1. 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

2. Outline The context for public health spending in Scotland? The role of NHSHS The wider health system How are these arrangements working in practice? Looking ahead

3. Context Improving health…. …..but persistent and widening health inequalities Financial pressures Emphasis on prevention

4. 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

5. Local delivery….. Delivered by Community Planning Partners Configured in Community Planning Partnerships Expressed in Single Outcome Agreements

6. …… National direction Directed by Scottish Government through - statement of ambition and community planning guidance - National Community Planning Group - broad priorities

7. Priorities - strategic Faster shift to prevention More joint resourcing Co-production and assets-based approaches

8. Priorities - specific Early Years Outcomes for Older People (including health and social care) Safer Communities and Offending Health Inequalities (including physical activity opportunities) Economic Growth and Recovery Employment (especially youth employment)

9. 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?

10. Cost-effective/VFMLikely to reduce health inequalities Potential savings from reduced ‘failure demand’

11. Building relationships With SGs, CPPs and 3 rd 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

12. Themes Balance between central guidance and local autonomy? 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…..”