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Social Policy > Healthcare > Flashcards

Healthcare Flashcards

1
Q

Klein (1995)

A

Reaction to Thatcher’s reforms was “biggest explosion of political anger and professional fury in the history of NHS”

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2
Q

Reaction to Thatcher’s reforms was “biggest explosion of political anger and professional fury in the history of NHS”

A

Klein (1995)

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3
Q

Wilsford (1994)

A

HEALTH POLICY CHANGE

  1. Thatcher centrally directed radical health reforms alongside just 4 ministers, No. 10 Policy Unit and small team from Department of Health
  2. In many healthcare systems, reform difficult due to path-dependency
  3. Credibility of Ken Clarke (health minister under Thatcher) helped ‘sell’ reforms to unenthusiastic public
  4. Radical changes in UK health policy change due to political system + power of PM
  5. Introduction of management in 80s meant new managers supported Thatcher’s health reforms, which gave them greater influence + control
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4
Q

Evidence that powerful PMs able to shape health policy development alongside small group

A
  1. Thatcher:
    (i) Launched major review in 1987 TV interview w/o consulting cabinet colleagues
    (ii) Centrally directed radical policy reforms alongside just 4 ministers, No. 10 Policy Unit and small team from Department of Health (Wilsford 1994)
  2. Blair:
    (i) Similarly announced on TV in 2000 that he intended to bring UK health spending up to EU average as % GDP w/o warning cabinet or civil servants
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5
Q

Who was Thatcher’s Health Minister when radical reforms enacted?

A

Ken Clarke

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6
Q

How did Health Minister (Ken Clarke) help with Thatcher’s health reforms?

A

Credibility of Ken Clarke helped ‘sell’ reforms to unenthusiastic public

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7
Q

Who was in ‘inner circle’ that almost single-handily formulated Thatcher’s radical health policy reforms?

A

Thatcher centrally directed radical health reforms alongside just 4 ministers, No. 10 Policy Unit and small team from Department of Health

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8
Q

Evidence of a Health Minister playing a key role in passing health policy reforms?

A

King’s Fund (2015)

Secretary Lansley played a “central role” in reforms and was determined to push through legislation so future governments couldn’t “modify/dilute his reforms by administrative fiat”

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9
Q

Secretary Lansley played a “central role” in reforms and was determined to push through legislation so future governments couldn’t “modify/dilute his reforms by administrative fiat”

A

King’s Fund (2015)

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10
Q

How did opposition from GPs change Thatcher’s proposals for GP fund-holding?

A

Opposition from GPs + BMA forced Thatcher to make GP fund-holding optional

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11
Q

Evidence of the ‘entrenched professional autonomy’ of doctors?

A
  1. Doctors retained professional autonomy – confidential patient relationships + primarily accountable (still) to peers, not managers
  2. GPs not salaried employees, but independent contractors
  3. Consultants able to undertake private work in addition to NHS work
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12
Q

Evidence that many managers within NHS supported Thatcher’s health reforms, which gave them greater influence + control?

A

Wilsford (1994)

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13
Q

Evidence of health spending increases under Blair

A

By 2007, real NHS spending 40% higher than 5 years earlier due to pledge

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14
Q

Evidence of health spending increases under New Labour:

By ….., real NHS spending …..% higher than ….. years earlier due to pledge

A

Evidence of health spending increases under New Labour:

By 2007, real NHS spending 40% higher than 5 years earlier due to pledge

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15
Q

King’s Fund (2017)

A
  1. Total resources available for NHS broadly in line w/EU average (though below average in per person spending)
  2. Several resource deficiencies in key areas (compared to EU average):
    (i) Doctors and nurses per population
    (ii) MRI and CT scanners
  3. Spending on administration and management relatively low compared to EU average
    (i) 1997-2010: no. NHS managers increased 37% during period in which total NHS spending doubled in real terms
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16
Q

Which key resource deficiencies did the King’s Fund (2017) identify in the NHS (vs EU average)?

A

(i) Doctors and nurses per population

(ii) MRI and CT scanners

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17
Q

How does total NHS spending compare internationally?

A

King’s Fund (2017)

Total resources available for NHS broadly in line w/EU average (though below average in per person spending)

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18
Q

Evidence that NHS relatively cost-effective

A
  1. King’s Fund (2018):
    (i) based on available data, evidence suggests NHS relatively cost-effective compared to similar countries
    (ii) Generic drugs – UK prescribes 1 of highest % of generic drugs in Europe, cheaper than branded rivals
  2. King’s Fund’s (2017) international comparison suggests UK spends relatively little on administration
    (i) 1997-2010: no. NHS managers increased 37% during period in which total NHS spending doubled in real terms
  3. Hospital HealthcareCom (2002)
    (i) compare costs of procedures in Europe
    (ii) >½ cost less in NHS vs 5 European healthcare systems reviewed
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19
Q

King’s Fund (2018)

A

NHS = COST-EFFECTIVE

  1. Based on available data, evidence suggests NHS relatively cost-effective compared to similar countries
  2. Generic drugs – UK prescribes 1 of highest % of generic drugs in Europe, cheaper than branded rivals

HIGH MORTALITY RATES

  1. Cancer – survival rates below average
    (i) Due to later detection and less successful treatments
  2. Heart attacks – morality rates within 30 days of being admitted to hospital below average
    (i) Doesn’t appear to be explained by characteristics of patients
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20
Q

Hospital HealthcareCom (2002)

A

NHS = COST-EFFECTIVE

(i) compare costs of procedures in Europe
(ii) >½ cost less in NHS vs 5 European healthcare systems reviewed

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21
Q

Evidence that spending on administration increased under New Labour? Context?

A

King’s Fund’s (2017)

1997-2010:
no. of NHS managers increased 37%, but during a period in which total NHS spending doubled in real terms

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22
Q

….. (…..)

(i) compare costs of procedures in Europe
(ii) ….. cost less in NHS vs ….. European healthcare systems reviewed

A

Hospital HealthcareCom (2002)

(i) compare costs of procedures in Europe
(ii) >½ cost less in NHS vs 5 European healthcare systems reviewed

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23
Q

Evidence of patient satisfaction with the NHS?

A

BSA (2018)

  1. ~60% are “very or quite satisfied” with the NHS
  2. Significant increases in patient satisfaction under New Labour (% ‘very or quite’ satisfied increased from ~40% to ~60%)
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24
Q

….. (2018)

  1. …..% are “very or quite satisfied” with the NHS
  2. Significant increases in patient satisfaction under New Labour (% ‘very or quite’ satisfied increased from …..% to …..%)
A

BSA (2018)

  1. ~60% are “very or quite satisfied” with the NHS
  2. Significant increases in patient satisfaction under New Labour (% ‘very or quite’ satisfied increased from ~40% to ~60%)
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25
Q

BSA (2018)

A
  1. ~60% are “very or quite satisfied” with the NHS
  2. Significant increases in patient satisfaction under New Labour (% ‘very or quite’ satisfied increased from ~40% to ~60%)
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26
Q

Evidence that mortality rates for some big causes of death higher than comparable countries in UK

A

King’s Fund (2018)

  1. Cancer – survival rates below average
    (i) Due to later detection and less successful treatments
  2. Heart attacks – morality rates within 30 days of being admitted to hospital below average
    (i) Doesn’t appear to be explained by characteristics of patients
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27
Q
  1. Potential problems with international survey comparisons of health systems?
  2. How might this affect survey responses in the UK?
A
  1. Responses may be shaped by wider social and political perceptions
  2. Positive public perception of NHS may skew responses
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28
Q

What 4 types of equity does Le Grand (1982) distinguish?

A

Equity of:

  1. Public spending
  2. Use
  3. Cost
  4. Outcome
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29
Q

Who distinguishes 4 types of equity?

Equity of:

  1. Public spending
  2. Use
  3. Cost
  4. Outcome
A

Le Grand (1982)

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30
Q

Evidence of inequity/inequality in the NHS

A
  1. Le Grand et al (2003)
    (i) Strong evidence that lower SES groups use NHS services less than expected based on self-reported illness compared to higher SES groups
  2. Nuffield Trust (2018)
    (i) Gap not large, but GP patient surveys show people in deprived areas report lower satisfaction and lower ease of booking appointments
    (i) Poorer areas tend to have fewer GPs per head
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31
Q

Le Grand et al (2003)

A

NHS INEQUITY

  1. Strong evidence that lower SES groups use NHS services less than expected based on self-reported illness compared to higher SES groups

2a. More confident middle classes better able to articulate themselves to GPs (promoting onward referrals)
2b. Lower SES groups less likely to go to doctor at all and likely to be less confident/more deferential, (leading to lower referral rates)

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32
Q

Nuffield Trust (2018)

A

GP INEQUITY

(i) Gap not large, but GP patient surveys show people in deprived areas report lower satisfaction and lower ease of booking appointments
(i) Poorer areas tend to have fewer GPs per head

CCG INEQUITY

(i) No statistically significant association between deprivation of a CCG’s residents and variety of indicators (e.g. % left waiting for more than 18 weeks, 4-hour A+E target)
(ii) More deprived CCGs have shorter median waiting times for planned care, though gap = tiny

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33
Q

Evidence of differential use of the NHS based on SES

A

Le Grand et al (2003)

Strong evidence that lower SES groups use NHS services less than expected based on self-reported illness compared to higher SES groups

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34
Q

Why does Le Grand et al (2003) find strong evidence that lower SES groups use NHS services less than expected based on self-reported illness compared to higher SES groups?

A
  1. More confident middle classes better able to articulate themselves to GPs (promoting onward referrals)
  2. Lower SES groups less likely to go to doctor at all and likely to be less confident/more deferential, (leading to lower referral rates)
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35
Q

NHS choice reforms?

A
  1. NHS Improvement Plan (2004):
    (i) Greater personal control over timing and location of care
    (ii) ‘Supply market’ allows patients to choose from any healthcare provider, w/all treatments funded by NHS
    (iii) Enable patients to book appointments online
  2. NHS choices website (2007)
    (i) aimed to provide range of data so patients able to compare hospitals, facilitating increased choice
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36
Q

Key elements of choice in NHS Improvement Plan (2004)

A

(i) Greater personal control over timing and location of care
(ii) ‘Supply market’ allows patients to choose from any healthcare provider, w/all treatments funded by NHS
(iii) Enable patients to book appointments online

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37
Q

aim of NHS choices website (2007)?

A

Aimed to provide range of data so patients able to compare hospitals, facilitating increased choice

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38
Q

Evidence of extent to which patients aware of choice introduced in NHS?

A

Dixon (2008)

National patient survey data showed that 61% unaware before visiting GP that they had choice of hospital for appointment

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39
Q

Dixon (2008)

A

National patient survey data showed that 61% unaware before visiting GP that they had choice of hospital for appointment

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40
Q

….. (…..)

National patient survey data showed that …..% unaware before visiting GP that they had choice of hospital for appointment

A

Dixon (2008)

National patient survey data showed that 61% unaware before visiting GP that they had choice of hospital for appointment

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41
Q

Greener (2008)

A
  1. Patients encouraged to use choice as ‘exit’ strategy from poor service providers
  2. But reluctant to change GP due to travel distance from home
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42
Q

Why patients reluctant to change GP?

A

Greener (2008)

Travel distance from home

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43
Q

Evidence of limitations of extent to which choice actually exercised in the NHS?

A
  1. Greener (2008)
    (i) Patients reluctant to change GP due to travel distance from home
  2. Crinson (2009)
    (i) Even in primary form of choice (location of hospital treatment), patients likely to defer to GPs’ judgements
  3. Dixon (2008)
    (i) National patient survey data showed that 61% unaware before visiting GP that they had choice of hospital for appointment
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44
Q

Crinson (2009)

A

LIMITS OF CHOICE

  1. Even in primary form of choice (location of hospital treatment), patients likely to defer to GPs’ judgements

MANAGERIALISM

2a. Previously doctors controlled every-day resource allocation (thought to prioritise clinical needs over cost control)
2b. Reforms in 80s appointed new ‘general managers’ (non-clinicians) to try to manage performance + control costs

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45
Q

Name and year of Thatcher’s radical health policy White Paper?

A

1989, Working for Patients

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46
Q

Baggott (1997)

A

2-TIER ACCESS

GP fund-holding practices found it easier to refer their patients to specialist hospital, exercising greater leverage over secondary care services

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47
Q

Evidence that GP fund-holding created a system of 2-tier access to hospital services?

A

Baggott (1997)

GP fund-holding practices found it easier to refer their patients to specialist hospital, exercising greater leverage over secondary care services

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48
Q

GP fund-holding practices found it easier to refer their patients to specialist hospital, exercising greater leverage over secondary care services

A

Baggott (1997)

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49
Q

How were PCTs different to GP fund-holding?

A

PCTs universalised GP fund-holding, in effect

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50
Q

What are CCGs?

A
  1. Clinical Commissioning Groups = consortia of GPs

2. Represent all GP practices in local area

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51
Q

Evidence that “universalisation” of GP fund-holding improved equity

A

Nuffield Trust (2018)

(i) No statistically significant association between deprivation of a CCG’s residents and variety of indicators (e.g. % left waiting for more than 18 weeks, 4-hour A+;E target)
(ii) More deprived CCGs have shorter median waiting times for planned care, though gap = tiny

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52
Q

Barr (2012)

A

By 2001, significantly fewer health authorities more than 4% away from amount needed to match resources w/needs equally

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53
Q

Evidence of significant geographical inequity in health resources in 80s?

A

Le Grand (1982)

(i) In the 80s, the top socio-economic group received 40% more NHS spending per person reporting illness than bottom group

54
Q

….. (…..)

(i) In the ….. , the top socio-economic group received …..% more NHS spending per person reporting illness than bottom group

A

Le Grand (1982)

(i) In the 80s, the top socio-economic group received 40% more NHS spending per person reporting illness than bottom group

55
Q

Le Grand (1982)

A

NHS EQUITY

  1. Top socio-economic group receives 40% more NHS spending per person reporting illness than bottom group
  2. Distinguishes equity of:
    (i) Public spending
    (ii) Use
    (iii) Cost
    (iv) Outcome
56
Q

Baggott (2004)

A

NHS FORMULA FUNDING

Blair government gave greater weight to health inequality adjustments in allocation funding formulas to tackle health inequity

SOCIAL CARE

> 80% of long-term nursing and residential care for the elderly provided by independent sector by value in 2000

57
Q

New Labour gave greater weight to health inequality adjustments in allocation funding formulas

A

Baggott (2004)

58
Q
  1. When was NICE created?

2. Why?

A
  1. 1999

2a. Remedy ‘postcode lottery’
2b. Improve allocation of NHS resources

59
Q

Nuffield Trust (2008)

A

Though NICE guidance technically mandatory since 2003, some survey evidence of variable compliance at local level

60
Q

Though NICE guidance technically mandatory since 2003, some survey evidence of variable compliance at local level

A

Nuffield Trust (2008)

61
Q

Evidence of variable compliance with NICE guidelines?

A

Nuffield Trust (2008)

62
Q

Since when has NICE guidance been technically mandatory?

A

2003

63
Q

When was internal market in health introduced?

A

1991

64
Q

When and why was managerialism introduced into the NHS?

A

Crinson (2009)

  1. 80s reforms appointed new ‘general managers’ (non-clinicians) to try and manage performance + control costs
  2. Thought that doctors prioritised clinical needs over cost control
65
Q

NHS implicit rationing mechanism

A

GPs = gatekeepers

66
Q

Public health policies under Thatcher?

A
  1. Mass information campaigns on smoking, heart disease and drugs
  2. GP pay linked to no. immunisations
67
Q

Public health policies under Major?

A
  1. ‘Health of the Nation’ strategy
  2. Strategy focused on disease targets in key areas, kick-starting national focus on public health and clinical prevention
68
Q

Public health policies under Blair?

A
  1. Pro-active sport policy in schools
  2. Efforts to improve early detection and screening of cancer (e.g. breast cancer)
  3. Banned tobacco advertising
69
Q

Public health policies under May?

A
  1. Sugar tax on soft drinks implemented in 2018 to try and curb obesity (incl. among children)
70
Q

Evidence of wasteful NHS use?

A

PAGB (2015)

Almost 20% of A+E visits in 2014 due to conditions that could have been self-treated at home

71
Q

PAGB (2015)

A

WASTEFUL NHS USE

Almost 20% of A+E visits in 2014 due to conditions that could have been self-treated at home

72
Q

….. (…..)

  1. Almost …..% of A+E visits in ….. due to conditions that could have been self-treated at home
A

PAGB (2015)

  1. Almost 20% of A+E visits in 2014 due to conditions that could have been self-treated at home
73
Q

What % of A+E visits in 2014 were due to conditions that could have been self-treated at home?

A

PAGB (2015)

20%

74
Q

Why is there little substantive research evidence that any commissioning approach has made a significant impact?

A

Health Foundation (2004)

Due to disruption of continuous policy changes

75
Q

Health Foundation (2004)

A

‘little substantive research evidence that any commissioning approach has made a significant’ impact, given continuous policy changes disruptive

76
Q

Wilkin et al (2002)

A

Primary-care led commissioners changed patterns of service provision, suggesting greater responsiveness to local needs

77
Q

Primary-care led commissioners changed patterns of service provision, suggesting greater responsiveness to local needs

A

Wilkin et al (2002)

78
Q

Evidence that primary-care led commissioning had positive impact?

A

Wilkin et al (2002)

Primary-care led commissioners changed patterns of service provision, suggesting greater responsiveness to local needs

79
Q

Why have PCTs and CCGs not resulted in significant economies of scale?

A

Wyke et al (2001)

  1. Organisational management and coordination costs increased
  2. Because large no. complex contracts produced, managed + monitored
  3. This has stifled cost savings
80
Q

Wyke et al (2001)

A

PCTs and CCGs not resulted in significant economies of scale because:

  1. Organisational management and coordination costs increased
  2. Because large no. complex contracts produced, managed + monitored
  3. This has stifled cost savings
81
Q

Evidence that introduction of competition in the NHS led to cost-savings?

A
  1. Soderlund et al (1997)
    (i) Productivity improvements associated w/becoming trust hospital
    (ii) But effect may be due to selection bias
    (iii) Hospitals also incentivised to under-state true productivity before achieving trust status to demonstrate subsequent improvement
  2. Mulligan (1998) – cost-efficiency of NHS overall rose ~0.5% faster per year following introduction of internal market
82
Q

Soderlund et al (1997)

A

(i) Productivity improvements associated w/becoming trust hospital
(ii) But effect may be due to selection bias
(iii) Hospitals also incentivised to under-state true productivity before achieving trust status to demonstrate subsequent improvement

83
Q

Mulligan (1998)

A

Cost-efficiency of NHS overall rose ~0.5% faster per year following introduction of internal market

84
Q

….. (…..)

Cost-efficiency of NHS overall rose …..% faster per year following introduction of internal market

A

Mulligan (1998)

Cost-efficiency of NHS overall rose ~0.5% faster per year following introduction of internal market

85
Q

Evidence that competition between hospitals reduces waiting times?

A

Dawson et al (2007)

Competition between London hospitals reduced waiting time

86
Q

Competition between London hospitals reduced waiting time

A

Dawson et al (2007

87
Q

Dawson et al (2007)

A

Competition between London hospitals reduced waiting time

88
Q

Le Grand et al (1998)

A

Review concluded there’s little clear evidence of overall change in quality of care being provided by hospitals following introduction of competition

89
Q

Braithwaite (2015)

A

UNINTENDED CONSEQUENCES OF TARGETS

  1. 4 hour A+E target led to patients being held outside in ambulances to avoid ‘starting the clock’
  2. 2/3 patients admitted in 10 minutes before 4-hour deadline, even when admission could have been entirely avoided for many
90
Q

Evidence that health targets may have unintended consequences

A

Braithwaite (2015)

  1. 4 hour A+E target led to patients being held outside in ambulances to avoid ‘starting the clock’
  2. 2/3 patients admitted in 10 minutes before 4-hour deadline, even when admission could have been entirely avoided for many
91
Q

….. (…..)

  1. ….. A+E target led to patients being held outside in ambulances to avoid ‘starting the clock’
  2. ….. patients admitted in ….. minutes before ….. deadline, even when admission could have been entirely avoided for many
A

Braithwaite (2015)

  1. 4 hour A+E target led to patients being held outside in ambulances to avoid ‘starting the clock’
  2. 2/3 patients admitted in 10 minutes before 4-hour deadline, even when admission could have been entirely avoided for many
92
Q

Evidence of impact of infection control targets under New Labour

A

Incidence of MRSA fell by more than half

93
Q

By how much did the incidence of MRSA fall following infection control targets under New Labour

A

MRSA fell by more than half

94
Q

Commonwealth Fund (2017)

A
  1. NHS the best, safest and most affordable of 11 advanced welfare democracies (based on international patient survey data)
  2. Caveat – NHS performed poorly compared w/other nations in terms of health outcomes (i.e. early deaths, cancer survival + general health of population)
95
Q

Dayan et al (2018)

A

% who have skipped a health consultation due to cost:

UK = <5%
US = >20%
Average= ~8%
96
Q

Evidence that people not deterred from using NHS due to cost (in international context)

A

Dayan et al (2018)

% who have skipped a health consultation due to cost:

UK = <5%
US = >20%
Average= ~8%
97
Q

….. (…..)

% who have skipped a health consultation due to cost:

UK = .....%
US = .....%
Average= .....%
A

Dayan et al (2018)

% who have skipped a health consultation due to cost:

UK = <5%
US = >20%
Average= ~8%
98
Q

How have Coalition encouraged greater plurality of healthcare providers?

A

‘Level playing field’ for ‘any qualified’ private/voluntary sector providers wishing to compete for NHS work

99
Q

Evidence of NHS centralisation

A
  1. New national regulatory bodies, incl. Healthcare Commission (sets standards of care + management in England, inspects NHS organisations and produces performance ratings)
  2. NICE issues guidelines on cost-effectiveness of different healthcare interventions
100
Q

Role of the Healthcare Commission

A
  1. Sets standards of care + management in England
  2. Inspects NHS organisations
  3. Produces performance ratings
101
Q

How have recent governments strengthened NHS management?

A
  1. Appointment of individuals w/key remit for achieving aims + objectives (e.g. chief executives of health bodies)
  2. Tougher performance targets
  3. New performance assessment systems
102
Q

How is healthcare in Scotland and Wales different to England?

A

Bevan et al (2014)

Abolished purchaser/provider split, w/NHS returning to similar model to pre-internal market era

103
Q

How is healthcare in Ireland different to England?

A

Bevan et al (2014)

  1. Retained purchaser/provider split
  2. But don’t encouraging competition or emphasise strong performance management
104
Q

Devolution means it is no longer possible to speak of a “UK NHS”

A

Bevan et al (2014)

105
Q

Evidence of increasing use of private finance within the NHS

A
  1. Effective privatisation of most long-term residential health + social care provision in 80s/90s
  2. Dental and optical care – due to increased role of private finance, NHS essentially a residual service for those unable to afford full cost of private care
  3. Expansion of PFI increased dependency on private capital investment
106
Q

Problems with use of PFI in healthcare

A

Pollock (2004) - PFI criticised for not delivering long-term value for money:

  1. More expensive than public financing (commercial interest rate > government interest rate)
  2. Costs for new buildings come out of current operating revenues, decreasing flexibility to meet rising demand
  3. Locks trusts into paying for buildings over decades, when needs/requirements may have changed
107
Q

Pollock (2004)

A

PFI criticised for not delivering long-term value for money:

  1. More expensive than public financing (commercial interest rate > government interest rate)
  2. Costs for new buildings come out of current operating revenues, decreasing flexibility to meet rising demand
  3. Locks trusts into paying for buildings over decades, when needs/requirements may have changed
108
Q

Who criticised PFI for not delivering value for money?

A

Pollock (2004)

109
Q

Key legislation in long-term residential health + social care that led to its effective privatisation?

A

Community Care Act (1990)

110
Q

Key driver of effective privatisation of long-term residential health + social care?

A

Fiscal concerns

111
Q

Examples of ways in which NHS never been totally dependent on state finance and provision?

A
  1. Majority of NHS budget spent on services provided by private sector (drugs, equipment)
  2. Much of NHS budget spent on services provided by independent contractors (notably GPs)
112
Q

Evidence that most long-term residential health + social care now provided by the independent + private sector?

A

Baggott (2004)

> 80% of long-term nursing and residential care for the elderly provided by independent sector by value in 2000

113
Q

….. (…..)

…..% of long-term nursing and residential care for the elderly provided by independent sector by value in …..

A

Baggott (2004)

> 80% of long-term nursing and residential care for the elderly provided by independent sector by value in 2000

114
Q

Early Thatcher health reforms?

A
  1. Contracting out of non-clinical services (e.g. cleaning)

2. Business-style management methods introduced

115
Q
  1. Total resources available for NHS broadly in line w/EU average (though below average in per person spending)
  2. Several resource deficiencies in key areas (compared to EU average):
    (i) Doctors and nurses per population
    (ii) MRI and CT scanners
  3. Spending on administration and management relatively low compared to EU average
    (i) 1997-2010: no. NHS managers increased 37% during period in which total NHS spending doubled in real terms
A

King’s Fund (2017)

116
Q

NHS = COST-EFFECTIVE

  1. Based on available data, evidence suggests NHS relatively cost-effective compared to similar countries
  2. Generic drugs – UK prescribes 1 of highest % of generic drugs in Europe, cheaper than branded rivals

HIGH MORTALITY RATES

  1. Cancer – survival rates below average
    (i) Due to later detection and less successful treatments
  2. Heart attacks – morality rates within 30 days of being admitted to hospital below average
    (i) Doesn’t appear to be explained by characteristics of patients
A

King’s Fund (2018)

117
Q

NHS INEQUITY

  1. Strong evidence that lower SES groups use NHS services less than expected based on self-reported illness compared to higher SES groups

2a. More confident middle classes better able to articulate themselves to GPs (promoting onward referrals)
2b. Lower SES groups less likely to go to doctor at all and likely to be less confident/more deferential, (leading to lower referral rates)

A

Le Grand et al (2003)

118
Q

GP INEQUITY

(i) Gap not large, but GP patient surveys show people in deprived areas report lower satisfaction and lower ease of booking appointments
(i) Poorer areas tend to have fewer GPs per head

CCG INEQUITY

(i) No statistically significant association between deprivation of a CCG’s residents and variety of indicators (e.g. % left waiting for more than 18 weeks, 4-hour A+E target)
(ii) More deprived CCGs have shorter median waiting times for planned care, though gap = tiny

A

Nuffield Trust (2018)

119
Q

By 2001, significantly fewer health authorities more than 4% away from amount needed to match resources w/needs equally

A

Barr (2012)

120
Q

NHS FORMULA FUNDING

Blair government gave greater weight to health inequality adjustments in allocation funding formulas to tackle health inequity

SOCIAL CARE

> 80% of long-term nursing and residential care for the elderly provided by independent sector by value in 2000

A

Baggott (2004)

121
Q

(i) Productivity improvements associated w/becoming trust hospital
(ii) But effect may be due to selection bias
(iii) Hospitals also incentivised to under-state true productivity before achieving trust status to demonstrate subsequent improvement

A

Soderlund et al (1997)

122
Q

EVALUATION OF 2012 HEALTH + SOCIAL CARE ACT

  1. Emphasis on diverse provider market led to significant increase in no. contracts being awarded to private providers
  2. But no significant increase in spending because these contracts much smaller than those awarded to NHS providers
A

King’s Fund (2018)

123
Q

Evidence on impact of 2012 Health + Social Care Act on private provision

A

King’s Fund (2015)

  1. Proposal for patients to access care from ‘any qualified provider’ taken a “back seat”
  2. Emphasis on diverse provider market led to significant increase in no. contracts being awarded to private providers
  3. But no significant increase in spending because these contracts much smaller than those awarded to NHS providers
  4. <10% of NHS budget spent on care from non-NHS providers, so claims of privatisation highly exaggerated
  5. Little change in % of NHS budget spent on non-NHS providers since Coalition came to power, w/most of the (modest) increases occurring under New Labour
124
Q

King’s Fund (2015)

A

HEALTH + SOCIAL CARE ACT 2012

  1. Secretary Lansley played “central role” in reforms and was determined to push through legislation so future governments couldn’t “modify/dilute his reforms by administrative fiat”
  2. Proposal for patients to access care from ‘any qualified provider’ taken a “back seat”
  3. Emphasis on diverse provider market led to significant increase in no. contracts being awarded to private providers
  4. But no significant increase in spending because these contracts much smaller than those awarded to NHS providers
  5. <10% of NHS budget spent on care from non-NHS providers, so claims of privatisation highly exaggerated
  6. Little change in % of NHS budget spent on non-NHS providers since Coalition came to power, w/most of the (modest) increases occurring under New Labour
125
Q

HEALTH + SOCIAL CARE ACT 2012

  1. Secretary Lansley played “central role” in reforms and was determined to push through legislation so future governments couldn’t “modify/dilute his reforms by administrative fiat”
  2. Proposal for patients to access care from ‘any qualified provider’ taken a “back seat”
  3. Emphasis on diverse provider market led to significant increase in no. contracts being awarded to private providers
  4. But no significant increase in spending because these contracts much smaller than those awarded to NHS providers
  5. <10% of NHS budget spent on care from non-NHS providers, so claims of privatisation highly exaggerated
  6. Little change in % of NHS budget spent on non-NHS providers since Coalition came to power, w/most of the (modest) increases occurring under New Labour
A

King’s Fund (2015)

126
Q

What proportion of the NHS budget is spent on non-NHS care?

A

King’s Fund (2015)

<10%

127
Q

Which government introduced competition between hospital trusts?

A

Thatcher/Conservative

128
Q

Which government introduced competition between NHS and non-NHS providers?

A

Blair/New Labour

129
Q

Evidence that NHS actually spends relatively little on administration

A

King’s Fund (2017)

  1. Spending on administration and management relatively low compared to EU average
  2. 1997-2010: no. NHS managers increased 37% during period in which total NHS spending doubled in real terms
130
Q

….. (…..)

  1. Spending on administration and management relatively low compared to ….. average
  2. From ….. to ….., the no. NHS managers increased ….% during period in which total NHS spending …..
A

King’s Fund (2017)

  1. Spending on administration and management relatively low compared to EU average
  2. 1997-2010: no. NHS managers increased 37% during period in which total NHS spending doubled in real terms

Social Policy (5 decks)

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