Northern Ireland health service comes in second

Northern Ireland comes second among the four parts of the UK in the amount spent per patient, according to a breakdown just published by the respected Health Service Journal.
“Huge contrasts found between UK nations. Patients in the UK’s four nations have dramatically different experiences of the NHS.”
Scotland came highest in spending per patient at £1262, compared to NI at £1214, Wales at £1186 and England £1,086. NI has the second highest ratio of GPs per 1.000 patients, 0.63 compared with Scotland’s 0.76.

Among the comparisons:

Same day admissions discharged

43% rise in the proportion of emergency admissions discharged on the same day in England between 2004 and 2007.

In Wales the rise was 34% and 12% in Northern Ireland .

In Scotland it fell by 2%.

In Northern Ireland, 12% of emergency admissions were discharged in under a day compared with 25% in England.

Patients discharged in England were 37% more likely to require emergency readmission within 28 days than in Northern Ireland.

There were 193 elective admissions per 1,000 population in Northern Ireland in 2007 – 51% higher than the rate in Wales

The Northern Ireland health department denied the rising elective admissions reflected a greater propensity for surgical intervention and said in part the rates were due to delivering on “very challenging waiting time targets” from 2005-07.

But these quite encouraging facts come with their own health warning.

“Dr Nick Goodwin, from the King’s Fund health think-tank, said the data should be interpreted with caution as it is collected differently in each area. He also warned that the data did not take in to account existing health inequalities or the infrastructure in place before different policies were adopted by each government.”

Still, it’s good to see at least one aspect of devolution working well – the exposure of different performances of varying efficiency and different priorities according to different health needs. More explanations are needed from Michael McGimpsey and co. More details of resources compared are below the fold.
Summary of variations in UK nations

37% Increase in A&E attendances in England between 2004 and 2007. In the three other nations the rate rose by no more than 3 per cent

1 in 10 The rate of emergency admissions in 2007 in Wales. The rate continues to rise. Wales has the lowest rate of elective admissions but the highest rate of emergency admissions

43% Rise in proportion of emergency admissions discharged on the same day in England from 2004-07. In Wales it was 34 per cent. The rate in Scotland fell by 2 per cent and in Northern Ireland it rose by 12 per cent

12% Emergency admissions discharged in less than one day in Northern Ireland, compared with 25 per cent in England. Patients discharged in England are 37 per cent more likely to require emergency readmission within 28 days than in Northern Ireland

The number of elective admissions per 1,000 population in Northern Ireland in 2007 – 51 per cent higher than the rate in Wales

The four systems

England National targets to improve performance, especially on waiting times. Hospital funding follows the patient under the payment by results system and there is an increasing emphasis on a provider/commissioner split to improve efficiency and patient focus.

2002-03 spend per head: £1,085
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2002-03 hospital beds per 1,000 population: 3.8
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GPs per 1,000 population: 0.57

Scotland Abolished the quasi-internal market in 2004 and created 15 integrated health boards (later cut to 14), responsible for both purchasing and providing secondary and primary care. Services funded on block contracts.

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2002-03 spend per head: £1,262
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2002-03 hospital beds per 1,000 population: 6
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GPs per 1,000 population: 0.76

Wales Twenty-two local health boards responsible for commissioning care from the 13 acute trusts (excluding the ambulance trust and since cut to eight) and commissioning and providing primary and community services. Funds most acute activity through block contracts with acute trusts. The Assembly government is now consulting on merging boards and trusts to create an integrated model akin to Scotland’s.

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2002-03 spend per head: £1,186
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2002-03 hospital beds per 1,000 population: 5
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GPs per 1,000 population: 0.61

Northern Ireland Devolution slowed by suspension of the assembly in 2002 (restored 2007). Commissioner/provider split between four health and social service boards and 18 health and social service trusts – cut to five in 2007.

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2002-03 spend per head: £1,214
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2002-03 hospital beds per 1,000 population: 4.9
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GPs per 1,000 population: 0.63