Marketing strategy resources for clinical psychologists - Appendices

253 Pages·2007·2.33 MB·English

Appendix 1.

Better Allocation for Better Health and Healthcare:
The First Annual Population Value Review
Better Allocation for Better Health
and Healthcare:
The First Annual Population Value
Review

Peter Brambleby, Andrew Jackson
and J. A. Muir Gray

Foreword by:
Duncan Selbie, Commissioning Director

NHS National Knowledge Service Commissioning Directorate
Department of Health

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Contents

Foreword

Programme Budgeting for commissioners: in brief
What is the aim of commissioning?
What is the aim of the annual population value review?
Why have an annual population value review?
How can we improve healthcare locally through the annual population value
review?
How do I conduct an annual population value review?
What is the right answer?
What will be the outcome of this annual population value review?

Section 1:
Taking the plunge into Programme Budgeting and Marginal Analysis
What is Programme Budgeting and Marginal Analysis (PBMA)?
What data and resources are available to undertake Programme Budgeting?
Data on expenditure
Data on outcomes
How is the information collected?
What do I do now?
Additional resources to support commissioners

Section 2:
What tasks do I need to do for the general assessment of the whole budget?
Proformas 2.1 and 2.2

Section 3:
What tasks do I need to do for the specific assessment of a programme budget for a
single disease category?

Section 4:
The future
What further information will be available to increase the usefulness of
Programme Budgeting?
More detailed programme and sub-programme financial data
More reliable data
More outcome and output data
Marginal analysis

Further reading

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Annex 1:
Background to Programme Budgeting
What is the National Programme Budgeting Project?
Why is Programme Budgeting important now?
What is the history of Programme Budgeting?
When was Programme Budgeting introduced into the NHS?
The National Programme Budget Project Board
What are the benefits of Programme Budgeting for the NHS?
What are the advantages of Programme Budgeting to individual NHS
organisations?
How will Programme Budgeting be used in the long term?

Annex 2:
The Annual Review of Evidence, Process, Outcomes and the Configuration of the 50
major health problems (EPOC) Programme

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Foreword
Dear Colleagues,

Welcome to the first Annual Population Value Review.

One of the core functions of commissioners is resource allocation to different population
groups based on an analysis of need. Excellent work has been done by the Programme
Budgeting Team within the Department of Health, and clear information about spend on
each patient group can now be provided for each PCT. In the first instance, this will raise
questions about the accuracy of the data, however, this will improve with use.

Before the start of the next financial year (2007-2008), each primary care trust (PCT)
might want to reflect upon the distribution of resources among the different groups and
how the distribution compares with the distribution of other commissioners, particularly
commissioners who are serving populations that have a similar socio-economic profile.

Some of you will already be experienced in the technique of Programme Budgeting, but
for those of you who are not we have been fortunate in obtaining the skill and experience
of both Peter Brambleby, lately Director of Public Health at Norwich PCT, and Andrew
Jackson from the DH Finance Directorate to help promote and disseminate this work.

For those to whom this technique is new, the main objective this year is to reflect upon
the distribution of resources across and within programme categories, and to identify
areas that would reward further investigation and analysis. For those who have already
carried out programme budgeting before, data can offer the opportunity for more detailed
analysis and action.

It is our intention to produce guidance on marginal analysis at a later date. For many of
you, this will be of most use during the second annual value population review, which
will be based on 2006-07 data available from November 2007.

Throughout 2007, more detailed work on individual programme budgets relating to
disease groups and then specific conditions within each disease group will take place as
part of the work for the National Knowledge weeks, introduced by the National
Knowledge Service with the focus on individual conditions.

I commend this work to you and look forward to seeing its impact on the ground.
Duncan Selbie
Commissioning Director
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Programme Budgeting for commissioners: in brief

Over the last year, there has been an acceleration of the commissioning function in the
NHS.

In July 2006, the Department of Health published the Commissioning Framework for
Hospital Services and the complementary Commissioning Framework for Health and
Well-being was published in December 2006.

In November 2006, Richard Douglas wrote to the NHS explaining that data on
programme budgets and outcomes was available to commissioners.

What is the aim of commissioning?
When commissioning health services, the aim is to maximise value for the population
served from the resources invested on the population’s behalf. This can be done in two
ways: directly and indirectly.

The commissioner can maximise value directly by allocating the resources they control
among the patient and population groups within the population to best effect. The
resources can be invested with specific health objectives, as follows:
• to reduce health inequalities and improve equity;
• to promote and improve the health of the population;
• to improve the value and quality of healthcare.
Value derived from investment in healthcare is maximised when it is impossible to
reallocate resources from one patient or population group to another to achieve more
benefit or less harm. This is sometimes referred to as allocative efficiency, a task
increasingly shared with local authorities as service providers.

The commissioner can maximise value indirectly by using their contracting power to help
providers of health services improve the quality and safety of the healthcare they provide
while minimising its cost. This is sometimes referred to as technical efficiency.

What is the aim of the annual population value review?
The aim of the annual population value review is to improve healthcare for the local
people for whom the commissioner is responsible by clarifying the allocation decisions
that have been made, both explicitly and implicitly.

In order to do this we need to initiate NHS learning from expenditure and outcomes data
that will enable us to improve the planning and delivery of services based on need rather
than traditional patterns of investment.

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Why have an annual population value review?
The annual population value review for 2007 will be the first in a series.

The first annual population value review will give commissioners an opportunity to
reflect on the distribution of resources among different programmes according to the
programme classification developed by the Department of Health from the International
Classification of Diseases version 10 (ICD10) Classification.

It will also enable commissioners in newly created primary care trusts (PCTs) to reflect
on the pattern of investment in health services that they have inherited following the
recent re-organisation.

The second Annual Population Value Review will be launched in December 2007.
However, it will be preceded by training opportunities to improve commissioners’ skills
in marginal analysis
How can we improve healthcare locally through the annual
population value review?
The first steps that need to be taken before we can improve healthcare locally are to
identify:
• the distribution of resources between different population groups;
• how the amount invested in each major health category compares with those for
the national average;
• how the amount invested in each major health category compares with the
amounts invested by the commissioners serving populations that have a similar
socio-economic profile.
This gives us the foundation from which we can assess the appropriateness and
effectiveness of these investments in terms of the health outcomes achieved for the local
population.

How do I conduct an annual population value review?
The first phase in conducting an annual population value review is to compile a summary
of expenditure in the programme budget categories. Having done this, circulate the data
widely with appropriate explanations and possible reasons for high and low levels of
spending.

The audience for this information should include:
• patient forums;
• practice-based commissioners;
• clinicians in hospital and community settings;
• specialist commissioning groups;
• local authority personnel, especially those responsible for local area agreements
(LAAs);
• local strategic partnerships;
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• overview and scrutiny committees;
• local media.

What is the right answer?
“There is no right answer for this one.”
Richard Gleave

As commissioners have to match local need to local resources, the situation for each PCT
will be different for each population in England. However, it is essential that
commissioners are aware of any variations in expenditure, and are able to explain the
reasons for outliers on particular programmes of spend, and have a plan to bring them
into line if there is no plausible explanation for the variation seen.

What will be the outcome of this annual population value
review?
For the first year, the main outcomes will be:
• a better understanding among the newly created commissioners of the distribution
of resources they have inherited;
• stimulation of discussions on each programme’s position with respect to PCTs
serving similar populations;
• identification of opportunities to improve health and healthcare locally;
• initiation of discussions with local authorities on matching health needs and
investment in health services for the local population.

Topics for discussion about individual programme budgets could include:
• programme objectives;
• programme budgets (“inputs”);
• programme activities (“outputs”);
• programme achievements (“outcomes”).

Ultimately, the focus of discussion for the Annual Population Value Review is the
redeployment of resources to achieve better value outcomes to meet objectives.
Information that can be used to support detailed discussion about individual programmes
will be provided during the National Knowledge Weeks, which are being organised as
part of the EPOC Programme (see Annex 2). The focus of the National Knowledge
Weeks will be the principal health issues within each programme budget, providing:
• up-to-date evidence about relevant health problems;
• detailed information about prescribing and hospital utilisation trends and
variations.

Given the recent innovation of programme data collection, there may be variation in the
data. If there is lack of confidence in the financial estimate for a programme budget, the
discussion should still go ahead but be framed in terms of:
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• admissions to hospital;
• prescriptions;
• staff;
• beds and bed-days;
• theatre sessions;
• similar tangible resources.

If nothing else, discuss programme objectives, such as meeting un-met needs and tackling
inequalities.
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Section 1:
Taking the plunge into Programme Budgeting and
Marginal Analysis (PBMA)

What is Programme Budgeting and Marginal Analysis (PBMA)?
Programme budgeting is a technique that enables personnel in a health service, and those
who use the health service, to identify how much money has been invested in major
health programmes, with a view to influencing future investment. Marginal analysis is an
economic appraisal technique that evaluates incremental changes in costs and benefits
when resources in programmes are increased, decreased or deployed in different ways.

PBMA can be used within programmes of care or across services and programmes within
a health organisation.

The technique provides users with the capacity to identify:
• Where resources are currently being invested;
• The level of effectiveness of those investments;
• The most effective way of investing in health services in future in relation to the
needs of the population for which services are being commissioned.

Programme budgeting provides a rich source of information that will enable managers
and clinicians to work together to improve healthcare for the local population (see box
below). Although the best way to use the information generated by programme budgeting
is through a structured analytical technique particularly marginal analysis, information on
programme budgets can be used by anyone – it is not necessary to have skills in
economic appraisal.

Delivery of efficient (and in the case of the NHS, equitable) health care requires doctors
to take responsibility for resources and to consider the needs of populations while
managers need to become more outcome and patient centred. …programme budgeting
and marginal analysis has the potential to align the goals of doctors and managers and
create common ground between them.
Ruta et al. (2005)1

1 Ruta, D., Mitton, C., Bate, A. et al. (2005) Programme budgeting and marginal analysis: bridging the
divide between doctors and managers. British Medical Journal 330: 1501-1503.
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