Doubling expenditure on the National Health Service in England had a variable impact on health system performance

A report published yesterday reveals that while public expenditure on health care in England more than doubled between 1997 and 2010, the impact on health system performance has been variable.

Between 1997 and 2008 health expenditure in cash terms more than doubled from £55.1 billion to £125.4 billion. Expenditure on health care per capita increased from £231 in 1980 to £1,168 in 2000, and by 2008 it was £1,852. This spending was accompanied by a continuous programme of transformation of the National Health Service (NHS) in England.

Expansion of the NHS workforce has been a key focus of government policy since 2000. Thus, there are over 50,000 more doctors, including 10,000 more GPs, and almost 100,000 more nurses and midwives.

However, NHS productivity did not increase over this period. The most recent measure, which includes an element for quality improvements, shows NHS output increased rapidly between 1997 and 2008, at over 4.5% per annum, but the increase in inputs was even greater at almost 4.75% per annum

Nevertheless, the NHS made substantial progress in some areas, particularly improving access to elective care, and, to a lesser degree, outcomes. Waiting lists have halved and people wait less time for treatment. The 1.3 million people on NHS waiting lists in 1998 fell to under 600,000 in 2008.

Reducing health inequalities was another key target, but despite various policies introduced to meet that target, the position has worsened, even though the health of the population overall has improved.

The Health System in Transition report on England is the most comprehensive overview of the health and social care system in England produced this century.