Funding and performance of healthcare systems in the four countries of the UK before and after devolution Sheelah Connolly, Gwyn Bevan and Nicholas Mays The Nuffield Trust The Nuffield Trust is a charitable trust carrying out research and policy analysis on health services. Its focus is on the reform of health services to improve the efficiency, effectiveness, equity and responsiveness of care. Current work themes include new forms of care provision, commissioning, efficiency, competition and international comparisons. For more information on our work programme, and to subscribe to our free e-newsletter, visit www.nuffieldtrust.org.uk Published by The Nuffield Trust, 59 New Cavendish Street, London W1G 7LP Telephone: 020 7631 8450 Facsimile: 020 7631 8451 Email: [email protected] Website: www.nuffieldtrust.org.uk Charity number 209201 © The Nuffield Trust 2010 ISBN-13 978-1-905030-40-8 Typeset by Page One Telephone 01543 264214 Cover design by Liquid Telephone 07947 484 195 Printed by Winstonmead Print Telephone 01509 213456 Contents The authors ........................................................................ viii Contents of boxes, tables and figures Acknowledgements .............................................................. ix Chapter 2: Devolution: background, arrangements and their implications ......................................................... 7 Foreword .............................................................................. x Box 2.1: Policy and organisational characteristics Summary ............................................................................. xi of the four countries of the UK ...................... 17 Chapter 1: Introduction ........................................................ 3 Chapter 3: Methods .......................................................... 25 Chapter 2: Devolution: background, arrangements Table 3.1: List of indicators included in the and their implications ........................................................... 7 cross-country analysis .................................... 26 Chapter 3: Methods ............................................................ 25 Table 3.2: List of indicators included in the comparison of Scotland, Wales and Northern Ireland Chapter 4: Cross-country comparisons ............................... 33 and the English regions.................................. 30 Chapter 5: Comparisons of Scotland, Wales and Northern Ireland with English regions.................................. 61 Chapter 4: Cross-country comparisons ............................ 33 Chapter 6: Discussion ........................................................ 95 Figure 4.1: Male life expectancy at birth in England, Scotland, Wales and Northern Ireland Appendix ........................................................................ 107 (1996, 2002 and 2006) ................................ 33 Figure 4.2: Female life expectancy at birth in England, Scotland, Wales and Northern Ireland (1996, 2002 and 2006) ................................ 34 Figure 4.3: NHS expenditure per capita in England, Scotland, Wales and Northern Ireland (1996, 2002 and 2006) ................................ 35 Figure 4.4: Relative per capita spend on NHS Figure 4.12: Outpatient appointments per hospital and public expenditure (2006/07; medical and dental staff member in UK = 100) ................................................. 36 England, Scotland, Wales and Northern Ireland (1996, 2002 and 2006) .................. 44 Figure 4.5: Hospital medical and dental staff (whole time equivalents) per 1,000 population in Figure 4.13: Inpatient admissions per hospital medical England, Scotland, Wales and Northern and dental staff member in England, Ireland (1996, 2002 and 2006) ................... 37 Scotland, Wales and Northern Ireland (1996, 2002 and 2006) .............................. 45 Figure 4.6: General practitioners per 1,000 population in England, Scotland, Wales and Northern Figure 4.14: Day cases per hospital medical and Ireland (1996, 2002 and 2006) ................... 38 dental staff member in England, Scotland, Wales and Northern Ireland (1996, 2002 Figure 4.7: Nursing, midwifery and health visiting staff and 2006) .................................................. 46 (whole time equivalents) per 1,000 population in England, Scotland, Wales and Figure 4.15: Outpatient appointments per nursing, Northern Ireland (1996, 2002 and 2006) .... 39 midwifery and health visiting staff member in England, Scotland, Wales and Northern Figure 4.8: Management and support staff (whole Ireland (1996, 2002 and 2006) .................. 47 time equivalents) per 1,000 population in England, Scotland, Wales and Northern Figure 4.16: Inpatient admissions per nursing, midwifery Ireland (1996, 2002 and 2006) .................. 40 and health visiting staff member in England, Scotland, Wales and Northern Ireland Figure 4.9: Total outpatient appointments per 1,000 (1996, 2002 and 2006) .............................. 48 population in England, Scotland, Wales and Figure 4.17: Day cases per nursing, midwifery and health Northern Ireland (1996, 2002 and 2006) .... 41 visiting staff member in England, Scotland, Figure 4.10: Day cases per 1,000 population in England, Wales and Northern Ireland (1996, 2002 Scotland, Wales and Northern Ireland and 2006) .................................................. 49 (1996, 2002 and 2006) .............................. 42 Table 4.1: Activity: operation rates (per 10,000) for Figure 4.11: Inpatient admissions per 1,000 population selected hospital procedures in England, in England, Scotland, Wales and Northern Scotland, Wales and Northern Ireland Ireland (1996, 2002 and 2006) .................. 43 (1996, 2002 and 2006) .............................. 51 Figure 4.18: Percentage of the population waiting less Chapter 5: Comparisons of Scotland, Wales and than six months for day case or inpatient Northern Ireland with English regions.............................. 61 admission in England, Wales and Northern Figure 5.1: Populations of the nine English GORs Ireland (1996, 2002 and 2006) .................. 52 and Scotland, Wales and Northern Figure 4.19: Percentage of the population waiting less Ireland (2006) ............................................ 61 than three months for outpatient Table 5.1: Selected socio-economic indicators for appointment in England, Wales and the UK, English GORs, England, Wales, Northern Ireland (1996, 2002 and 2006) .... 53 Scotland and Northern Ireland (2006) ........ 63 Figure 4.20: Percentage of category A ambulance calls Figure 5.2: Selected socio-economic indicators for met within eight minutes in England, Scotland, Wales, Northern Ireland and Scotland and Wales (1999 to 2006)............. 54 the North East region of England Figure 4.21: Percentage of the population reporting (2006; England = 100) .............................. 64 satisfaction with the general running of the Figure 5.3: Standardised mortality ratios (males and NHS in England, Scotland, Wales and females separately) of the nine English Northern Ireland (1996, 2002 and 2006) .... 55 GORs and England, Scotland, Wales and Figure 4.22: Percentage of the population reporting Northern Ireland (2006) .............................. 65 satisfaction with inpatient care in England, Figure 5.4: Perinatal and infant mortality rates of the Scotland, Wales and Northern Ireland nine English GORs and England, Scotland, (1996, 2002 and 2006) .............................. 56 Wales and Northern Ireland (2006).............. 66 Figure 4.23: Percentage of the population reporting Figure 5.5: Life expectancy at birth of the nine satisfaction with outpatient care in England, English GORs and England, Scotland, Scotland, Wales and Northern Ireland Wales and Northern Ireland (2006).............. 67 (1996, 2002 and 2006) .............................. 57 Figure 5.6: Percentages of the population aged 65–74 Figure 4.24: Percentage of the population reporting for males and 60–74 for females and satisfaction with GP care in England, aged 75 and over in the nine English Scotland, Wales and Northern Ireland GORs and England, Scotland, Wales and (1996, 2002 and 2006) .............................. 58 Northern Ireland (2006) .............................. 68 Figure 5.7: Percentages of the population reporting Figure 5.13: Management and support staff longstanding illness, limiting longstanding (whole time equivalents) per 1,000 illness and restricted activity in the nine population in the ten English SHAs and English GORs and England, Scotland, England, Scotland, Wales and Northern Wales and Northern Ireland (2006) ............. 69 Ireland (2006) ............................................ 76 Figure 5.8: Selected health indicators for Scotland, Figure 5.14: General practitioners per 1,000 population Wales, Northern Ireland and the in the ten English SHAs and England, North East region of England (2006; Scotland, Wales and Northern Ireland (2006) .. 77 England = 100) .......................................... 70 Figure 5.15: Staff per 1,000 population for Scotland, Figure 5.9: Total NHS expenditure per capita for the Wales, Northern Ireland and the North nine English GORs and England, Scotland, East region of England (2006; Wales and Northern Ireland (2006) ............. 71 England = 100) .......................................... 78 Table 5.2: Comparisons of SMRs and per capita spend Figure 5.16: Total outpatient appointments per 1,000 for the nine English GORs and Scotland, population in the nine GORs of