Transcript 8m x 5m

eHealth Strategy Board
eHealth Programme: Funding Requirements Projections
6th December 2016
Status of these Projections
• Reflect the current aspirations for investment prior to a new Digital Health
and Care Strategy
• Focus is on the next 3 years, but some costs will run on as a higher base cost
• Review and prioritisation undertaken by the NHS Board eHealth Leads and
the Scottish Government eHealth Division (primarily a categorisation)
• Detailed estimates only available for some developments, high level and order
of magnitude estimates elsewhere
• Probable that without substantial new funding much further prioritisation will
be required (essentially delay some projects)
Current Sources of eHealth Funding
2016/17 Estimated
Expenditure (£m)
Scottish Government core eHealth revenue funding (note: 2016/17 figure is the
budgeted £76.5m reduced by £2.9m which is carried forward to 2017/18)
£73.6m
Expenditure by the geographic NHS Boards from their general allocation
£125m
Expenditure by the Special NHS Boards, primarily NHS NSS, NHS 24 and SAS.
Sub-Total to Compare to £261m Expenditure in 2012/13
HEPMA programme funding.
Primary Care Digital Services Programme (£4m revenue and £2m capital).
TEC programme (reduced from £9m).
ePharmacy programme funding.
Total Expenditure in 2016/17 (Revenue and Capital)
£35m
£234m
£3.6m
£6m
£7.5m
£7m
£258m
Trend in eHealth Funding (SG eHealth Division)
£140,000,000
£120,000,000
£100,000,000
£80,000,000
eH Rev Ex
eH Cap Ex
£60,000,000
£40,000,000
£20,000,000
£2007/08 2008/09 2009/10 2010/11 2011/12 2012/13 2013/14 2014/15 2015/16 2016/17
Overall Funding Trend
2012/13 IM&T Expenditure Survey:
• Total spending was £261m
• Overall IM&T Expenditure was 2.3% of the Revenue Resource Limit (range 0.5% to 12% across NHS organisations)
2016/17 IM&T Expenditure Estimate:
• Total spending was £258m
• Overall IM&T Expenditure was 2.0% of the circa. £13bn total funding
• However:
• Circa. 4.7% contract inflation and 8% staff costs increase
• Range, complexity and criticality of eHealth systems has increased: more systems, 24 x 7 operations
• This keeps the current systems running - there remain significant gaps in the systems portfolio
• Currently significant replacement / upgrading of systems is required within the existing eHealth systems portfolio
• There are aspirations for complex new analytics and ‘Apps’
Savings Efforts:
• Cost reductions from the baseline 2011/12 costs of the NSS eHealth SLA for national systems/services (£39m)
• In 2016/17 £11.1m p.a. reductions achieved, but limited by £3.6m funding cuts (7.5%) and £2m inflation
Healthcare Providers: IT Spending as a Percentage
of Operational Expense
Source: Gartner IT Key Metrics Data
Overall eHealth New Investment Aspirations: 5 Years
Category
Committed
Essential
Sub-Total
High Priority
Other Possible
Grand-Total
2017/18
(£000)
5,500
8,034
2018/19
(£000)
4,356
12,230
2019/20
(£000)
741
14,908
2020/21
(£000)
309
12,094
13,534
16,586
15,649
12,403
12,301
70,473
6,783
21,956
20,330
21,808
16,207
87,084
2,528
8,026
14,724
15,724
14,724
55,726
22,845
46,568
50,703
49,935
43,232
213,283
2021/22 5 Yr Total
(£000)
(£000)
300
11,206
12,001
59,267
Committed Category
Community Health Index (CHI) and Scottish Child Public Health and Wellbeing System:
• Total cost of £73m (£58m solution, £15m programme) over the period 2013/14 to 2027/28
• Peak funding requirements are £37m over the period 2016/17 to 2019/20, which will be funded
in part by:
• £12.7m from the eHealth reinvestment fund
• £4.67m p.a. in 2018/19 and 2019/20 from existing recurring budgets
• This leaves additional outstanding required funding of over the period 2016/17 to 2019/20:
Funding Option
2017/18
2018/91
2019/20
Baseline Profile
£11.5m
£3.6m
(£0.04m)
£5.5
£4.4
£0.8
Option 3 Profile (supplier funded)
• All funding scenarios generate cash releasing savings from circa. 2020/21 onwards, and these
would largely cover any higher payments with an ongoing surplus
Essential Category Projects: Replacement and Upgrading
eHealth Financial Investment
Opportunities V0.16
5a GP Core Systems Re-Provision
5b SWAN: Bandwidth for Hosted GP
6 Payroll
7 Office Applications (O365)
8 PACS
9 Deploy SNOMED CT
10 SCI Gateway Redevelopment
11 SCI Store Development
12 ECS/KIS/PCS/ACP
13 Employee Support System (eESS)
Subtotal Essential Projects
2017/18 2018/19
(£000)
(£000)
964
2,769
1,025
1,695
700
1,250
3,900
675
320
1,000
770
496
600
500
500
2,800
300
8,034
12,230
2019/20 2020/21 2021/22
(£000)
(£000)
(£000)
4,332
5,004
4,911
1,380
1,380
1,380
2,900
3,900
3,900
3,900
500
2,000
2,000
1,000
150
150
896 340 340
14,908
12,094
12,001
5 Year
Total
17,980
6,860
4,850
15,600
5,495
2,300
1,482
600
1,000
3,100
59,267
High Priority Category Projects: New Clinical Systems
eHealth Financial Investment
Opportunities V0.16
14 HEPMA
15 New Community Systems
16 Deploy Patient Portal
17 Patient Monitoring (Track and Trigger)
18 National Sexual Health System
19 SCI-Diabetes
20 Single Medications Record
Subtotal High Priority Developments
2017/18 2018/19
(£000)
(£000)
4,638
11,284
1,000
8,172
1,000
1,000
1,000
145
2019/20
(£000)
6,298
8,532
2,000
2,000
2020/21
(£000)
8,588
6,720
2,000
3,000
2021/22
(£000)
5,197
5,760
2,000
3,000
5 Year
Total
36,005
30,184
8,000
9,000
145
500
1,500
1,500
250
3,750
21,956
20,330
21,808
16,207
87,084
6,783
Other Possible Developments (£56m over 5 Years)
• GP Technical Environment: Standardised Desktop, Hardware Replacement
Programme, Hosted Environments, SWAN for O365 and Skype
• GP IT Innovation: Clinical Decision Support, eConsult, Electronic Registration, CoDesign and Apps., GP Process Review Implementation
• GP / Community / Social Care Integration Infrastructure for Mobile Working (may
not be needed depending on the community solution)
• Other Community Services: Pharmacy, Dentistry, Optometry (no major
requirements at present)
• Further Training, Informatics (big data), Process Change and Change Management
SG eHealth Division Budget 2017/18 (Projected Income)
SG eHEALTH DIVISION BUDGET (INCOME £000)
1
2
3
4
5
6
7
8
9
Core eHealth Budget
Increase in Core eHealth Budget in 18/19 and 19/20
HEPMA Funding
NHSCR Funding
Primary Care Digital Services Programme Funding
Additional Primary Care Fund Transfer
TEC Programme
2016/17 Retained Funding from the Strategy Fund
2016/17 Retained Unused Budget
10 Total Income
2017/18 2017/18
£ 76,500
£
£
£
£
£
£
£
4,000
700
2,000
3,000
7,500
1,900
1,000
£
96,600
SG eHEALTH DIVISION BUDGET (EXPENDITURE £000)
DISTRIBUTION TO NHS BOARDS:
CENTRAL AND REGIONAL STAFFING:
COMMITTED DIRECT FUNDING SUPPORT:
COMMITTED ONGOING PROGRAMMES:
20 - NHSCR
21 - TEC
22 - CHI Programme (smoothed profile)
23 - Payroll
24 - PACS Procurement Support
25 - Primary Care Digital Services Programme
UNCOMMITTED (Replace / Enhance Existing Systems)
26 - GP Re-Provisioning (supplier / transition costs)
27 - GP Re-Provisioning (additional SWAN connections)
28 - SCI Gateway / Store Development (rescheduled)
29 - ECS Development (reduced from £500k p.a.)
30 - O365 Licensing
31 - SNOMED CT Deployment (reduced from £1m p.a.)
32 - eESS (new HR system)
33 - Possible MiDIS Extension Support
UNCOMMITTED (New Systems / Developments)
34 - HEPMA
35 - Patient Portal (reduced from £1m in 17/18)
36 - Community Replacement (reduced from £1m in 17/18)
37 - NaSH (National Patient Online Appointment Booking)
38 - Patient Monitoring (Track & Trigger) (deferred)
39 - Single Medication Record ('Closing the Loop') (deferred)
40 Total Expenditure
41 Current Surplus / (Deficit)
2017/18 2017/18
£ 69,000
£
2,500
£
2,150
£ 16,750
£
700
£ 7,175
£ 5,500
£
700
£
675
£ 2,000
£
3,139
£
964
£ 1,025
£
800
£
350
£
5,145
£
-£
98,684
2,084
£ 4,000
£
600
£
400
£
145
SG eHealth Division Budget
2017/18 (Projected Expenditure)
SG eHealth Division Budget 2017/18 to 2019/20 (Projected Income)
SG eHEALTH DIVISION BUDGET (INCOME £000)
1
2
3
4
5
6
7
8
9
Core eHealth Budget
Increase in Core eHealth Budget in 18/19 and 19/20
HEPMA Funding
NHSCR Funding
Primary Care Digital Services Programme Funding
Additional Primary Care Fund Transfer
TEC Programme
2016/17 Retained Funding from the Strategy Fund
2016/17 Retained Unused Budget
10 Total Income
2017/18 2017/18
2018/19 2018/19
2019/20 2019/20
£ 76,500
£ 76,500
£
76,500
£
£
£
£
£
£
£
£ 6,500
£ 700
£
£
3,800
700
£ 9,000
£
9,000
4,000
700
2,000
3,000
7,500
1,900
1,000
£
96,600
£ 92,700
£ 90,000
SG eHEALTH DIVISION BUDGET (EXPENDITURE £000)
DISTRIBUTION TO NHS BOARDS:
CENTRAL AND REGIONAL STAFFING:
COMMITTED DIRECT FUNDING SUPPORT:
COMMITTED ONGOING PROGRAMMES:
20 - NHSCR
21 - TEC
22 - CHI Programme (smoothed profile)
23 - Payroll
24 - PACS Procurement Support
25 - Primary Care Digital Services Programme
UNCOMMITTED (Replace / Enhance Existing Systems)
26 - GP Re-Provisioning (supplier / transition costs)
27 - GP Re-Provisioning (additional SWAN connections)
28 - SCI Gateway / Store Development (rescheduled)
29 - ECS Development (reduced from £500k p.a.)
30 - O365 Licensing
31 - SNOMED CT Deployment (reduced from £1m p.a.)
32 - eESS (new HR system)
33 - Possible MiDIS Extension Support
UNCOMMITTED (New Systems / Developments)
34 - HEPMA
35 - Patient Portal (reduced from £1m in 17/18)
36 - Community Replacement (reduced from £1m in 17/18)
37 - NaSH (National Patient Online Appointment Booking)
38 - Patient Monitoring (Track & Trigger) (deferred)
39 - Single Medication Record ('Closing the Loop') (deferred)
40 Total Expenditure
41 Current Surplus / (Deficit)
2017/18 2017/18
£ 69,000
£
2,500
£
2,150
£ 16,750
£
700
£ 7,175
£ 5,500
£
700
£
675
£ 2,000
£
3,139
£
964
£ 1,025
£
800
£
350
£
2018/19 2018/19
£ 69,000
£ 2,500
£ 2,650
£ 14,126
£ 700
£ 7,500
£ 4,356
£ 1,250
£ 320
£ 10,464
£
£
£
£
£
£
£
£
£
4,332
1,380
1,000
£
£
3,950
500
200
£
200
£
9,000
£ 6,500
£ 1,500
£ 1,000
£
-£
98,684
2,084
£ 107,740
-£ 15,040
Current Stage and Post 2019/20 Costs
Strategy, Infrastructure and Applications Funds.
Civil Service and Regional Staff.
TrakCare and Mcrosoft Support.
Pass through cost.
Internal programme.
Preferred Supplier Appointed. Costs reduce.
Pre-OBC. One-off costs.
Pre-Procurement. Costs rise to £2m for 2 years.
Programme ends in 2017/18.
£ 11,362
2,769
1,695
1,000
350
3,950
500
5,145
£ 4,000
£
600
£
400
£
145
£
£
£
£
£
2019/20 2019/20
£ 69,000
£ 2,500
£ 1,400
£ 12,341
700
7,500
741
2,900
500
OBC. Procurement in 2017. Costs Continue.
£1.4m p.a. continuing cost.
Pre-OBC. One-off costs.
Pre-OBC. One-off costs.
Pre-OBC and Contract. Costs continue.
Feasibility Study. Largely one-off costs.
Risk study commencing.
£ 14,970
£
£
£
3,800
1,500
8,170
£
£
1,000
500
Implementation. Schedule flexible.
Pre-OBC. Costs likely to rise.
Pre-OBC. Costs continue, with some reduction.
Pre-OBC. One-off cost.
Pre-OBC. Costs rise and continue.
Pre-OBC. Costs rise for implementation.
£ 111,573
-£ 21,573
Summary of the Key Financial Challenges
• Funding for CHI / Child Health: £10.5m - £15m over next 3 years: Minimum £5.5m in
17/18, and £4.4m in 18/19
• Payroll re-platforming: £5m over 3 years: feasibility study to be completed
• GP systems re-provisioning: circa. 12m over the next 3 years: – large new additional cost
at OBC stage, success of the procurement negotiation is a critical objective to free funding
for other investments
• O365: £4m p.a. – annual revenue implication from 2018/19
• Supporting the implementation of new clinical applications over the next 5 years:
(HEPMA £36m, Community £30m, Patient Portal £8m, Patient Monitoring £9m, Medicines
Reconciliation £4m)
Next Steps
Short Term:
• Establish short term 2017/18 funding parameters to allow budget finalisation
• Confirm short term funding decisions required for CHI / CH and for Essential Category Projects
• Further prioritisation meetings as required (eHealth Leads, CCLG)
Medium Term (1 Year):
• Establish the impact of the new Digital Health and Social Care Strategy (Strategy and Funding Levels)
• Seek policy division / functional (Primary Care, Workforce Finance, HR) funding for relevant developments
• Take a view on future use of the Strategic Fund – possible greater retention for national developments
• In due course incorporate the outcome of GP procurement and other OBC and feasibility studies
The eHealth Strategy Board is asked to:
• Support the need to protect eHealth funding at national and local levels from any further
reductions in 2017/18
• Support the need for:
• an additional circa. £2m to fully fund the 2017/18 profile presented here
• an additional £6m in 2017/18, to fully fund the £11.5m required for the CHI / CH programme
• Advise on which areas of activity should be impacted should the additional £2m not be available
• Endorse the position that eHealth will need to continue to be a recipient of transformation
funds given the increasing costs of IT support for general practice and community
• Endorse the requirement for substantial additional funding in future years (based on
comparators elsewhere circa. 3% of operating expenditure over the medium term and 4% over
the longer term)