The Record of the NHS

It is recognised internationally that the National Health Service "is a remarkably cost-effective institution" [11]. It achieves health outcomes comparable to those achieved in other countries with similar or higher incomes and at a cost, in terms of share of national income, that is significantly lower than in most such countries.

The charts in this Appendix depict graphically this record of achievement and show how far the NHS has come during the last 50 years; a reflection of the skill and dedication of all its staff and of the resources which successive Governments have devoted to it. As a result the NHS has retained the allegiance of the population to an extent matched by very few other national health services; only about 12% of the population have some form of private health insurance compared with a third of the population in Australia, 40% in New Zealand and over 60% in Canada.

The NHS has played a major role in improving the health of the population. Since the NHS was founded, life expectancy has increased by 7.6 years for men and 7.8 years for women, or roughly one and a half years a decade. Over the same period, infant mortality rates have fallen by more than 80% (from 40 per 1,000 live births to 6 per 1,000).

These trends are broadly comparable with those in other West European countries. In terms of life expectancy and infant mortality rates the health of our population is similar to that of other countries in the European Union (Chart 1, Chart 2, Chart 3).

The general improvement in life expectancy has been accompanied by a major reduction in the inequality in the age at which people die. Forty years ago a third of annual deaths occurred before the age of 65. Today the proportion is one-sixth (Chart 4).

The NHS has contributed to major changes in the incidence of particular diseases since 1940. Chart 5 shows the relationship between the uptake of immunisation against measles, and the number of notifications of the disease.

The most criticised aspect of the NHS over the last 40 years has been the length of waiting times. Recent years have seen a dramatic fall in the number of people waiting for more than one year for elective admission (Chart 6). This decline can be attributed to better management, the hard work of staff and a large growth in hospital activity.

The total number of hospital admissions, including day cases, has increased threefold since 1949. Adjusting for the increase in population, hospital admission rates per 1,000 population have more than doubled since 1970. The increase in treatment rates has benefited all age groups but has been particularly pronounced for older people (Chart 7). For example, for people aged 85 and over, the last 25 years have seen an increase in hospital admission rates from 250 per 1,000 to over 500 per 1,000.

The increase in hospital in-patient activity reflects a huge growth in elective surgery and a very substantial increase in emergency admissions (Chart 8). Elective surgery has more than doubled over the last 14 years.

The growth in hospital in-patient activity has been accompanied by an even more dramatic decline in the length of hospital stays for in-patients. Excluding day cases, average lengths of stay have fallen by almost 60% since 1970 (Chart 9). In consequence, the total number of hospital beds has been falling for 30 years.

There have been equally dramatic shifts in service provision. For example, the last ten years have seen a major shift in residential services for people with a mental illness, away from the large asylums to a much more varied spectrum of community services, including group homes, 24 hour nursed NHS accommodation and residential care homes (Chart 10).

The increase in hospital and community health service activity has been paralleled by the growth in primary care services. For example:

• The number of GP consultations has risen by nearly 40% since 1971 (Chart 11).

• The number of prescriptions has nearly doubled since 1970, with a particularly rapid increase over the last ten years (Chart 12).

• The number of adult dental treatments has roughly doubled over a similar period (Chart 13).

The increases in primary care services have been made possible by major increases in professional staff. The number of GPs has risen by 40% over the last 25 years (Chart 14). The number of practice nurses has increased much more rapidly over the last 15 years (Chart 15).

Underpinning the growth in health service activity has been a steady increase in expenditure on the NHS. For example, over the last 20 years, expenditure has risen faster than total national income (Chart 16). Over the same period the share of NHS expenditure in GDP has risen from 4.8% to 5.8%.

The growth of services is also a reflection of improvements in efficiency and a tribute to the increased productivity of NHS staff. Over the last 20 years, labour productivity across the hospital and community health service as a whole has risen by over 40%, broadly in line with trends in labour productivity across the whole economy (Chart 17).