Is the English NHS underfunded?

Do targets matter? A comparison of English and Welsh National Health priorities

National priorities and performance management regimes in the National Health Services of England and Wales diverged following devolution, most notably with respect to the use of waiting time targets, which have been progressively strengthened in England but were abandoned in Wales in the immediate post-devolution period. We analyse routine data collected over a six-year period from three English and one Welsh hospital trust close to the English-Welsh border to ascertain whether: (a) there is evidence of differential performance over time that relates to the country where the hospital is located; (b) within each hospital, there is evidence that English and Welsh patients faced different waiting times. Over the period the English hospitals recorded increased levels of activity, undertook proportionately more day case activity, and mortality rates fell. Activity levels remained constant in Wales, the proportion of day case activity fell, proportionately more non-elective patients were admitted, and mortality rates rose. There is partial evidence that English patients faced lower waiting times than their Welsh counterparts and were more likely to be admitted within a target waiting period. The stronger performance management regime operating in England appears to have contributed to higher levels of performance in the English hospitals over the period.

Primary care in the UK: understanding the dynamics of devolution

The United Kingdom is ostensibly one country and yet public policy often varies between its constituent territories - England, Scotland, Wales and Northern Ireland. Health policy illustrates the dilemmas inherent in an apparently unitary system that permits scope for territorial variation. Administrative devolution has now been accompanied by political devolution but their interaction has yet to produce policy outcomes. This paper describes recent health policy reform with regard to primary care in terms of the tension inherent in current policy between notions of a 'one nation NHS' and the territorial diversity wrought by devolution. The paper provides a framework for understanding the emergent outcomes by exploring various concepts. In particular, the existing character of territorial policy networks, the properties of policies in devolved territories and intergovernmental relations are considered from various disciplines to examine whether greater diversity or uniformity will result from the dual reform process. Whilst this evaluation can, at this stage, only be preliminary, the paper provides a framework to appraise the emerging impact of devolution upon primary care in the UK.

Regional variation in varicose vein operations in England 1989-1996

AIM

To determine accuracy of Office of Population Censuses and Surveys (OPCS) codes for varicose vein (VV) operations and differences in regional activity over 7 years.

METHODS

OPCS codes were obtained for VV operations (L85, L87) for the 8 English regions 1989/90-1995/96. Data were also obtained for the 4 districts of the old Oxford Region. Centrally collected codes for one hospital were compared with audit data from the same hospital.

RESULTS

There was a marked inter-regional variation in VV activity, e.g. in 1995/96 the range of operations/100,000 population was 102 (Anglia & Oxford) to 138 (West Midlands). There was a gradual increase in the number of operations carried out nationally from 98/100,000 in 1989/90 to 121/100,000 in 1995/96. The numbers peaked in 1991/92, coinciding with a 'waiting list initiative'. When compared with audit data, accuracy of coding improved throughout the study period. There was a 55% inaccuracy in 1989/90 compared with 2% in 1995/96. In each year, codes overestimated the volume of work actually carried out.

CONCLUSION

OPCS codes broadly reflect VV activity. Difference in VV activity in different parts of the country are apparent.

Laboratory medicine in the United Kingdom: 1948-1998 and beyond

The National Health Service in the United Kingdom was created in 1948, effectively becoming the main provider of healthcare and funded by the government from taxation. By the late 1970's, and despite many achievements, it was seen to be approaching a financial crisis. Radical reforms were introduced in the early 1990's bringing in general management, a split between purchaser and provider, and competition. Whilst there has been a change of government more recently several of these initiatives have been retained, with the exception of competition (the internal market) which has been abandoned. There is now a much greater focus on the quality of care with increased clinical and financial accountability. Laboratory medicine (generally termed pathology in the United Kingdom) has evolved to meet the demands of more patients, reducing turnaround times, a greater repertoire of investigations and a continuing improvement in productivity. There is an increasing focus on improved dialogue between the laboratory and the clinician covering interpretation of results, audit of services and outcomes, research and development and continuous education in the pursuit of a high quality service. The major challenges for the future focus on alternative modes of delivery, on issues relating to staffing and on quality of service, in the face of an ever increasing demand.