1. Getting out what we put in: how productive is the NHS in England? Adriana Castelli, Mauro Laudicella Andrew Street & Padraic Ward

2. Outline Introduction Methodology Data Sources Results Conclusions

3. Introduction NHS – tax financed system Important therefore to monitor how our money is being spent Significant increases in spending in recent years Are we getting out what we are putting in?

4. Methodology (outputs) Productivity growth = [Output/Input]-1 Necessary to attach a relative value (cost) to each type of output so that these can be aggregated Changes in categorisation categories –Using a mapping or imputation method Incorporating quality into our index –Waiting times –Survival times –Disease management

5. Methodology (inputs) Input growth calculated directly or indirectly Direct measure relies on accurate price & volume data being available Indirect measure uses expenditure data and a price deflator to estimate the volume effect Both measures are equivalent

6. Data Sources

7. Results (1)

8. Results (2) Survival rates

9. Results (3)

10. Results (4)

11. Conclusions Negative productivity growth (1998/9 – 2003/4) –New pay rewards –Increased recruitment as part of EWTD Since then output growth has increased –Not only are more patients being treated but the quality of the treatment received has improved Slowdown in input growth –Levelling off of staff recruitment –Less reliance on agency staff Overall NHS productivity growth has been positive or at least constant in recent years

12. References Castelli A, Laudicella M, Street A. Measuring NHS output growth: Centre for Health Economics, University of York. CHE Research Paper 43; 2008. http://www.york.ac.uk/inst/che/pdf/rp43.pdfhttp://www.york.ac.uk/inst/che/pdf/rp43.pdf Street A, Ward P. NHS input and productivity growth 2003/4 - 2007/8: Centre for Health Economics, University of York, CHE Research Paper 47; 2009. http://www.york.ac.uk/inst/che/pdf/rp47.pdf http://www.york.ac.uk/inst/che/pdf/rp47.pdf