What's Happening to Nhs Spending Across The
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DATA BRIEFING bmj.com Ж Data briefing: How satisfied are we with the NHS? (BMJ 2011;342:d1836) Ж Data briefing: What’s happening to waiting times? (BMJ 2011;342:d1235) Ж Data briefing: Does poor health justify NHS reform? (BMJ 2011;342:d566) WHAT’S HAPPENING TO NHS SPENDING ACROSS THE UK? England has traditionally lost out in the per capita health spend across all UK countries, but John Appleby finds it is faring better in the current economic climate Figure 1 : Changes in NHS spending per head: 2011-2015 Source see 1 In much of the discussion and debate about healthcare spending and reform, the “N” in NHS seems often to stand for England. And 102 Real change in spending: yet, of course, around 10 million people 2010–15 in the UK (equivalent to the population of Portugal or Greece) do not live in England or (generally) use its healthcare services. 100 For those of us who do live in England and consume English based media, not noting –0.9% the existence of such English bias may itself be an example of English bias (or plain ignorance). 98 Apart from confusing England for the UK, there is also a problem with treating the UK –2.2% as the UK. The Organisation for Economic 1=100 Cooperation and Development (OECD), –3.3% 96 for example, treats the NHS as a UK-wide organisation for the purposes of collecting health statistics. Devolution means that this aggregation makes less sense than it once did. This is not just an issue for the UK. Many 94 Index real spend: 2010- spend: real Index countries—Spain, Italy, Germany—have forms of devolved administrative, political, and policy arrangements in healthcare (and other areas) that can make aggregation at a 92 national level if not wrong, at least potentially England misleading. Northern Ireland What territorial unit of analysis makes Wales sense depends on the question and the Scotland topic. To take one (albeit absurd) example, 90 FIFA’s rankings of international football teams do not contain a UK team ranking based on –10.7% a composite of the four UK countries’ match results. But how much sense does it make, 88 for instance, to combine NHS spending into 2010-1 2011-2 2012-3 2013-4 2014-5 one aggregate number? Year But given the political arguments about whether the NHS has received a real increase On average, over the past seven years NHS spending per head in funding over the next four years as the in Scotland has been around 15% higher than in England— government claim, it is important to be clear about which NHS is being protected equivalent to a financial gap of over £15bn (or not). Certainly planned health spending 1178 BMJ | 28 MAY 2011 | VOLUME 342 DATA BRIEFING in Northern Ireland is not going up in real London Traditionally, terms—it will be cut by around 2.2% by 2014-5 (fig 1).1 2 And in Scotland, NHS £15.2 bn South East spending spending will be cut in real terms by around £13.3 bn per head in 3.3% this year (with no plans yet made for North West spending in subsequent years).3 £13.1 bn England has Despite these cuts, the NHS has done been lower quite well compared with other areas of £9.5 bn West Midlands spending in Northern Ireland and Scotland. than in all But in Wales, the NHS is set for a real budget England £9.2 bn Yorkshire and Humberside other parts cut of nearly 11% over three years.4 As for £89.9 bn £8.9 bn the NHS in England (for which the political East of the UK pledge was made) it looks as if real spending £8.6 bn South West will be around 0.9% lower in 2014-5 than in 5 £7.2 bn 2010-1. For the UK NHS as a whole funding East Midlands will be cut in real terms by 2014-5. £5.0 bn NHS spending in England dominates UK North East spending of course—spending in the South West region alone is equivalent to that of Wales and Northern Ireland combined, and UK NHS £10.2 bn Scotland London’s healthcare spending is equivalent £109 bn to that of Wales and Scotland combined (fig 2). But traditionally, spending per head £5.6 bn Wales Figure 2 : UK NHS in England has been lower than in all other 2008/9 spending parts of the UK (fig 3). On average, over the breakdown by past seven years NHS spending per head £3.3 bn Northern Ireland country and region in Scotland has been around 15% higher Source see 2 than in England—equivalent to a financial gap of over £15bn—or the annual budget of London’s entire NHS.6 2200 Change in spend /head 2002–10 56% Scotland John Appleby chief economist, King’s Fund, London, UK [email protected] Competing interests: The author has completed the 2000 65% Wales unified competing interest form at www.icmje.org/ coi_disclosure.pdf (available on request from him) and declares no support from any organisation for 75% England the submitted work; no financial relationships with 1800 any organisation that might have an interest in the submitted work in the previous three years; and no other 54% Northern relationships or activities that could appear to have Ireland influenced the submitted work. 1600 Provenance and peer review: Commissioned; not externally peer reviewed. 1 HM Treasury. GDP deflators: Latest figures. 2011. 1400 www.hm-treasury.gov.uk/data_gdp_fig.htm. NHS spending /head of population (£) 2 Northern Ireland Executive. Budget 2011-2015. www.northernireland.gov.uk/revised_budget_-_ website_version.pdf 3 Scottish Government. Scotland’s spending plans 1200 and draft budget 2011/12. www.scotland.gov.uk/ Publications/2010/11/17091127/0 4 Welsh Assembly. Final budget: February 2011. http://wales.gov.uk/about/budget/ 1000 finalbudget2011/?lang=en. 4 -9 5 HM Treasury. Spending review 2010. Cmnd 7942. -8 www.hm-treasury.gov.uk/spend_index.htm 2007 2004-5 2002-3 2006-7 2003- 2005-6 2008 6 HM Treasury. Public Expenditure Statistical Analyses 2009-0 (PESA). 2011. www.hm-treasury.gov.uk/pespub_ Year index.htm. 2 Cite this as: BMJ 2011;342:d2982 Figure 3 : Changes in NHS spending per head, 2002-2010 Source see BMJ | 28 MAY 2011 | VOLUME 342 1179 BMJ GROUP AWARDS PHOTOS BY CHRISPHOTOSBY SHARP CHRISPHOTOSBY SHARP Winners from clockwise top l: Doctors for You, India, Medical Team in a Crisis Zone award; Richard Feinmann and his wife Pat, Getting Evidence into Practice award; Ian Dufton, Clinical Leadership award; CRASH-2 trial collaborators, London School of Hygiene and Tropical Medicine, Research Paper of the Year A WINNING NIGHT The BMJ Group Awards ceremony on 18 May celebrated the best of healthcare and research, reports Nigel Hawkes Success, professional recognition, and even a scat- Ann as “part doctor, part campaigner, part stalker” should be kept before the public until it demands tering of Hollywood glitter made the third annual for her subtle, persistent, and ultimately successful reform.” Mr Esler went on: “He happens to be the BMJ Group Awards at the Hilton on Park Lane a pursuit of his support, and said it was “a massive grandfather of someone called Nick Clegg—I won- night to remember for winners and guests alike. honour” for him to help pick up her award. der what happened to him?” This year 13 awards were presented for excel- The awards, said Fiona Godlee, editor in chief lence in research, practice, innovation, sustaina- of the BMJ , were a showcase for all that is best Innovation bility, communication, and—a new category—for in healthcare and research, and she had been Improvements in healthcare often begin with the best medical team in a crisis zone. Richard delighted by the more than 650 entries. Gordon research. The first award of the evening, for Peto, the leading British epidemiologist, won Dickson, chief executive of headline sponsors research paper of the year, went to Haleema the Lifetime Achievement award, while the prize MDDUS (the Medical and Dental Defence Union Shakur and her team at the London School of for Health Communicator of the Year went to the of Scotland),said his company was delighted Hygiene and Tropical Medicine for a trial that doughty and much-loved general practitioner, to be sponsoring once again awards that recog- showed a low cost drug, tranexamic acid, had the Ann McPherson, who set up the website Health nised the dedication of healthcare professionals capacity to save many lives by reducing bleeding TalkOnline. throughout the world. after trauma. Road traffi c injuries are a major and Dr McPherson, who has pancreatic cancer, Gavin Esler, the BBC TV broadcaster who co- growing cause of death worldwide, while haemor- was too ill to attend the ceremony but the actor hosted the event with Dr Godlee, said that in the rhage causes a third of deaths in hospitals. Hugh Grant, whom she had persuaded to back toils of the NHS reform in England we should all Dr Shakur thanked the 274 hospitals and her v enture, stepped up to accept it alongside her be inspired by Hugh Clegg, a former editor of the 20 000 patients and their families for agree- h usband Klim McPherson. Mr Grant described BMJ , who wrote: “A subject that needs reform ing to participate in the trial, which compared 1180 BMJ | 28 MAY 2011 | VOLUME 342 BMJ GROUP AWARDS Members of STeLI, London Deanery, Excellence in Healthcare Education award; Ann McPherson (inset), Healthcare Communicator award, accepted by her husband Klim and DIPEx patron Hugh Grant; Paediatric Sickle Cell Disease Team, King’s College, London, secondary care team of the year; John Richmond, primary care team of the year tranexamic acid with placebo.