1. 2010/11 and beyond The financial environment NoSPG 24 February 2010 North of Scotland Planning Group

2. Key Messages Revenue funding uplift % in 2010/11 now lower than pay cost inflation including pay drift Expectation that revenue funding uplifts from 2011/12 will be very low – possibly zero Capital funding from 2010/11 to be cut by around 20% per annum – this equates to £100 million for Grampian over next five years NHS staff pay needs to be frozen from 2011/12 to match funding levels and avoid job losses North of Scotland Planning Group

3. Key Messages NHSG is facing a £37 million budget gap in 2010/11 alone. Dependent on Government policy on pay, following years could be worse Indications from recent CE meeting that other boards face equivalent gaps Boards to continue to maximise efficiency and productivity – benchmarking with best in class useful guide to efficiency North of Scotland Planning Group

4. Key Messages Despite that, radical urgent action required by Government and Boards to address financial pressures Review HEAT targets required. What can reasonably be “toned down” that would cut costs? Can Government provide non-recurring funding to allow staff to voluntarily terminate contracts? North of Scotland Planning Group

5. Key Messages NHS in Scotland facing a watershed. Government and Boards to collaborate urgently in finding solutions North of Scotland Planning Group

6. Implications for Service Vacancy Controls (different approach in Board Areas –Slowing the Recruitment Process Down –Recruitment Freeze –Replacing with Lower Grade Staff –Internal Recruitment Only North of Scotland Planning Group

7. Implications for Service No funding for Developments –Funding the existing core service is priority –Achieving cost reductions essential –However some developments may be approved if investment required is less than existing cost North of Scotland Planning Group

8. Implications for Service No funding for Developments –Funding the existing core service is priority –Achieving cost reductions essential –However some developments may be approved if investment required is less than existing cost North of Scotland Planning Group

9. Opportunities ? Service Redesign across Region Service Rationalisation across Region Repatriation of Activity from Outwith Regional boundaries Working across Board Boundaries to Fully Utilise Existing Capacity Sending Patients outwith Region if More Cost Effective North of Scotland Planning Group

10. Opportunities ? Procurement Savings –Joint Purchasing for anything outwith National Contract –Review BMS/DES % –Ensuring Consistency in use of Products –Replacing Equipment Leases with Capital Purchase North of Scotland Planning Group

11. Opportunities ? Embrace New Technologies (CT ?) where Evidence Clearly Demonstrates Effectiveness and Affordability Reduction in Bed Numbers if reduce ALOS? Other Ideas!!!! North of Scotland Planning Group

12. CARDIAC SURGERY COSTS North of Scotland Planning Group

13. CARDIOLOGY IN-PATIENTS North of Scotland Planning Group

14. CARDIOLOGY DAY CASES North of Scotland Planning Group

15. IN THE NEW FINANCIAL ENVIRONMENT NOTHING IS IMPOSSIBLE BUT MOST THINGS ARE A CHALLENGE North of Scotland Planning Group

16. AND THE GOOD NEWS IS? IT COULD HAVE BEEN WORSE North of Scotland Planning Group

17. QUESTIONS North of Scotland Planning Group