1. Shaping the Future 9 th October 2012 Understanding the Financial Context Reg Middleton Chief Financial Officer West Kent Clinical Commissioning Group

2. A context of lower growth compared to earlier years; increasing pressures from demographic changes in the area, an ever increasing range of treatments available, increasing expectations of patients and the public So……. we need to do our best to ensure that we get the most from every £ of investment in healthcare that we make Key Headlines

3. Resource Outlook Current planning assumption is to assume 0% change to NHS budgets over the medium term So we will need to manage the cost of the ageing population and other demographics within a cost base broadly the same as today’s So the challenge is…. How to do some things more cheaply, and to question whether some things we (can) do, represent better use of our resources and should therefore be prioritised over another? And at the same time, maintaining or improving the standards of quality and safety

4. How we currently deploy our funds 2012/13 Budget £000 South East Coast acute trusts 225,112 Community services and GP prescribing 110,937 Non South East Coast acute trusts 42,819 Mental Health 39,778 Non NHS including Continuing Care 43,928 Contingency 5,080 NET OPERATING COSTS 467,653 Typically expressed on the basis of the “Setting of Care” where patients are seen. But our investment choices are far more complex than that…..

5. Programmes of Care Geographies Age group Planned Care/Urgent Care/Long Term Conditions Screening/Interventions/Rehab/Maintenance Setting of Care Dimensions

6. An illustration using Programme Costs

7. West Kent PCT Expenditure by Care Setting 2011-12

8. West Kent PCT Expenditure by Programme 2011-12 Mental health is the largest single programme of expenditure In West Kent, tend to spend more on cancer than expected 24 programmes of care, some broken down into sub- categories In West Kent, tend to spend less on dental than expected

9. Cancer Expenditure by Setting of Care 2011-12

10. Endocrinology Expenditure by Setting of Care 2011-12

11. Commissioning Choices Do we want to spend relatively more, or less on: – Primary Care, Community Care, Hospitals – One health programme over another – Screening vs. specialist care – One population group over another – One age group over another And how do we make these choices?