What does the future hold for funding care outside of hospitals? | George Stoye

George Stoye

If the NHS's 70th birthday present is to really shift the needle, policymakers must fundamentally rethink spending patterns and improve data collection on NHS care provided outside of hospitals, argues George Stoye.

The recent NHS funding announcement will provide much relief to a health service facing pressures on many fronts. But now the NHS must decide how it uses this money, and which areas of care to prioritise.

One possibility is to increase funding for care outside of acute hospitals. Community and primary care represent the main point of contact for many people with the health service, with almost four times as many patient contacts with these services compared to hospitals.

Despite this, hospitals account for the majority of NHS spending. And while the 2016 General Practice Forward View promised to increase funding for primary care (which accounted for about 9 per cent of the Department of Health spending in 2016/17), over the next few years at almost double the rate of other NHS spending, this would mark a big departure from past trends in spending if delivered.

In a recent report that I co-authored, we examined how increases in NHS funding have changed over the past few years. Between 2011/12 and 2016/17, spending by the Department of Health grew by 15 per cent. In contrast, spending on primary care fell by 4 per cent. This follows a decade where spending on primary care grew, but at a much slower rate (2.8 per cent per year between 1999/2000 and 2011/12) than the wider NHS (5.5 per cent). Primary care therefore does not appear to have been the priority for spending either in the short or longer term.

These spending patterns are reflected in what the NHS actually buys with their money. Between 1996 and 2016, the number of hospital doctors per head increased by more than 70 per cent. Inpatient activity in hospitals has also doubled. But when you look at the number of GPs relative to the population, these numbers have actually fallen. And since 2011/12, the numbers of full-time equivalent GPs have also fallen in absolute terms.

Why then, if non-hospital care is so important, is this not reflected in recent spending patterns?

Two related reasons come immediately to my mind. First, many of the highest profile targets in the NHS refer to hospital care. The media and the public care a lot about A&E and elective waiting times, areas which saw rapid improvement throughout the 2000s, but whose struggles have been widely publicised in recent years.

Targeting hospital care has put an added emphasis on this part of the NHS, both in the minds of the public and policymakers. While patients clearly care about access to GPs, the lack of regular reporting in this area means less public attention is place here.

Second, a lack of good quality data on NHS care provided outside of hospitals makes it very hard to really evaluate what is happening to care on a national level. This may in part explain why the targets discussed above are so focused on hospitals, where in general high-quality patient data are recorded. This makes it possible to understand trends in the quality and quantity of the care received by their patient. This is less common for primary care, while consistent data for community care and social care is (currently) virtually non-existent.

It is therefore impossible to really understand what is happening in these areas, to monitor changes over time, or to target investment in a way that improves efficiency and patient outcomes.

Policymakers need to improve the collection of data in these areas if they really want to understand what is happening here and to make sure that future investments in these areas bear fruit.

George Stoye is a senior research economist at the Institute for Fiscal Studies (IFS). Follow the IFS on Twitter @TheIFS

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