Basic overview of the NHS Structure. Simple Understanding around the flow of money in the NHS including local and national commissioning. Understand the financial pressures facing the NHS.

Providers and commissioners of NHS services in England: 209 clinical commissioning groups 135 acute non-specialist trusts (including 84 foundation trusts) 17 acute specialist trusts (including 16 foundation trusts) 54 mental health trusts (including 42 foundation trusts)  35 community providers (11 NHS trusts, 6 foundation trusts, 17 social enterprises and 1 limited company) 10 ambulance trusts (including 5 foundation trusts) 7,454 GP practices 853 for-profit and not-for-profit independent sector organisations, providing care to NHS patients from 7,331 locations

Watch the animation: https://youtu.be/m71C3kQmpEA

1. Funding Source: https://www.kingsfund.org.uk/projects/nhs-in-a-nutshell/nhs-budget UK public health spending grew in real terms by an average of 1.3% per year between 2009–10 and 2015–16. This is substantially below average growth of 4.1% per year between 1955–56 and 2015–16. Spending growth under the coalition government was the lowest five-year average since records began (though generous compared with the cuts to spending in other government departments over the same period). 2. Total UK health spending, including both public and private expenditure, was in line with the unweighted EU-15 average (9.8% of national income) in 2015. However, it was substantially below the levels of the US (16.9%), Japan (11.2%), Germany (11.1%) and France (11.0%). Recent projections from the Office for Budget Responsibility (OBR) indicate that health spending is likely to increase considerably over the next 50 years. Regardless of short-term funding decisions, the next government faces a challenge to design and implement a long-run solution to these spending pressures. While health spending has considerably increased over time, so has demand for health services. One major driver of this increase in demand is population growth. Between 1955 and 2015, the UK population grew by 14.2 million people, or by 0.4% per year. This means that while health spending has grown by an average of 4.1% per year over this period, real per-capita spending has increased by 3.7%. (https://www.ifs.org.uk/uploads/publications/bns/BN201.pdf)

1. Funding Source: https://www.kingsfund.org.uk/blog/2016/01/how-does-nhs-spending-compare-health-spending-internationally

2. Population & Demographics The number of UK residents aged 90 and over has almost tripled since the early 1980s The UK population is both increasing and ageing. Current projections show this pattern is set to continue. 73.3 Million, projected UK population by 2037 The old age dependency ratio (OADR) measures the number of people of State Pension Age (SPA) and over for every 1,000 people of working age (16 to SPA). The OADR provides an idea of the relationship between working and pensioner populations. The OADR was steady at around 300 from the 1980s to 2006, but rose in 2007-09 as women born in the post-World War II baby boom reached SPA. With planned SPA increases taking place between 2010 and 2046 under current legislation, it is expected that – for every 1,000 people of working age in 2037 – there will be 365 people of SPA. Source: https://visual.ons.gov.uk/uk-perspectives-the-changing-population/

3. Population Health “Improvements to healthcare and living healthier lives mean that as a nation we are living longer and newborn boys and girls can expect to live for 79 and 83 years respectively. However while we are living longer we are spending a smaller proportion of our overall lives in good health which puts a greater challenge on health services.” Sarah Caul, Senior Health Researcher https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/healthandlifeexpectancies/bulletins/healthstatelifeexpectanciesuk/2013to2015#people-can-expect-to-live-over-three-quarters-of-their-life-in-good-health

3. Population Health

About 15 million people in England have a long-term condition. 3. Population Health About 15 million people in England have a long-term condition. Treatment and care for people with long-term conditions is estimated to take up around £7 in every £10 of total health and social care expenditure. Long-term conditions are more prevalent in older people (58 per cent of people over 60 compared to 14 per cent under 40) and in more deprived groups (people in the poorest social class have a 60 per cent higher prevalence than those in the richest social class and 30 per cent more severity of disease) (1). People with long-term conditions now account for about 50 per cent of all GP appointments, 64 per cent of all outpatient appointments and over 70 per cent of all inpatient bed days. Treatment and care for people with long-term conditions is estimated to take up around £7 in every £10 of total health and social care expenditure (1).  People living with a long term condition are less likely to be working than the general population; 72% of the general population are in work whereas 59% of people with LTCs are in work. Only 35% of people with a mental health condition are in work.    Of the people who report that they live with long term conditions, 24% have two LTCs and 20% live with three or more LTCs.  72% of people with long term conditions use their care plan to manage everyday health.  18% of people living with a long term condition smoke.  Long-term conditions account for: 50% of all GP appointments; 64% of all hospital outpatients appointments; 70% of all hospital bed days; and 70% of health and care spend. https://www.kingsfund.org.uk/projects/time-think-differently/trends-disease-and-disability-long-term-conditions-multi-morbidity

Vacancy rates push organisations toward using more expensive agency staff to fill gaps in rotas. It’s not just hospitals that are finding it difficult to recruit, the number of GP vacancy rates are also at 12.2% with regional variation as deprived areas are more difficult to recruit to. Less access to primary care means patients are more likely to attend A&E or ignore their health problems until they become more serious taking longer and costing more to address

The Kings Fund publish articles such as: Understanding NHS financial pressures: how are they affecting patient care? What is commissioning and how is it changing? Does the NHS need more money? NHS England website provides more information on commissioning Future-Focused Finance website has free tools including the Crossing Professional Boundaries Toolkit for clinicians and finance teams