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The Coalition's Record on Health

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The Coalition's Record on Health Working Paper 16 January 2015 The Coalition’s Record on Health: Policy, Spending and Outcomes 2010-2015 Polly Vizard and Polina Obolenskaya 1 WP16 The Coalition’s Record on Health: Policy, Spending and Outcomes 2010-2015 Acknowledgements Social Policy in a Cold Climate is funded by the Joseph Rowntree Foundation and the Nuffield Foundation, with London-specific analysis funded by the Trust for London. We are grateful for the support and guidance they have extended us throughout the programme. The views expressed are those of the authors and not necessarily those of the funders. The authors would like to thank colleagues at CASE including Cheryl Conner, Bert Provan, Jane Dickson, Nick Warner and Joe Johannes (IT). We are also grateful to David Utting and Tom Smith for their support with the production of final outputs, to Howard Glennerster for his advice throughout the SPCC prject, and to members of our external advisory group and the Social Policy in a Cold Climate team for their comments and guidance. We are also particularly grateful to Ellie Suh for here work on mental health data using Health Survey for England, and on barriers to health using European Qualtiy of Life Survey data. The authors would particularly like to thank Professor Professor Howard Glennerster, Professor Julian Le Grand (LSE) and John Appelby (Kings Fund) for helpful and detailed comments and suggestions which made an important contribution to the development of this paper. Responsibility for errors in fact, substance or interpretation remains with the authors. We welcome comments on this paper, to [email protected]. 2 WP16 The Coalition’s Record on Health: Policy, Spending and Outcomes 2010-2015 Contents 1. Introduction ................................................................................................................................ 7 The Coalition’s Inheritance ................................................................................................. 7 Overview ............................................................................................................................. 9 2. Goals ......................................................................................................................................... 17 Conservative and Liberal Democratic Manifesto Commitments on Health ....................... 17 The Coalition Agreement and Programme for Government ............................................. 21 The role of the central state and the Coalition’s model for public services ....................... 24 3. Policies ..................................................................................................................................... 27 Proposals for health reform following the transition to Government ................................. 27 The enactment of the Health and Social Care Act (2012) ................................................ 28 Overview of the Coalition’s health reforms ....................................................................... 30 Minimum standards and quality regulation: the Government’s response to the Francis Inquiry 36 Other policies, strategies and measures ........................................................................... 38 4. Resources ................................................................................................................................ 41 Trends in real public sector expenditure on healthcare .................................................... 41 Estimates of the funding gap by 2020 ............................................................................... 46 Trends in total (public and private) expenditure on health ................................................ 47 International comparisons ................................................................................................. 48 The Coalition’s health financing model ............................................................................. 50 Resource allocation funding formula ................................................................................. 51 5. Provision .................................................................................................................................. 54 Inputs, outputs and productivity ........................................................................................ 54 Supply, demand and need ................................................................................................ 59 The balance of public, private and third sector provision .................................................. 65 6. Outcomes ................................................................................................................................. 69 Healthcare access and quality .......................................................................................... 69 Life expectancy, the “major killers” and infant mortality .................................................... 78 Non-medical determinants ................................................................................................ 96 Suicide, mental health and general health ........................................................................ 99 7.Conclusions, overall evaluation and looking forward ............................................................ 105 Continuity or change? ..................................................................................................... 105 Evaluating the impact of the reform programme ............................................................. 108 Challenges for an incoming Government ........................................................................ 113 Appendix 1: Supplementary tables – resources ........................................................................ 116 Appendix 2: supplementary tables - health outcomes .............................................................. 124 References..................................................................................................................................... 148 3 WP16 The Coalition’s Record on Health: Policy, Spending and Outcomes 2010-2015 List of figures Figure 1: Conservative Party 2010 Manifesto -– commitments on health ............................................ 19 Figure 2: Liberal Democratic Party 2010 Manifesto -– commitments on health ................................... 20 Figure 3: The Coalition Programme for Government – commitments on health ................................... 22 Figure 4: Overview of the Coalition healthcare reform programme ...................................................... 35 Figure 5: International comparisons of total (public and private) expenditure on health as a percentage of GDP, 1997 to 2012 ........................................................................................................ 49 Figure 6: Out-of-pocket medical spending as a share of final household consumption in Europe, 2012 (or nearest year) ................................................................................................................................... 51 Figure 7 Number of full-time equivalent (FTE) qualified nursing, midwifery and health visiting staff, HCHS workforce, May 2010 to July 2014 (England) ............................................................................ 54 Figure 8 Number of full-time equivalent (FTE) staff, HCHS workforce, index numbers, May 2010 to July 2014 (England) .............................................................................................................................. 55 Figure 9 Finished consultant episodes, outpatient appointments attendances and A&E attendances, 2009 to 2012, indexed .......................................................................................................................... 56 Figure 10 Growth of healthcare supply compared with national income, need and demographic pressure, United Kingdom, 1997/98 to 2013/14 ................................................................................... 60 Figure 11 Growth of healthcare supply compared with national income, need and demographic pressure, United Kingdom 2009/10 to 2013/14 .................................................................................... 62 Figure 12: Growth of healthcare supply compared with national income, need and demographic pressure, England 2009/10 to 2013/14 ................................................................................................. 63 Figure 13 Growth of healthcare supply compared with need and demographic change, England, 2010- 11 to 2014-15 ........................................................................................................................................ 64 Figure 14: Changes in independent sector provision in community and mental health services and hospital care 2010/11-2012/13 ............................................................................................................. 67 Figure 15: Waiting times for referral to treatment ................................................................................. 73 Figure 16: Percentage waiting 4 hours or less (all) in A&E from arrival to admission, transfer or discharge (quarterly data), 2003-04 to 2014-15 (financial year quarters, up to September 2014), England ................................................................................................................................................. 74 Figure 17 Overall satisfaction with National Health Service, 1983 to
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