Disinvestment: some personal views

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Disinvestment some personal views

• David Parkin, Chief Economist

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How the Indian Government does it .
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What is disinvestment?

• Disinvestment suggests the opposite of
  investment
• Investment means resources are used to create
  future benefits instead of being used to obtain
  benefits now
• So does disinvestment mean obtaining benefits
  now instead of creating future benefits?
• OF COURSE NOT! It is a euphemism for not using
  resources for a particular purpose, whether the
  benefits are obtained now, in the future or never
• We could more accurately refer to it as
  deprioritisation, but that is an even worse
  euphemism
• This matters the lack of a proper language
  inhibits discussion of processes for dealing with
  it they may not simply be the mirror image of
  those used for investment

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Is disinvestment being taken seriously?

• Next stage review and QIPP
• PLUS
• A period of significant financial challenge
• Disinvestment being taken seriously

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WCC disinvestment competencies (1)

• Competency 6 Prioritise investment of all spend
  in line with different financial scenarios and
  according to local needs, service requirements
  and the values of the NHS
• Sub competency 6B Prioritisation of investment
  and disinvestment to improve populations health
• Sub competency 6C Incorporation of priorities
  into strategic investment plan to reflect
  different financial scenarios

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Competency 6

• The PCT has defined criteria for evaluating and
  prioritising investment and disinvestment (B
  Level 2)
• The PCT actively monitors what has happened as a
  result of past investment and disinvestment (B
  Level 3)
• Mature programme budgeting or equivalent
  methodology for all key priority care
  pathways/disease groups with integrated
  investment and disinvestment plans of up to 10
  years are in place (C Level 4)

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WCC disinvestment competencies (2)

• Competency 7 Effectively stimulate the market to
  meet demand and secure required clinical and
  health and well-being outcomes
• Sub competency 7C Creation of effective choices
  for patients

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Competency 7

• The PCT uses its understanding of the market, and
  patient feedback and input to make decisions on
  investment and disinvestment to create more
  effective choice (C Level 3)
• The PCT has clear investment and disinvestment
  processes which lead to a mix of providers based
  on clinically defined cost/quality trade-off (C
  Level 4)
• NB these are the only mentions

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WCC Governance criteria - Green

• Initiatives to ensure delivery of strategic goals
  and the PCTs programme of change
• Initiative investment or disinvestment
  requirements are
• Explicit
• Selected using clear and articulated criteria
• Sufficiently developed
• The PCT articulates how investments and
  disinvestments will change in multiple financial
  scenarios with clear rationale considering and
  stating wider implications (e.g. for services
  provided)

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WCC Governance criteria - Red

• Consistency of financial plan with the strategy
• The link between investment/ disinvestment
  decisions and health outcomes, reduced
  inequalities, and efficiency and effectiveness of
  health services is unclear
• Investment or disinvestment against each
  initiative is
• Not explicit by year
• Not modelled
• Timelines for investment or disinvestment are
  unclear