Panorama asks how has new funding changed the NHS
The government has doubled the amount spent annually on the NHS since 1997. It has made improving cancer survival rates and cutting deaths from heart disease, national priorities.
Overall, the government has committed to improving the health of the nation and reducing health inequalities. So we asked the experts whether - for all the extra money spent on the health service- are we any healthier? The answer was surprising:
According to Dr Mike Harley, health service performance expert and director of the Inter-authority Comparisons & Consultancy, based at Birmingham University:
"We don't know whether it's made us healthier or not. We know we've treated more patients than we used to".
According to Professor John Appleby, Chief Economist, King's Fund:
"I think we have a very, very poor and patchy view about how we converted money into people's health. What the NHS needs to get to grips with is a routine measure of people's health. So before we go into hospital and while you're in hospital and when you come out the other end, and we can then see what the change in people's health status is. We could then actually see what contribution the NHS was making to changing people's health."
Productivity in the NHS
We also asked them whether there's been any attempt to assess what we'd got back in terms of the output of the health service- its productivity. John Appleby told Panorama that
"... the NHS, like all public services, has been measuring the ratio of its inputs to its outputs, and that's a measure of productivity or efficiency. The measure has actually been fairly crude. When we talk about outputs, we're not talking about people's health here, what we're talking about are ambulance journeys, operations, day cases and so on, all bundled together.
NHS EFFICIENCY INDEX
Graph showing productivity in the NHS for 1990/1 to 2000/01
These are the sort of activities that the NHS does, and you could say if you do more operations that's a good thing. Maybe it's not though. Maybe there are some operations we want to do fewer of, or do them more appropriately. It's a crude measure and recent years have shown that measure going down (see graph) i.e. as more money has gone into the service, the NHS, in terms of its measured outputs, has not gone up as fast as the increase in the money, so what we get is a downturn in the productivity graph (see link). The figures aren't available beyond 2001 because this assessment is no longer made."
The government has recognised that it hasn't got a decent productivity measure and commissioned Sir Tony Atkinson, warden of Nuffield College Oxford, to examine better ways of analysing productivity and output in key areas like health and education. Atkinson says current output counts in health "do not measure the quality of the output, such as a change in the quality of the patient experience, or clinical effectiveness". His final report recommending new methodologies for assessing productivity was published at the end of January by the National Statistics office. The full report can be found on their website (see related internet links)
The government's own Healthcare Commission, which inspects and assesses NHS trusts, says that:
"With the task of promoting improvement comes the challenge of establishing whether improvement is actually taking place. One nationally important measure examines how long patients are waiting for care. It is also crucial to continue to refine ways of measuring what some call productivity, or what is achieved in relation to what is invested. Equally, we must find better ways of learning from patients' experiences. We need to improve the way in which we approach the task of auditing clinical quality at a national level, by giving clinicians the tools necessary to compare practice and improve care. These tasks reflect our concern for the quality of care being provided, but we are also concerned with whether patients and the public are getting value for money. Decisions on spending, both local and national, are important influences on both quality of care and value for money."
"If we are going to have healthcare services that invest for health, we must
find new ways of assessing their value and their productivity, or achievements in improving health."
The full report can be found on their website (see related internet links)