4 December 2017
Jessica Morris

Jessica Morris

Research Analyst
Nuffield Trust

This month we updated the UK health expenditure indicator where we compare our spending on health care goods and services with that of other countries. We also added the latest data to our interactive charts exploring A&E performance, treatment and diagnostic test waiting times, delayed transfers of care, and access to antenatal services. This briefing provides an overview of key trends in the data.

UK health expenditure

Health care systems are organised and financed differently across the world, but it is widely agreed that universal access to quality health care at an affordable cost is a basic need. Data on health care expenditure enables us to compare spending on health care per capita or as a percentage of GDP, irrespective of differences in health care systems.

Between 1986 and 2009, health expenditure per capita increased at a similar rate in most European countries – the UK had an average year-on-year increase of $150. Following this, spending patterns in some countries diverged which may be a result of the global financial crisis. Health spending in the UK appears to have grown considerably more than the average year-on-year increase between 2012 and 2013, but this is largely due to the UK’s adoption of the OECD’s most recent system of health accounts. See this Nuffield Trust blog for more information. Between 2015 and 2016, UK health expenditure per capita only increased by $67.

In 2016, the UK spent $4,192 on health care per capita which was just above the Organisation for Economic Co-operation and Development (OECD) average. We outspent Italy, Spain and Portugal, but underspent France, Germany and Sweden. As a percentage of GDP, the UK spent 7.7% on public health care which was just above the average of the EU15 countries. 2.0% of GDP was spent on private health care, which was just below the EU15 average.

Accident & emergency

The NHS Constitution sets out that a minimum of 95% of patients attending A&E should be admitted, transferred or discharged within four hours of their arrival. The proportion of patients seen within four hours has been declining in recent years – in October 2017 the target was not met for approximately 9% of patients. Meanwhile, the total number of A&E attendances has been increasing, almost reaching 6 million attendances in Q1 2017/18.

For an in-depth analysis of what’s causing increasing A&E waits, see the QualityWatch report Focus on: A&E attendances

Treatment and diagnostic test waiting times

Referral to treatment (RTT) and diagnostic test waiting times are both key measures of health care quality. Shorter waiting times allow patients to get faster access to the treatments they need.

In 2012, it became a statutory requirement that at least 92% of people should have a RTT time of less than 18 weeks. However, this target has not been met since March 2016, and the number of people on the waiting list for treatment has been increasing, reaching 3.8 million in September 2017.

There is a further expectation which states that less than 1% of patients should wait longer than six weeks for a diagnostic test. This target was initiated to support the achievement of the 18-week RTT target. However, in September 2017 2% of patients were waiting longer than six weeks and the number of people on the waiting list reached 898,000.

Delayed transfers of care

Timely transfer of patients who are ready to be discharged out of acute or non-acute care is an essential part of their care pathway. Services need to work together to ensure safe, person-centred transfers without delay. The number of delayed transfer of care (DTOC) beds increased rapidly between 2014 and 2017, reaching a peak of 6,660 DTOC beds in February 2017. Since then, DTOC bed numbers have fallen slightly to 5,610 in September 2017, where there were a total of 168,302 delayed days.

For a more detailed look at DTOCs see the Nuffield Trust’s latest briefing.

Access to antenatal services

Timely access to antenatal assessment is a national priority in the NHS. The latest data for this indicator shows that the proportion of maternities which had an antenatal assessment by 12 weeks and 6 days of pregnancy has generally increased since 2009. However, this may in part be due to a decrease in the number of maternities over time.

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