Transcript Slide 1

A brief history of NHS
funding over the last ten
years…
Prof John Appleby
Chief Economist
King’s Fund
Bust, boom, bust?
• 1997-2000: Stick to Conservative
spending plans
• 1999/2000: Blair announces NHS
funding boost
• 2002: Derek Wanless forecasts
future funding needs
• 2007 CSR: slow down in NHS
funding growth…
UK NHS: Cash and real spending: 1997/8-2010/11
140,000
…to £130
billion…
120,000
A real
increase
of 110%
80,000
60,000
From £44
billion…
Cash
Real
40,000
20,000
2010-11
2009-10
2008-09
2007-08
2006-07
2005-06
2004-05
2003-04
2002-03
2001-02
2000-01
1999-2000
1998-99
0
1997-98
£millions
100,000
2010-11
2009-10
2008-09
2007-08
7.0
2006-07
2005-06
2004-05
2003-04
2002-03
2001-02
2000-01
1999-2000
1998-99
1997-98
96-97
95-96
94-95
93-94
92-93
91-92
90-91
89-90
88-89
87-88
86-87
85-86
84-85
83-84
Per cent
UK NHS spending as percentage of GDP
9.0
8.0
…to £1 in 12
6.0
5.0
4.0
3.0 £1 in 20
From
in the
entire
2.0
economy spent
1.0
on the
NHS…
0.0
Average real
increase per
year
Percentage annual change in UK NHS real spending
Thatcher
Thatcher/Major
Major
Blair
Blair
Blair
Brown
10
2.0%
pa
Real change: Per cent
8
3.8%
pa
3.8%
pa
3.8% pa
7.6%
pa
6.8% pa
4% pa
After years of parsimony…
6
…political decision to
spend more…
4
2
0
…but growth slows (it will
feel like a cut)…
83- 84- 85- 86- 87- 88- 89- 90- 91- 92- 93- 94- 95- 96- 97- 98- 99- 00- 01- 02- 03- 04- 05- 06- 07- 08- 09- 1084 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06 07 08 09 10 11
-2
On target for Wanless
recommendations?…
Future UK and EU health care spending?
15
13
EU average
Actual UK
12
Slow uptake
Solid progress
11
Fully engaged
3% real NHS grow th
10
Linear (EU average)
Pow er (EU average)
9
8
7
6
5
…but now catching up…
4
Historically, UK has lagged
behind EU-15 countries…
3
2
1
2023
2020
2017
2014
2011
2008
2005
2002
1999
1996
1993
1990
1987
1984
1981
1978
1975
1972
1969
1966
1963
0
1960
Per cent GDP
14
The £64 billion question:
Where did the money go?
…higher costs
UK NHS spending increase: 2002/3-2007/8
Total cash: £43.2 billion
Inflation absorbed
£18+billion….
…leaving around
56% of the cash
increase to buy
extra things
…higher pay costs
Hospital and community health service pay inflation:
1997-2007
200
Pay inflation: up
80% in ten
years….
180
160
Index: 1997=100
140
120
100
Large pay awards
for doctors in
particular as a
result of new
contracts ….
80
60
40
20
0
1997-98
1998-99 1999-2000 2000-01
2001-02
2002-03
2003-04
2004-5
2005-6
2006-7
2007-8
…more staff
Change in English NHS staff: 1997 to 2006
All support staff
A quarter of a
million new NHS
staff over ten
years….
Allied health professionals
Ambulance
But last few years
have seen
minimal increases
as NHS deals with
deficits and plans
for a tighter
financial future
Practice nurses
Nursing, midwifery, HV staff
GPs
Consultants
Total
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
…shorter waiting times
Inpatient waiting list: England
1400000
1200000
Waiting list now at
its lowest since
1974….
Quarterly
data for
2007
800000
600000
200000
2005
2002
1999
1996
1993
1990
1987
1984
1981
1978
1975
1972
1969
1966
1963
1960
1957
1954
1951
0
…and waiting
times reduced
massively:
virtually no one
waiting more then
6 months….
2007
400000
1948
Numbers waiting
1000000
…more patients
Elective admissions
6,200,000
6,100,000
6,000,000
5,900,000
5,800,000
5,700,000
5,600,000
11% increase in
elective
admissions….
5,500,000
5,400,000
5,300,000
5,200,000
5,100,000
1998
1999
2000
2001
2002
2003
2004
2005
…more, more, more!
• Virtually all NHS Plan ‘shopping
list’ targets met:
– 100 new hospitals
– Modernising 3,000 GP premises
– 75% of all MRI/CT scanners and
linear accelerators now new…
– But, problems with ICT investment
– …backlog maintenance…single
rooms…
….value for money?
• Higher unit costs
• Lower admissions per consultant
and per nurse….
• Official productivity measures
show downward trend…
• Poor financial control (deficits…)
…greater satisfaction?
Public (net) satisfaction with NHS services
('Net' = very plus quite satisfied minus very plus quite dissatisfied)
80
NHS overall
General Practice
Dentistry
Inpatients
Outpatients
Accident & Emergency
70
60
40
30
20
10
-20
2006
2005
2004
2003
2002
2001
2000
1999
1998
-10
1997
0
1996
Per cent
50
Net satisfaction
with NHS
overall highest
it has been
since
1980s….(sham
e about NHS
dentistry…)
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