Muir Gray: Developing a system budget

Muir GrayRead the rest of this series of blogs about designing and planning population based systems of care here.

Step 8: Developing a system budget

One of the aims of developing systems is for clinicians and patient representatives to be involved in the stewardship of resources. They can fight for more resources, but they also need to accept responsibility for maximising value from the resources allocated. It is essential to prepare a budget for the system of care, starting with all the resources that contribute to the service.

Resource Key points for reflection while estimating the budget
Patients Probably the most neglected resource
Carers Another neglected resource
Patient organisations Play an invaluable role in networks
General practice Bearing in mind that general practitioners vary very much in their practice
Community services These may be based in a community services organisation or work as outreach services from a hospital
Social care Even if supported from another financial stream they are key resources
Private care More relevant for some health services with both positive and negative impact on health service resources
Pharmacists Their knowledge and skills are probably the most underused in the healthcare workforce
Medication Often the fastest growing resource
Specialist clinics The term “outpatients” is a 19th century term which is outdated
Hospital beds Even though these are not owned by the relevant specialty, an estimate of bed days needs to be included in the inventory
Laboratory services May need to be repeated for different types of service, e.g. biochemistry or haematology, depending on the condition
Specialist personnel The most valuable and expensive resource
Real estate Wards, clinics, offices—at present rarely charged to clinical teams but this will change
Information Technology (IT) Consumer of resources but also potential saver of resources
Management and administration Essential to maximise productivity but what is the right level of investment?

If finance can be assigned to these resource categories so much the better, but it is better to be accurate than precise.

Muir Gray is visiting professor of knowledge management, Nuffield Department of Surgery, University of Oxford.

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