ScotPHN is hosted by

• 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

• Public sector financial restructuring
• NHSScotland Quality Strategy - emphasis on quality (and costefficiency)
• 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

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

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

• 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

• 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)
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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)
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Total Ineffective Healthcare Interventions by
Type
Surgery 21
Treatment (inc. drugs, tests etc.)
Therapy (inc. psychotherapy and devices)
Model of care
Screening
Total
232
21
12
5
291
ScotPHN is hosted by

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.
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• 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

• 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

ScotPHN is hosted by