2014/15 FINANCIAL OUTLOOK AND
CHALLENGES
Overview
• Financial Context
• Summary of 2014/15 position:
 Key pressures/service developments
 Savings opportunities
• 2015/16 and future outlook
• Implications for 2014/15 and Choices
Scale of Financial Challenge in 2014/15
Additional funding
of £420m needed
to meet all
identified costs of
meeting existing
policies and
expectations
Savings of £170m
have been
identified by
DHSSPS
DHSSPS
budget due to
increase by
£90m
A funding gap of
£160m still
needs to be
resolved
DHSSPS Budget 2010 Profile
Budget 2011-15
Settlement
Current Expenditure
% Uplift
Real Terms %
(updated April 2014)
Capital Expenditure
2011/12 2012/13 2013/14 2014/15
£m
£m
£m
£m
4,383.1 4,447.6 4,569.2
1.5%
2.7%
-
4,659.4
2.0%
-0.3%
0.9%
-0.2%
325.4
224.8
200.5
Efficiencies Already Delivered
2011/12 2012/13 2013/14
£m
£m
£m
Trusts/LCGs
106
137
101
Family Health Services
Other non-HSC
opportunities
30
42
33
32
6
5
168
185
139
Total
£m
492
Efficiency Indicator Trends
Average
Length of Stay
2009/10 2012/13
HSC
Days
Days
IMPROVEMENT
General Surgery
5.0
4.6
0.4 Days
General Medicine
7.2
6.0
1.2 Days
Obstetrics
2.7
2.3
0.4 Days
2009/10 2012/13
HSC
%
%
IMPROVEMENT
Day case rate
(all admissions)
30.2
32.1
+1.9%
Opening position for 2014/15
Significant
unresolved
challenges experienced in
2013/14
Reliance on non-recurrent
measures in 2013/14:
 In Year Monitoring
 Managed
slippage/deferral of
expenditure
The HSC is carrying
deficits of
£115m into
2014/15
Latest Assessment of 2014/15
2014/15
£m
2013/14 HSC pressures carried forward
(115)
HSC identified pressures
(275)
DHSSPS identified pressures
(30)
Total Funding Requirement
(420)
Measures identified to address funding requirement:
DHSSPS additional allocation for 2014/15
90
Opportunities in Local Economies
130
Regional Opportunities
25
Non-HSC Opportunities
15
Total Opportunities
260
Unresolved Funding Gap
(160)
Key Pressures in 2014/15
Pay & non-pay inflation
£52m
NICE Drugs
£19m
Demography
£35m
MH and LD Resettlement
£17m
Service Developments
£76m
Specialist Hospital Services
£7m
Family Health Services
£37m
Transforming Your Care
£21m
Public Health Agency
£4m
Revenue Costs of Capital
£7m
Service Developments in 2014/15
Psychological
Therapies
£2.5m
NICE Drugs
£19m
ED Capacity
Planning
£5m
Cath labs
£4.5m
Elective
Care
£15m
Family and Child
Care
£7m
Normative
Nursing
£12m
Savings Opportunities 2014/15
2014/15
£m
Trusts
130
Regional Opportunities
25
Other non-HSC opportunities
15
170
Savings Opportunities at Trusts – 2014/15
ACUTE
REFORM
SOCIAL CARE
REFORM
STAFF
PRODUCTIVITY
• Reduce Excess
Bed Days
• Increase in day
case rates
• Reduce Did Not
Attends
• Improve theatre
utilisation
• Reduce level of
cancellations
• Reablement
• Shift to lower
cost provision
• Reform of Social
Care
• Review of skill
mix
• Reduction in
backfill (whilst
maintaining safe
staffing levels)
• Reduce sickness
absence
• Unit cost
management
OTHER
PRODUCTIVITY
• Rationalisation
of the estate
• Procurement
• Management
costs/shared
services
2015/16 Outlook
• Total additional pressures are estimated at
£317m
• There is a growing trend of cost pressures:
2011/12 2012/13 2013/14 2014/15 2015/16
Cost pressures as % of
total DHSSPS Budget
5.1%
5.5%
5.6%
6.1%
6.6%
Population
Northern Ireland Projected Population trend 2011 2051,
(Based on 2010 MYE)
Northern Ireland Population, by age and gender 2012
Male
Female
90 & over
80-84
70-74
60-64
50-54
40-44
30-34
20-24
10-14
0-4
100000
100%
80%
85+
60%
60-84
40%
16-59
Under 15
20%
50000
0
50000
100000
0%
2011
2021
2031
2041
2051
The 2011 Census, indicates that 20% of the resident population were aged 60+.
By 2021 it is projected that this will increase to 23.2% and by 2051 almost one third (32.6%)
of the population will be aged 60+.
Between 2011 and 2051, the proportion of the population aged 85+ is expected to increase
from 1.7% to 6.7% .
Unplanned Admissions to HSC Hospitals in Northern Ireland with a
Long Term Condition for those aged 65 and Over by HSC Trust,
By 2020: Number of adults with LTC will increase
2010/11
40% in RoI, 30% in Northern Ireland
80% of GP consultations & 60% of hospital bed
days relate to LTC and complications.*
* Source: Making Chronic Conditions Count IPHI
Key Reform Initiatives Under TYC
Shifting 5% of hospital expenditure with
reinvestment in primary, community
and social care services
Improving integration of care through the
development of integrated care partnerships –
reducing need for unnecessary hospital visits
Maximising the potential of technology
Building a model of care which is focused on
the individual rather than the institutions
Impact of budget allocation – 2014/15
• Deterioration in waiting times for elective services – which
would exacerbate the health inequalities we are committed
to addressing
• Compromising the safety and quality of services provided
to patients and clients
• Compromising the delivery of statutory requirements,
Programme of Government commitments and key
Ministerial priorities and commitments
• A growing parity gap between Northern Ireland and the rest
of the UK by not funding all demand led pressures
Choices For Executive
1
Increase even further the extent of savings required
across the HSC
2
Constraining pay for HSC staff
3
Reducing the range and/or standard of services offered
4
Impose additional charges or co-payments for services
5
Provide additional recurrent resources to DHSSPS