Transcript a slidepack of charts and tables from the submissionppt

Representation to
the 2015 Spending
Review
The Health Foundation
September 2015
About the Health Foundation
The Health Foundation is an independent charity working
to improve the quality of health care in the UK.
We are here to support people working in health care
practice and policy to make lasting improvements to
health services.
We carry out research and in-depth policy analysis, fund
improvement programmes to put ideas into practice in the
NHS, support and develop leaders and share evidence to
encourage wider change.
We want the UK to have a healthcare system of the
highest possible quality – safe, effective, person-centred,
timely, efficient and equitable.
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Figure 1: Public spending on health in the UK 1949/50 to 2013/14 in
2014/15 prices, and as a percentage of national income
160
140
£billion
120
8%
Public sector spending on health %
GDP
Public sector spending on health
7%
6%
100
5%
80
4%
60
3%
40
2%
20
1%
0
0%
Source: Health Foundation calculations, using data from: Public Sector Statistical Analyses 2014 (HM Treasury), Fiscal Facts: Spending by function (Institute of
Fiscal Studies), OHE Guide to UK Health and Health Care Statistics 2013 (Office of Health Economics, Hawe E and Cockcroft L), UK National Accounts – The Blue
Book (Office for National Statistics), GDP deflators at market prices, and money GDP (HM Treasury).
Note: GDP deflators for 1949/50 to 1954/55 are estimated.
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Table 1: Health expenditure in England from 2009/10 to 2015/16
health expenditure,
cash terms (£)
2009/10
2010/11
2011/12
2012/13
2013/14
2014/15
2015/16
98,419
100,418
102,844
105,222
109,777
113,300
116,574
2.0
2.4
2.3
4.3
3.2
2.9
108,558
109,226
109,976
112,419
114,433
116,574
-0.7
0.6
0.7
2.2
1.8
1.9
annual change, cash
terms (%)
health expenditure,
2015/16 prices (£)
annual change,
real terms (%)
109,341
Source: PESA 2015
Note: health expenditure is measured as total department expenditure limit, excluding depreciation
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Table 2: Average annual increase in hospital activity based on
providers ‘time series, 2008/09-2014/15
2008/09-2009/10
2010/11-2014/15
Outpatient first attendances
7.6%
2.1%
Total inpatient admissions
2.8%
2.0%
non-elective
3.2%
1.0%
elective
2.6%
2.8%
4.7%
1.1%
of which:
A&E Attendances
Source: NHS England A&E attendances and Monthly hospital stats
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Figure 2: Average annual increase in hospital activity based on
providers’ time series, 2009/10-2014/15
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Figure 3: Change in number of trusts in deficit from 2012/13 to
2014/15
2012/13
2014/15
2013/14
Deficit
28, 11%
Surplus
66,
27%
129,52
%
221, 89%
117,48
%
183,
73%
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Figure 4: change in annual productivity for the acute sector from
2009/10 to 2013/14
2.83%
0.41%
2010/11
2011/12
-0.94%
-0.95%
2012/13
2013/14
Source: Lafond, S. Roberts, A. Charlesworth, A. Hospital finances and productivity: in a critical condition?
The Health Foundation, 2015.
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Table 3: Expenditure by Councils with Adult Social Services
Responsibilities (CASSRs) by accounting category, 2009/10 to
2013/14, England, £bn in 2015-16 prices
2009/10
Net current
expenditure
2010/11
16.1
2011/12
15.8
2012/13
15.7
Change
2009/10 to
2013/14
2013/14
15.3
15.0
-7%
Average
annual
change
-2%
Source: NASCIS PSS-EX1 return
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Figure 5: Indexed growth in real total gross expenditure on Adult
Social Care in England and demographic pressure, 2007-08 to 2012-13
115
Expenditure
110
Population 65+
105
100
95
90
2007-08
2008-09
2009-10
2010-11
2011-12
2012-13
Source: CIPFAstats (online), Social Care Actuals 2007/08-12/13 PSS EX1 return via Buchardt T, Obolenskaya P, Vizard P. The Coalition’s Record on Adult Social
Care: Policy, Spending and Outcomes 2010-2015. 2015.
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Figure 6: Number of clients receiving services (community-based
services, residential care or nursing care) provided or commissioned
by local authorities with social services responsibilities, by client
type, 2009/10 to 2013/14, England
1,800,000
1,600,000
1,400,000
Total,
1,273,280
1,200,000
1,000,000
Physical Disability,
841,645
800,000
600,000
400,000
Mental Health,
257,540
200,000
2009/10
2010/11
2011/12
2012/13
2013/14
Source: NASCIS; Referrals and Packages, module P1
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Figure 7: Need for and receipt of help with Activities of Daily Living
(ADLs) in the last month, by equivalised household income and sex
Men
Received help
11%
Middle
17%
Lowest
12%
Highest
Women
Income tertile and sex
Needed help
10%
Highest
19%
Middle
21%
Lowest
0
5
10
15
20
25
30
35
40
Percentage
Source: Health Survey for England, 2013
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Table 4: Estimated budget for English NHS in 2019/20 and 2020/21
according to the manifesto commitment, assuming inflation rises as
assumed for GDP Deflator, July 2015
2015/16
2019/20
2020/21
TDEL plus real terms £8bn
increase by 2020/21 (2015/16
prices)
£116.6bn
£122.9bn
£124.6bn
TDEL plus real terms £8bn
increase by 2020/21 (cash
terms)
£116.6bn
£132.4bn
£137.5bn
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Table 5: Meeting the manifesto commitment – implied increases in the
NHS England, Public Health England and Health Education England –
all financial figures in billion, stated in cash terms
2015/16
2019/20
2020/21
Average annual
change in cash
terms
TDEL plus £8bn real-terms
increase by 2020/21 (cash
terms)
£116.6
£132.4
£137.5
3.4%
1.3%
NHS England receives £8bn
(cash terms)
£101.1
£115.8
£120.5
3.6%
1.5%
PHE budget rises at same rate
as NHS England (cash terms)
£3.7
£4.2
£4.4
3.6%
1.5%
PHE budget received from
Department of Health rises at
same rate as NHS England
(cash terms)
£0.9
£1.0
£1.0
3.6%
1.5%
HEE budget rises at same rate
as NHS England (cash terms)
£4.9
£5.6
£5.8
3.6%
1.5%
Remainder (cash terms)
£9.7
£10.0
£10.2
1.0%
-1.0%
Amount of remainder for Capital
£4.6
£4.8
£4.8
1.0%
-1.0%
Average annual
change in real terms
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Table 6: The affordability challenge as set out in Monitor planning
guidance
2014/15
2015/16
2016/17
2017/18
2018/19
Total affordability challenge
3.1%
6.6%
5.5%
4.7%
4.6%
Provider efficiency
2.0%
2.5%
2.0%
2.0%
2.0%
System efficiency
1.0%
2.0%
0.1%
1.0%
1.0%
Remaining challenge
0.1%
2.1%
2.5%
1.7%
1.6%
£1.46bn
£1.7bn
£1.26bn
£1.26bn
Remaining Challenge (£)
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Figure 8: Provider forecasts of future demand – 2012 and 2013
forecasts
185000
180000
175000
170000
165000
160000
155000
150000
2008
Actual staff in post
2009
2010
2012 (SHA) provider
2011
2012
2013
2014
2013 provider's minimum forecast requirements
2015
2016
2017
2018
2013 provider's maximum forecast requirements
Source: Health Education England
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Figure 9: Average weekly earnings in the public and private sectors
December 2000 – June 2015 (rolling 12-month averages
Private
Public
500
480
Nominal £ per week
460
440
420
400
380
360
340
300
DEC
MAR
JUN
SEP
DEC
MAR
JUN
SEP
DEC
MAR
JUN
SEP
DEC
MAR
JUN
SEP
DEC
MAR
JUN
SEP
DEC
MAR
JUN
SEP
DEC
MAR
JUN
SEP
DEC
MAR
JUN
SEP
DEC
MAR
JUN
SEP
DEC
MAR
JUN
SEP
DEC
MAR
JUN
SEP
DEC
MAR
JUN
SEP
DEC
MAR
JUN
SEP
DEC
MAR
JUN
SEP
DEC
MAR
JUN
320
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
Source: Health Foundation calculations using Office for National Statistics series KA4U for the public sector (excluding financial services) and series KA4O for
the private sector, derived from the Monthly Wages and Salaries Survey. Updated from: Cribb, J. Emmerson, C. Sibieta, L. Public sector pay in the UK. IFS. 2015.
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Figure 10: Annual average real-terms change in average earning per
person from 2009/10 to 2013/14
Public sector
NHS
Private sector
-0.31%
-0.51%
-1.77%
Source: HSCIC NHS Staff Earnings Estimates to January 2014; Provisional statistics, ONS Annual Survey of Hours and Earnings
Note: Average earnings for NHS staff in England exclude earnings of staff employed under bank and agency contracts. Public and private sector pay refers
to average annual gross pay per person for all UK employees, while NHS pay refers to average earning per employee of the English NHS.
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Figure 11: Difference between public and private pay, January 2008 to
June 2015
10
2010
2013
MAY
MAR
JAN
NOV
JUL
2014
SEP
MAY
JAN
MAR
SEP
NOV
JUL
MAY
JAN
MAR
NOV
JUL
2012
SEP
MAY
MAR
JAN
NOV
JUL
2011
SEP
MAY
JAN
MAR
SEP
NOV
JUL
MAY
JAN
MAR
NOV
JUL
2009
SEP
MAY
JAN
MAR
NOV
JUL
2008
SEP
MAY
JAN
0
MAR
Nominal £ per week
5
2015
-5
-10
-15
Source: Health Foundation calculations using Office for National Statistics series KA4U for the public sector (excluding financial services) and series KA4O for the
private sector, derived from the Monthly Wages and Salaries Survey. Updated from: Cribb, J. Emmerson, C. Sibieta, L. Public sector pay in the UK. IFS. 2015.
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Table 7: Transformation Fund costs, 2016/17 to 2020/21 (2015/16 prices)
2016/17
2017/18
2081/19
2019/20
2020/21
Efficiency
Strand
£1.1bn
£1.1bn
£1.1bn
£1.1bn
£1.1bn
Development
Strand
£0.4bn
£0.8bn
£1.0bn
£1.0bn
£0.7bn
Total
Transformation
Fund
£1.5bn
£1.9bn
£2.1bn
£2.1bn
£1.8bn
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