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

2002-03 hospital beds per 1,000 population: 3.8

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.


2002-03 spend per head: £1,262

2002-03 hospital beds per 1,000 population: 6

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.


2002-03 spend per head: £1,186

2002-03 hospital beds per 1,000 population: 5

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.


2002-03 spend per head: £1,214

2002-03 hospital beds per 1,000 population: 4.9

GPs per 1,000 population: 0.63

Former BBC journalist and manager in Belfast, Manchester and London, Editor Spolight; Political Editor BBC NI; Current Affairs Commissioning editor BBC Radio 4; Editor Political and Parliamentary Programmes, BBC Westminster; former London Editor Belfast Telegraph. Hon Senior Research Fellow, The Constitution Unit, Univ Coll. London

  • esmereldavillalobos

    Re: emergency admissions discharged on same day & emergency readmissions within 28 days.

    NI does well on this because (correct me if I’m wrong) there is no 98% admit or discharge in 4 hours rule in NI EDs (not yet anyway). This gives emergency physicians time to investigate people properly, come to a diagnosis and an appropriate disposal plan without a hospital manager breathing down their neck wondering if the patient will “breach” (the target). Patients in England get admitted inappropriately just to avoid “breaches” and keep the bean counters happy – it’s no wonder more get discharged on the same day.

    A higher readmission rate is partly due to lack of bed capacity (beds per 1,000 pop) so punters are turfed out more quickly to make room for the next one. Lack of bed capacity leads to hasty discharge and increase in nosocomial infection due to high rates of patient turnover.

    Re the increase in ED attendances in England well, Joe Public ain’t stoopid! If you had a sore throat and wanted to see a medic would you:

    a) ring your GP, fight with the receptionist for an appointment, and get one in 3 days (by which time you’ll probably be better anyway) if you’re lucky OR

    b) go to your local ED whenever you like (after work, in the early morning, weekends, bank holidays, 24-7-365), where you can be guaranteed 98% of the time you will be seen, investigated, treated and disposed of in 4 hours?

    It’s a no-brainer.

    Once the 4 hour rule is introduced in NI, things will change in much the same way. On the whole the advantages for patients much outweigh the disadvantages (no 8-12 hour waits just to see a doctor, no 72 hour trolley waits for a bed versus treatment possibly being a bit more slapdash but still safe). Do yourselves a favour and make it a 90% target for major (stretcher) cases and 100% for “walking wounded” – the advantages of being seen quickly for “minors” and the benefit of getting seen PROPERLY for the more acutely sick.

  • IJP


    The interesting thing is that the life expectancy in the UK nations is exactly the reverse of the spending ratio per capita, with Scotland by far the worst.

    Proof, if it were ever needed, that money isn’t everything. Surveys which focus on outcomes are much more relevant, in my view.

  • IJP @ 07:32 PM is surely correct. Nor would I see great reason to disagree with the essential arguments of esmereldavillalobos @ 05:30 PM.

    It comes down to whether we should have measurable outcomes to determine the effectiveness of spending, what those markers should be, and whether the markers should differ for a devolved series of disparate systems. Then it becomes an issue of whether comparisons between the four “national” systems are valid, when statistics are collected at that “national”. We might also debate how “sex education” and “health education” could or could not be included.

    Moreover, we should be aware that the privatizers are adept at exploiting any discrepancy, just as Big Pharma seems eminently capable of rousing public concern about any and every treatment that NICE does not instantly approve. Which is why, on second thoughts, I’ll shut up. Particularly so because the “Submit the word you see below” now reads “economic”.

  • Donnie Fiasco

    Big Pharma invest billions in bringing drugs to market so they are obviously going to be extortionately expensive until they get a mass market. If the health service can’t provide for the taxpayer then what are your taxes for? Simplistic and idealistic I know but it is what a lot of people believe.

  • runciter

    Big Pharma invest billions in bringing drugs to market

    Big Pharma spends more on advertising than R&D;