PBMA C@H in S&M

1. PBMAC@H in S&M

2. Delayed Discharges Current NHS Highland Delayed Discharge Position

3. Opportunity Cost of Delays 24,000 bed days lost to delayed discharge equates to circa £8m OPPORTUNITY COST

4. PBMA?

5. Generating options for investment • Imagine that services for older people will receive a budget increase of 10% next year. This would amount to approximately £X. • What service areas (either existing or new) would you want to allocate this increase spending to?

6. Generating options for investment and disinvestment • Imagine now that there is a budget cut of 10% to service for older people as of next year. Again, this would amount to £X. • What service areas would you prioritise for: • Design to save resources? • Actual cutbacks?

7. Marginal Analysis • Define and agree decision criteria • Criteria weighting • List of options for service growth and service reduction • Process supported by business cases. These should show how each option meets the agreed decision criteria using supporting evidence and expert opinion • Scoring options against criteria • Scoring of options then allows for each option to be ranked showing which is the preferred option • This then can allow for resources to be released from the lowest ranking service reduction option

8. Doing PBMA PBMA approaches needs assessment by asking five questions about resources: 1. What resources are available in total? 2. In what ways are these resources currently spent? 3. What are the main candidates for more resources and what would be their effectiveness and cost? 4. Are there any areas of care which could be provided to the same level of effectiveness but with less resources, so releasing those resources to fund candidates from (3)? 5. Are there areas of care which, despite being effective, should have less resources because a proposal from 3. is more effective (for £s spent)? Questions 1 and 2 pertain to the PROGRAMME BUDGET Questions 3-5 are addressed in MARGINAL ANALYSIS

9. Marginal Analysis • Define and agree decision criteria • Criteria weighting • List of options for service growth and service reduction • Process supported by business cases. These should show how each option meets the agreed decision criteria using supporting evidence and expert opinion • Scoring options against criteria • Scoring of options then allows for each option to be ranked showing which is the preferred option • This then can allow for resources to be released from the lowest ranking service reduction option

10. Criteria weights • Business Cases • Mental Health • Virtual Ward • Day Care • Care @ Home......THE WINNER!

11. 2013/14 Care @ Home Position Hospital unmet need • 40 people @ 10 hours per week • around 400 hours per week / £322k per annum Communityunmet need: • 246 people @ 10 hours per week • 2,460 hours per week / £2m per annum • Estimated cost of current unmet need is £2.3m p.a.  • Market split 60% (in house) / 40% (independent sector) • In-house provision more expensive • Competition between providers to recruit • Not all geographical areas of operation sustainable • Inconsistent (and some poor) quality of provision

12. Investment Shift in Care @ Home • Level playing field, means commissioning across sectors, not protecting in house service. • Stop the race to the bottom • Paying (75p) to achieve compliance with Living Wage • Collaborative zoning, means providers can access cost effective“runs”, not scattered provision • Disinvest in inefficiencies • Developing a single tariff for all providers which can be enhanced for rurality and complexity

13. Market Changes Quality of Provision

14. North Highland Changes in Provision

15. North Highland Changes in Provision Expenditure Independent Sector: £3.8m (37%) In House: £6.4m (63%) Clients Independent Sector:750 (60%) In-House: 506 (40%) So 100% could be provided for £6.36m?; saving £3.84m Unmet need was £2.3m £1.54m for.... In this climate?

16. Doing PBMA PBMA approaches needs assessment by asking five questions about resources: 1. What resources are available in total? In house resources included 2. In what ways are these resources currently spent? Reverse 60/40 split 3. What are the main candidates for more resources and what would be their effectiveness and cost? More C@H 4. Are there any areas of care which could be provided to the same level of effectiveness but with less resources, so releasing those resources to fund candidates from (3)? (Independent & Community) C@H 5. Are there areas of care which, despite being effective, should have less resources because a proposal from 3. is more effective (for £s spent)? In House C@H Questions 1 and 2 pertain to the PROGRAMME BUDGET Questions 3-5 are addressed in MARGINAL ANALYSIS

17. Commissioning (Staffside) • Defend (and seek to expand) numbers of jobs in the in-house services, ensuring that it does not become significantly proportionately smaller in the mix of care providers. • Defend (and seek to enhance) terms and conditions for staff in the in-house services (including pay/grading, holidays, travel time etc but also access to training, policies and procedures, health & safety, staff governance etc) • Defend (and seek to enhance) terms and conditions for staff in the private/voluntary sector (including pay/grading – living wage a minimum, holidays, travel time etc but also access to training, policies and procedures, health & safety, staff governance etc)

18. PBMA • Process • Justification • If not, what’s yours....

19. North Highland Changes in Provision Expenditure Independent Sector: £3.8m (37%) In House: £6.4m (63%) Clients Independent Sector:750 (60%) In-House: 506 (40%) So 100% could be provided for £6.36m?; saving £3.84m Unmet need was £2.3m £1.54m for.... In this climate?

20. Thank You Any questions?