Getting out what we put in: how productive is the NHS in

England?Adriana Castelli, Mauro Laudicella

Andrew Street & Padraic Ward

Outline

• Introduction

• Methodology

• Data Sources

• Results

• Conclusions

Introduction

• NHS – tax financed system

• Important therefore to monitor how our money is being spent

• Significant increases in spending in recent years

• Are we getting out what we are putting in?

Methodology (outputs)

• Productivity growth = [Output/Input]-1• Necessary to attach a relative value (cost) to

each type of output so that these can be aggregated

• Changes in categorisation categories– Using a mapping or imputation method

• Incorporating quality into our index– Waiting times– Survival times– Disease management

Methodology (inputs)

• Input growth calculated directly or indirectly

• Direct measure relies on accurate price & volume data being available

• Indirect measure uses expenditure data and a price deflator to estimate the volume effect

• Both measures are equivalent

Data Sources

Outputs Inputs HES TFRs Reference Costs Data PFRs QResearch Monitor - FTs Prescription Pricing Authority (PPA) data

Prescription Pricing Authority (PPA) data

The Information Centre

The Information Cenre DH – Price Deflators

Results (1)

Waiting times (days)

0

20

40

60

80

100

120

140

2003/04 2004/05 2005/06 2006/07

Hospital

Outpatient

Results (2)

• Survival rates

Electives

99.00%

99.25%

99.50%

99.75%

100.00%

2003/04 2004/05 2005/06 2006/07

In hospital

30 dayNon-electives

94.00%

96.00%

98.00%

100.00%

2003/04 2004/05 2005/06 2006/07

In hospital

30 day

Results (3)

Proportion with low blood pressure

50%

55%

60%

65%

70%

75%

80%

85%

90%

95%

2003/04 2004/05 2005/06 2006/07

CHD

Stroke

Hypertension

Results (4)

0.900

1.000

1.100

1.200

1.300

1.400

1.500

1.600

1998/9 1999/0 2000/1 2001/2 2002/3 2003/4 2004/5 2005/6 2006/7

output growth

input growth

productivity

Conclusions

• Negative productivity growth (1998/9 – 2003/4)– New pay rewards– Increased recruitment as part of EWTD

• Since then output growth has increased– Not only are more patients being treated but the quality of the

treatment received has improved

• Slowdown in input growth – Levelling off of staff recruitment – Less reliance on agency staff

• Overall NHS productivity growth has been positive or at least constant in recent years

References

• Castelli A, Laudicella M, Street A. Measuring NHS output growth: Centre for Health Economics, University of York. CHE Research Paper 43; 2008. http://www.york.ac.uk/inst/che/pdf/rp43.pdf

• Street A, Ward P. NHS input and productivity growth 2003/4 - 2007/8: Centre for Health Economics, University of York, CHE Research Paper 47; 2009. http://www.york.ac.uk/inst/che/pdf/rp47.pdf