Making better decisions on public health spending

Making better decisions on
public health spending: A
Scottish perspective
Neil Craig
NHS Health Scotland
Making better decisions on public health spending:
Getting to grips with value for money
The King’s Fund
18th September 2014
• The context for public health spending in
• The role of NHSHS
• The wider health system
• How are these arrangements working in
• Looking ahead
• Improving health….
• …..but persistent and widening health
• Financial pressures
• Emphasis on prevention
What is NHS Health Scotland?
NHS Special Health Board
Role: national agency for health improvement
Priority: reducing health inequalities
Aim: to improve Scotland’s overall health
record by focusing on the persistent
inequalities that prevent health being
improved for all
Local delivery…..
• Delivered by Community Planning Partners
• Configured in Community Planning
• Expressed in Single Outcome Agreements
…… National direction
• Directed by Scottish Government through
- statement of ambition and community
planning guidance
- National Community Planning Group
- broad priorities
Priorities - strategic
• Faster shift to prevention
• More joint resourcing
• Co-production and assets-based approaches
Priorities - specific
• Early Years
• Outcomes for Older People (including health
and social care)
• Safer Communities and Offending
• Health Inequalities (including physical activity
• Economic Growth and Recovery
• Employment (especially youth employment)
In practice?
• Community planning: a work in progress
• National steer vs local freedoms: is the
balance right?
• Multiple objectives of prevention:
- are they shared?
- are they mutually compatible?
Potential savings
from reduced
‘failure demand’
Likely to reduce health inequalities
Building relationships
• With SGs, CPPs and 3rd sector
• With COSLA e.g. through an Inequalities
Action Group
• Through a knowledge-into-action strategy
• Through a SG-sponsored Health Economics
Network for Scotland
=> Early days
• Balance between central guidance and local
• Local implications of national (or
international) evidence?
• Complexity vs accessibility
“Tell us, clearly, what the evidence says we
should be doing but don’t tell us what to do…..”

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