1. Scottish Public Health Network Update of 2007 literature review on disinvestment ScotPHN is hosted by

2. Scottish Public Health Network undertake prioritised national pieces of work where there is a clearly identified need; facilitate information exchange between public health practitioners, link with other networks and share learning; create effective communication amongst professionals and the public to allow efficient co-ordination of public health activity; and support and enhance the capabilities and functionality of the Scottish Directors of Public Health Group. ScotPHN is hosted by

3. New Ways of Working - Background Public sector financial restructuring NHSScotland Quality Strategy - emphasis on quality (and cost- efficiency) Public health Directorate must meet competing demands: –ensuring further progress in delivering health improvement and health inequality reduction against national targets; –refocusing resources on effectiveness in health service planning and development; and –maintaining appropriate health protection capacity to meet demands such as that exemplified by the H1N1 Pandemic. ScotPHN is hosted by

4. New Ways of Working – Project AIMS: establish the baseline of public health activities across Scotland to meet challenges; explore new ways of working which will maintain the necessary capacity within the public health function in Scotland; exemplify the contribution of public health in areas such as: –promoting efficiency in health improvement interventions; –health services disinvestment; and finding a way of modelling the impacts of future change on public health functional capacity. ScotPHN is hosted by

5. Disinvestment Elshaug et al. (2007) defined disinvestment as: ‘The process of partially or completely withdrawing health resources from any existing health care practices, procedures, technologies or pharmaceuticals that are deemed to deliver little or no health gain for their cost, and thus are not efficient health resource allocations’.” ScotPHN is hosted by

6. Disinvestment strand - Objectives To update previous work from 2007 To understand and promote public health contribution to disinvestment To understand and promote contribution to wider national planning agenda ScotPHN is hosted by

7. Previous work 2007 case study (Sheila Scott, Director of Public Health, NHS Western Isles) including a literature review of disinvestment (Ann Lees, NHS Greater Glasgow & Clyde) - four sentinel surgical procedures NICE programme – the ‘don’t dos’ lists NHS Healthcare Improvement Scotland (SHTG) ScotPHN is hosted by

8. Method SOURCES: BMJ Best Practice EBM database DARE/HTA/NHS EED NICE programme: –don’t do’s’ list –Optimal Reviews: Recommendation Reminders –Cost saving guidance Request to Directors of Public Health regarding local disinvestment work (2011) ScotPHN is hosted by

9. Literature review - results Ineffective Healthcare Interventions by Type Total Surgery21 Treatment (inc. drugs, tests etc.)232 Therapy (inc. psychotherapy and devices)21 Model of care12 Screening5 Total291 ScotPHN is hosted by

10. Examples of interventions for possible disinvestment include: coronary artery stenting in ischaemic heart disease; the use of many classes of drugs in the treatment of anxiety and depressive states; oxygen therapy in certain presentations of chronic obstructive pulmonary disease; the use of alcohol brief interventions in hospital inpatient settings; or several categories of clinical tests used in conditions such as chronic obstructive pulmonary disease, dyspepsia, epilepsy, familial breast cancer, fertility, growth hormone deficiency, hypertension, lung cancer, and Parkinson’s disease. Literature review - results ScotPHN is hosted by

11. How to implement? Not actually easy to disinvest – also much of it happens without any resource release! (cf NHS Greater Glasgow & Clyde review) Approaches to benefits realisation with disinvestment which include: –service redesign: using disinvestment to allow service redesign/ reconfiguration to be progressed beyond LEAN approaches; –substitution: within service disinvestment to allow reinvestment to address service pressure or allow limited service development; –resource release: managed service removal or closure. Good old fashioned “public health” (e.g. HCNA)! ScotPHN is hosted by

12. Way forward Disinvestment strand to be carried forward as part of the CMO Models of Care work-stream under the Efficiency and Delivery strand of the NHSScotland Quality Strategy. Wider NPF support to be routed through the regional planning teams for initial discussion. Further discussion on necessary mechanism(s). Public Health Directorates will be supporting this work, locally, regionally and nationally. ScotPHN is hosted by

13. ScotPHN Phil Mackie, Lead Consultant (phil.mackie@nhs.net / 0141 354 2978)phil.mackie@nhs.net www.scotphn.net ScotPHN is hosted by