CONTINUAL IMPROVEMENT

MAJOR RETHINK OF CURRENT PROVISION

IMPROVE SERVICE OR PREVENTION TO IMPROVE OUTCOMES

ACHIEVE SIMILAR FOR LESS?

Programme Budgets in NHS Bedfordshire

Cancer: Strategic focus on patient experience and reducing inequality

What is the message?

• An ideal resource allocation process has the following characteristics:– Compare competing options then choose, not say ‘yes’ or ‘no’ to

individual proposals as they arise– Have some way of checking if you are spending an unusually

small or large amount of money in a particular area– Favour services that will have a material impact on outcomes – Have some way of monitoring those outcomes– Encourage stakeholders to think about ideas for saving money

as well as spending money

• Programme budgets enables all of this– Data from SPOT tool published by Department of Health and

APHO

This slide has had a visual impact

• First slide included in presentations at:– East of England Public Health Conference– NHS Bedfordshire Mental Health Stakeholder Group– NHS Bedfordshire Engagement and Communications

Group– NHS Bedfordshire Board Nov ‘09 and Jan ’10– NHS Bedfordshire Strategy Committee

This slide has had a visual impact

• Comments received on slide demonstrate that it has been influential:– ‘This demonstrates that we need to have a serious discussion as to

whether we are prepared to spend the large amount of additional money we are spending on dentistry’

– ‘Examining programme budgets… now that is truly strategic’– ‘Fantastic, programme budgeting should become part of

commissioning cycle’– ‘Looking at programme budgets are the best way of mapping out

pathways, and can be used in conjunction with Map of Medicine’– ‘We can have a rational discussion as to what to invest and

disinvest in’

How has this helped decision making?Examining the mental health programme budget

Scatterplot tool used to assess proposals within mental health programme

– Using programme budgeting and marginal analysis, we have compared competing options within a programme budget

– Services that have had a material impact on outcomes and are otherwise most valuable have been prioritised, using resources allocated from services deemed less valuable

How has this helped decision making?

Bridge diagram for mental health programme budget

– Stakeholders have engaged in ideas about saving money as well as spending money

– By monitoring the outcomes in this programme budget, we will have a means of assessing the effect of allocation decisions

Contribution to Public Health Competencies

The following competencies are the most related:

– Support commissioning, clinical governance, quality improvement, patient safety, equity of service provision and prioritisation of health and social care services.

– Influence the development of policies, implement strategies to put the policies into effect and assess the impact of policies on health.

– Lead teams and individuals, build alliances, develop capacity and capability, work in partnership with other practitioners and agencies and effectively use the media to improve health and wellbeing.

Appendix

• Contact details: mark.lim@bedfordshire.nhs.uk

• Index:– Slide 1: ‘Killer Slide’– Slide 2: Criteria 1 (85 words)– Slide 3-4: Criteria 2 (130 words)– Slide 5-6: Criteria 3 (90 words)– Slide 7: Criteria 4 (76 words)