Hide Notes 

Slide 1: John Matheson & Stephen Gallagher Quality Driven Financial Performance Scottish Government
Slide 2: NHSScotland Event SCENE Horizon Scan 1 2 3 Economic Overview Quality and Efficiency Current Perspective
Slide 3: NHSScotland Event  Economic Overview
Slide 4: Percentage of national income 30 1948-49 1953-54 1958-59 1963-64 1968-69 1973-74 1978-79 1983-84 1988-89 1993-94 1998-99 2003-04 2008-09 2013-14 35 40 45 50 55 Total Managed Expenditure vs Current Receipts Current receipts Total Managed Expenditure
Slide 5: Public Sector net borrowing Public Sector net borrow ing 170 150 130 £ bn 110 90 70 50 30 0'8-09 09-10 10-11 11-12 12-13 13-14 14-15 F ina nc ia l y e a r March 2010 Budget June 2010 OBR pre budget report June 2010 OBR budget forecast
Slide 6: Two-Speed Recovery Two-Speed Recovery IMF GDP Forecasts for Advanced and Emerging & Developing Economies Annual GDP % Change 9 8 7 6 5 Percent Forecast 4 3 2 1 0 -1 -2 -3 -4 Average Growth 1998 2007 05 06 07 08 09 10 11 12 13 Advanced economies Emerging & Developing Economies Source: Reuters EcoWin
Slide 7: International GDP Growth - Update 1.00 0.75 0.50 0.25 Percent 0.00 -0.25 -0.50 -0.75 -1.00 Q3 United States 10 United Kingdom Q4 Japan Euro Zone Q1 11 Source: Eurostat Q2
Slide 8: SCENE ‘On the road from the City of Skepticism, I had to pass through the Valley of Ambiguity’ Adam Smith
Slide 9: % Annual Real Growth Rate in Scottish DEL Budgets 14% 13% 12% 11% 10% 9% 8% 7% 6% 5% 4% 3% 2% 1% 0% -1% -2% -3% -4% -5% -6% 00-01 01-02. 02-03. 03-04. 04-05. 05-06. 06-07. 07-08. 08-09. 09-10. 10-11. 10-11. '11-12 '12-13 13-14 Health Since Devolution SR2007 Next SR •IFS predictions – Dec 2009 •Reflects current use of EYF
Slide 10: Estimated Scottish Government DEL Expenditure – June 2010 Budget Results (2010/11 Prices) 32,000 2009-10 16 years 2025-26 30,000 £39 billion £42 £ Millions (2010-11 Prices) 28,000 26,000 24,000 22,000 20,000 /1 0 /1 8 /2 1 /2 3 /1 1 /1 3 /1 6 /2 4 /1 2 /1 4 /1 5 /1 7 /1 9 /2 0 /2 2 /2 5 /2 6 25 20 10 12 15 20 09 20 11 20 13 20 17 20 18 20 20 20 22 23 20 26 20 14 20 16 20 19 20 21 20 24 /2 7 20 20 20 20
Slide 11: UK Comprehensive Spending Review 2010 Scottish Government DEL Settlement 2011-12 to 2014-15 Change 2010-11 £bn Cash terms Resource Capital Total DEL 25.9 3.3 29.2 25.4 2.5 27.9 25.8 2.5 28.3 26.0 2.2 28.2 26.1 2.3 28.4 0.2 -1.0 -0.8 0.8% -30.3% -2.7% 201112 £bn 201213 £bn 201314 £bn 201415 £bn 2010-11to 2014-15 £bn %
Slide 13: NHSScotland Event Efficiency is a dimension Quality. It can be safer care, more timely and can offer better patient experience.
Slide 14: Quality & Efficiency – Two sides of the coin “To improve the overall quality and efficiency of NHSScotland while ensuring good value for money and achieving financial targets.”
Slide 15: Case study: NHS Tayside Older Peoples Services  Project established to realise significant improvements, both qualitative and financial. By focusing on the patient and removing waste, NHS Tayside is delivering:  Reduced inappropriate admissions,  Reduced length of stay through focus on patient goal setting and partnership working (from 27 to 18 days),  Lower readmissions by shifting the balance of care,  Capacity and capability in staff to proactively manage and support more effective and efficient patient pathways, and  Potential to save £1.4m p.a. in net savings from service reconfiguration.
Slide 16: Case study: NHS Borders Enhanced Recovery  Enhanced Recovery focuses on improving patient outcomes and speeding up a patient’s recovery after surgery. NHS Borders has successfully adopted and implemented this model of care for patients receiving planned major orthopaedic operations, resulting in a reduction in the length of stay in hospital for patients from an average of 7.7 days to a new average of 3.5 days.  This reduction not only represents a long-term productive opportunity for NHS Borders but also provides improved patient outcomes by reducing variability, decreasing the risk of infection, and ensuring that patients are active participants in their own recovery process.
Slide 17: We have a record of achievement…. NHS Scotland’s Health Boards delivered £262m of local efficiency savings in 2010/11, equivalent to 3.1% of baseline funding made available to NHS Boards. This exceeded the minimum level of savings required by £61m and made it the third year in a row that NHS Boards have exceeded their efficiency targets
Slide 18: NHS Scotland Productivity  No. of inpatient & day cases has increased every year since 2002/03 (1.41m in 2010/11)  No. of WTE has increased at similar rate but decreased last year  Number of staffed acute beds has reduced every year since 2006/07 (2009/10 average 17,099 beds); day case surgery up by 4.6% over the same period  ALOS for emergency inpatients from 4.2 days (06/07) to 3.7 days (09/10)
Slide 19: NHS Scotland Performance  Scotland has lowest median waiting time for 7 of 11 procedures (UK Health Stats comparisons)  Scotland has lowest 90th percentile waiting time for 7 of 11 procedures  99.9% patients waiting 12 weeks or less for 1st outpatient consultation  99.6% of patients waited 6 weeks or less for key diagnostic tests  HAI – Since 2007, c.diff cases reduced by 73%  HAI - Since 2007, MRSA bacteraemias reduced by 61%
Slide 20: Scottish Patient Safety Programme 72% reduction in critical care c.diff 1 2 3 4 23% increase in surgical briefings 58% decrease in ward c.diff 15% increase in ontime antibiotics` 14% increase in ward hand hygiene
Slide 21: Efficiency and Productivity Framework “To improve the overall quality and efficiency of NHSScotland while ensuring good value for money and achieving financial targets.” Focussed Approach:  Work-streams identified and links made to QAB and Delivery Groups How?  Support – supporting our workforce through engagement, partnership and placing quality at the centre. Cost reductions – using the data to identify potential based on variability of care Enablers – identifying, testing sharing and sustaining good practice.  Portfolio Board established to  identify priority projects  Return on Investment  Collective approach to implementation of what works. 
Slide 22: Work-streams: Reducing Variation, Waste and Harm • Primary Care & Community • Patient Flow & Acute Services • Workforce Productivity • Evidence Based Care • Prescribing, Procurement & Shared Services Service Redesign • Service Redesign & Innovation
Slide 23: Three Phases of Activity 1.    2.     Estimate Potentials based on variability Meaningful comparison Understanding blend of productivity, cash efficiency Building the quality as well as efficiency case for redesign Agree Priorities Best practice actions Case studies Pilot/Project based activity with clear ROI Agree what support required to deliver to scale 3. Benefits realisation and reporting, challenge to adopt, re-examine potential
Slide 24: Emerging portfolio 2011/12
Slide 25: What seems to make a difference?           Strong CEO leadership Clear Organisational Narrative linking Quality, Efficiency and Productivity Good use of information to identify opportunities and drive improvement Dedicated and rigorous Project Management Clinical Leadership and Engagement Clear system rules/norms (based on quality) and aligning incentives/sanctions Delegated budgetary responsibility and bottom up idea generation Directors focus on delivery of critical projects Ownership of benefits realisation (quality and efficiency) across organisation Agile, targeted improvement support to realise benefits within portfolio
Slide 26: Targeted Improvement – Case Study: NHS Lothian  Clear link to strategic objectives  Clear articulation of the place of continuous improvement in delivering significant quality and efficiency gains for the organisation  Evidence of triangulation in organisation between operational management, finance and improvement/modernisation teams  Table outlining projects, link to E&P themes, quality and capability benefits and the efficiency and productivity benefits Scheme Implementation of self management – COPD E&P quality themes Out-patients, community and primary care Quality and capability benefit Efficiency and productivity benefit Person-centred HEAT T10 approach, staff skills Savings of £460k pa development expected; 2,200 em adm avoided
Slide 27: NHSScotland Event  Current Perspective
Slide 28: SCENE Five Year Perspective – Development of Strategic Narrative detailing Five Year Vision – Recognition of challenges facing NHSScotland  State of Scotland’s Health  Demographic Profile  Challenge of UK Finances – UK Barnett Consequentials will be passed on to NHS – Service change to be described in the context of quality improvement – Different service delivery approaches required at a local, regional and national level
Slide 29: SCENE Health Manifesto Commitments – Delivery on Manifesto Commitments – Low in number       Alcohol Minimum Pricing Policy Health and Social Care Integration Family Nurse Partnerships Early Detection of Cancer Further Investment in Dementia Services Ring-fenced Support for Carers
Slide 30: SCENE Spending Review – Identify and Prioritise the spending policies which:  maximise economic recovery and increase sustainable economic growth  protect services for the most vulnerable  prioritise the most effective preventative spend  deliver actions to meet statutory targets on reducing greenhouse gas emissions
Slide 31: SCENE Spending Review – Exploring scope for  further integration;  new funding mechanisms;  reducing duplication; and  reflecting on the key messages from the Christie Commission.
Slide 32: SCENE Spending Review – Specific focus on the following areas:– Work to reduce carbon emissions – Early Years – Post-16 Education – Employability – Adult and Social Care – Support for Business – Assets & Infrastructure – Offending & Community Safety – Delivering Services in Rural Areas
Slide 33: SCENE Spending Review – Timetable  two months shorter than normal  Cabinet meeting 28th July  further Cabinet discussion 9th / 23rd / 30th August  Cabinet final sign-off 6th September  Spending Review and Draft Budget Announcement 21st September
Slide 34: SCENE Implications for Leaders (1) – The evidence base for what improves quality is clearer than for what reduces costs – The two agendas are related and leaders must connect them – Taking a broad and balanced approach to quality may improve clinical engagement – Increasing reliability and reducing variation matters – Have to do this with people and not to them
Slide 35: SCENE Implications for Leaders (2) – Greater efficiency alone won’t be sufficient – Needs both short term and long term approaches (low hanging fruit and culture shift required) – A requirement not a choice to connect quality and cost given what we know about demography and demand.
Slide 36: SCENE “We look to Scotland for all our ideas of civilisation” Voltaire (1694-1778)