1. DIFFICULT DECISIONS IN HEALTH CARE Presentation to OJHOSC Dr Ljuba Stirzaker Oxfordshire Primary Care Trust 13 March 2008 ITEM JHO8(a) JHO3.MAR1308R03.ppt

2. PCTs - 3 Principal functions To improve health and well-being of its population To commission a comprehensive and equitable range of high quality responsive and efficient services, within allocated resources To directly provide high quality responsive and efficient services where this gives best value Patients

3. About Oxfordshire PCT  Serves a population of 620,000 people  Total Budget for 2007/8 = £745 million = £1200 per person

4. Examples of cost of healthcare services Hospital outpatient appointment- £100 to 300 Heart by-pass surgery- £7,645 Hip replacement surgery- £5,500 Bariatric (obesity) surgery- £8,500

5. How the PCT spent its money in 2006/07  Commissioning hospital care £424M(62%)  Primary care £99M(14%)  Prescribing £82M(12%)  Community health services £57M(8%)  Public health £6M(<1%)  Other £14M(<2%)

6. NHS funds are finite, and resources are always scarce; therefore choices have to be made. Every choice represents a lost opportunity to do something else which might be done – this is the “Opportunity Cost” of making a choice. We can only spend each pound once.

7. There is a great deal to do…… Where do you start ? National priority Local priority Size of the health problem Impact on population The cost to the NHS New effective interventions Interest of local clinicians Strong patient lobby

8. The Oxfordshire Priorities Forum The key functions of the Forum are:  To consider locally identified innovations  To consider potential disinvestments  To advise on local implementation of NICE guidance

9. Priorities Forum cont… how do we do it?  Does the treatment work ?  How well does it work ?  How good is the evidence ?  Is it worth paying for ?

10. Individual Patient Requests Exceptions to ‘low priority treatments’ In order for funding to be agreed, there must be some unusual or unique clinical factor about the patient that suggests that they are:  significantly different to the general population of patients with the condition in question and  likely to gain significantly more benefit from the intervention than might be expected from the average patient with the condition.

11. IPR Process: a series of events… Treatment Request Panel Case Review Committee PCT Appeals Panel NHS Complaints Procedure

12. Examples of cost of healthcare - £1m to spend Drug treatment of AMD = 80 Patients (72 benefit) New cancer drug = 40 patients (12 benefit) Adult cochlear implants= 50 patients (45 benefit) Running a Community Hospital for one year