Healthcare across the UK: A comparison of the NHS in England, Scotland, Wales and Northern Ireland

29 June 2012

The National Audit Office has today published a report highlighting key trends and variations in the delivery of healthcare across the four nations of the UK. The report finds that, despite the shared history and similarities between the four nations, there are considerable variations in areas such as health outcomes, spending, staffing and quality.

Life expectancy varies significantly across the UK – from 75.9 in Scotland to 78.6 in England for men, and from 80.4 in Scotland to 82.6 in England for women. Spending on health services in the UK more than doubled in cash terms in the last decade. The rate of increase has been broadly similar in all four nations but spending per person continues to vary. In 2010-11, despite devoting a higher proportion of total public spending to health, England spent the least on health per person.

In line with the rise in spending, the number of NHS staff has increased over the last decade. Scotland has the most GPs per person (80 per 100,000 people in 2009 compared with 70 in England and 65 per 100,000 in both Wales and Northern Ireland). Scotland also has the most medical hospital staff and nursing, midwifery and health visiting staff per person.

Comparable data on the efficiency and quality of healthcare are patchy. In 2008-09, average hospital lengths of stay varied from 4.3 days in England to 6.3 days in Wales.  Hospital waiting times have fallen in all four nations in recent years, although there are notable variations in how long patients wait for common procedures. In 2009-10 waiting times tended to be lower in England and Scotland than in Northern Ireland and Wales. Across the UK, there have been significant improvements in levels of healthcare associated infections. For instance, in the four years to 2010-11, rates of MRSA infection dropped by a third or more in all nations.

Amyas Morse, head of the National Audit Office, said today:

“We publish this report at a time when the NHS across the UK is under increasing pressure to use resources more efficiently. Funding is tighter while the demand for healthcare continues to grow as a result of an ageing population and advances in drugs and technology.

“We consider that there would be value in the health departments in the four nations carrying out further work to investigate the variations in performance and identify how they can learn from each other to achieve better value for money for taxpayers and better care for patients.”

More spent per head in Scotland, but health benefits yet to show

Published Date: 10 June 2010

SCOTLAND is not seeing health improvements in line with the level of government spending, according to a new study.

• A report by a think-tank and auditors calls for more research into regional behaviour and health systems – to explain why Scotland’s health continues to struggle to improve. Picture: Getty

Just under £2,000 is spent per head on health in Scotland – about £250 more than in England – said the Centre for Public Policy for Regions (CPPR) think-tank and auditors KPMG.

The study said there was a 12-16 per cent higher spend per person and 30 per cent higher staffing levels north of the Border in the NHS.

Reductions in death rates, including from cancer, heart disease and strokes, were welcomed but the authors argued they do not go as far as expected.

On life expectancy, the report said improvements in Scotland did not match those in England.

The report also said that Scotland’s 30 per cent higher level of staffing should be investigated through a new regulatory body to ensure value for money.

CPPR’s John McLaren said: “Our research has shown that while health spending and staffing levels per head in Scotland appear to be greater than in England, we are not experiencing the improved health outcomes that might have been hoped would have followed.

“This could be due to worsening needs in Scotland relative to England, for example due to differing behavioural patterns, but at present it is difficult to convert any such higher needs into extra costs.”

The report said smoking has declined in the past ten years but the number of smokers in Scotland “remains higher” than elsewhere in the UK.

The rate of deaths linked to alcohol is more than double the rate in England, the study added.

“Greater comparability of UK health needs, health systems and behavioural patterns is required, along with the incorporation of lessons to be learnt from international evidence,” Mr McLaren said. “This research should be conducted with an eye to what potential savings or reductions in demand, with regards to future health budgets, might be possible.”

The Scottish Government said health was not improving quickly enough but said parts of the report were “ill-informed”.

Click the link to read the full article about Scotlands Health

Health chief warns of age timebomb facing the Hebrides

Exclusive: Mike Merritt

30 May 2010

The Western Isles’ director of public health is warning the Outer Hebrides faces a population timebomb, with the young leaving in droves and the area becoming an enclave for the elderly.

In her annual report, Dr Sheila Scott says that of all 40 community health partnerships in Scotland, the isles have the lowest percentage of men and women of working age.

And it has the second highest percentage of those aged 65 and over.

Over the last decade, the isles have lost nearly a sixth of their young and those up to early middle age – and even greater falls are predicted.

Latest projections from the General Registrar’s Office Scotland predict there will be an overall 5% decrease in the population between now and 2031.

This will include: a decrease of 23% in the population aged 0-16 years; a decrease of 18% in the working age population plus an increase of 47% in the population aged 65 and over.

Dr Scott said the isles’ population had fallen to just 26,200. In the last decade there has been a decline in the number of people aged 0-14 and 25-44 years – drops of 16% and 15% respectively – while the number of those aged 45-plus has risen by 8%.

Looming job cuts in the dominant public sector on the islands would exacerbate the population problems.

There are fears 450 jobs could be lost due to council cut-backs, and NHS Western Isles has to make over £13m of savings in the next five years. A further stress is the lack of cheap housing, with the isles having one of the highest totals of holiday homes.

An Outer Hebrides Migration Study predicted a decline in the number of women of child-bearing age from 4,500 in 2004 to 3,500 by 2019, a fall in the numbers of primary school-aged children from 2,100 to 1,800, a secondary-school population drop from 2,100 to 1,900 and an increase in the average age of the population from 42.4 to 45.3.

Follow the link to read the full article about age timebomb facing the Hebrides

NHS Grampian board's "Texting or Talking?" scheme aims to cut binge-drinking

Text message plan to curb binge drinking among young adults

Published Date: 13 May 2010
By Frank Urquhart

SCOTTISH health professionals are turning to text messaging in a radical bid to curb binge drinking among young adults.

NHS Grampian researchers have been chosen to carry out a year-long project in which people in their twenties seen as “hazardous” drinkers will be sent text messages, it was revealed yesterday.

Before they set out for pubs and clubs in Aberdeen at weekends, the texts will urge them to drink in moderation.

The tactic has proven effective in previous initiatives designed to help people quit smoking and to exercise more.

Dr Steve Baguley, sexual health specialist at the city’s Woolmanhill Hospital, who is heading the Scottish Government study, said the aim was to recruit more than 1,000 volunteers, mainly in their twenties, to take part in the pilot scheme and compare three different methods of intervention aimed at curbing excessive drinking.

One group will given be advice leaflets. The second group will be dealt with through a “brief intervention” – a short structured interview with a health professional which is the most common initiative currently used to encourage moderate drinking. The third group will receive text messages.

Those taking part in the so-called Texting or Talking study will be selected for the three groups at random.

Dr Baguley said: “Binge drinking is very common among people who come to sexual health clinics and we found in one study that 50 per cent were hazardous drinkers.

“Hazardous drinking – or binge drinking – is associated with poor sexual health: catching sexually transmitted infections, getting pregnant when you don’t want to and being sexually assaulted.”

He said the aim was to send the texting group a series of messages to their mobiles every Friday night before they leave home for a night out.

The messages will urge: “If you’re drinking this weekend, take it easy.” There will then be an additional text, containing various messages, including: “Make sure it’s you making the decisions. Eat before and while you drink. Use soft drink spacers.”

They will also be warned: “You’re more likely to be sexually assaulted if you’re drunk. Alcohol provokes the desire but takes away the performance.”

Dr Baguley added: “We are not trying to say don’t drink. We would just turn people off if we tried to insist on that. It is really to try to help people gain control of the situation when they are going out drinking.

“Texting has never been tried for alcohol before. Texting has been tried internationally and found to be effective for smoking cessation, weight loss and for promoting exercise and in the control of diabetes.

Click the link for more on text messaging scheme

Life Expectancy in Special Areas of Scotland

The Registrar General for Scotland today published a report on differences in life expectancy between urban and rural areas, deprived and less deprived areas, and Community Health Partnership areas. The report shows life expectancy in the period 2006-2008.

Commenting on these results, Registrar General for Scotland Duncan Macniven said:

“This report shows that life expectancy varies a great deal across Scotland. In general, people in the countryside live longer than people in towns. And there is a big difference in expected lifespans between the most deprived and least deprived areas – over 13 years for men and 9 years for women.”

The key points in this report for life expectancy at birth in 2006-2008 are:

Men in rural areas – remote and accessible – can expect to live over 3.5 years longer (77.2 and 77.5 years respectively) than men in large urban (73.7 years);

Women in rural areas – remote and accessible – can expect to live around 2 years longer (81.4 and 81.2 years respectively) than women in large urban areas (79.3 years);

Life expectancy decreases as deprivation increases;

Men in the 10 per cent least deprived areas of Scotland can expect to live for 13.5 years longer than men in the 10 per cent most deprived areas (80.8 years compared with 67.3 years);

Women in the 10 per cent least deprived areas of Scotland can expect to live around 9 years longer than those in the 10 per cent most deprived areas (84.1 years compared with 75.1 years);

Men in East Dunbartonshire Community Health Partnership area can expect to live over 8 years longer than men in North and East Glasgow Community Health and Care Partnership areas (78.0 years compared to 69.4 and 69.6 years respectively);

Women in East Dunbartonshire Community Health Partnership area can expect to live around 6 years longer than women in North and East Glasgow Community Health and Care Partnership areas (82.5 years compared to 76.0 and 76.8 years respectively);

In the 10 years since 1996-1998, life expectancy at birth has increased in every Community Health Partnership area, although in 11 cases by a margin so small or non-significant that it may be a consequence of the volatile nature of life expectancy estimates in small areas;

For men, the largest increase in life expectancy at birth, over the 10 year period, was in West Lothian Community Health Partnership area with 5.7 per cent (an improvement of 4.1 years) and for women in East Dunbartonshire Community Health Partnership area with 3.8 per cent (an improvement of 3.0 years);

The gap of 8.6 years between the Community Health Partnership area with the highest male life expectancy at birth and the Community Health Partnership area with the lowest has not changed over the 10 year period; for females it has increased by 0.7 years (from 5.8 years in 1996-1998 to 6.5 years in 2006-2008);

The gap between male and female life expectancy narrowed in all but 6 of the Community Health Partnership areas. The largest decrease (2.2 years) was in North Highland (4.0 years in 2006-2008 compared to 6.2 years in 1996-1998).

The full publication, Life Expectancy in Special Areas 2006-2008, is available on this website.