Anita Charlesworth talks about the state of finances in health and social care for the Nuffield Trust Health Policy Summit.

1. #ntsummit
Health and social care finances now and in the future
Anita Charlesworth, Director of Research and Economics, The
Health Foundation @AnitaCTHF
Chair: Dr Jennifer Dixon CBE, Chief Executive, The Health
Foundation @JenniferTHF

2. Looking ahead
The state of finances in health and social care
Anita Charlesworth, Director of Research and
Economics, the Health Foundation

3. Annual change in NHS spend per head in
England
March
2016
Looking ahead: the state of finances in health and social
care
Source: The Health Foundation, Nuffield Trust and Kings Fund ‘The spending review:
what does it mean for health and social care?’ December 2015

4. Social care spending 2009/10 to 2019/20,
real annual changes
March
2016
Looking ahead: the state of finances in health and social
care

5. Potential funding gap for adult social care in 2019/20, with
likely impact of new minimum wage, based on projections
from the government, OBR and PSSRU
March
2016
Looking ahead: the state of finances in health and social
care
Source: The Health Foundation, Nuffield Trust and Kings Fund
‘The spending review: what does it mean for health and social care?’ December 2015

6. Change in Public Health Allocations –
2015/16 to 2020/21 (2015/16 prices)
March 2016 Looking ahead: the state of finances in health and
social care
-3.8%
-2.2%
£3.47bn
£3.07bn
-5.0%
-4.0%
-3.0%
-2.0%
-1.0%
0.0%
2.8
2.9
3.0
3.1
3.2
3.3
3.4
3.5
2015/16 2016/17 2017/18 2018/19 2019/20 2020/21
Allocation(£bn)
Year-on-year real terms growth Real terms spend

7. Net reported surplus/deficit for NHS providers
between 2012/13 and quarter 3 of 2015/16, £m
(2015/16 prices)
March 2016 Looking ahead: the state of finances in health and
social care

8. NHS QIPP savings 2011-12 to 2014/15
Year Outturn/forecast Saving (£ bn), cash
terms
Saving (£ bn) 2015/16
prices
2011-12 Outturn 5.8 5.9
2012-13 Outturn 5.0 5.1
2013-14 Outturn 4.3 4.4
2014-15 Outturn 1.8 1.8
TOTAL 16.9 17.1
Source: correspondence with NHS England on 04/02/2016
March 2016 Looking ahead: the state of finances in health and
social care

9. Factors associated with financial difficulty
in 2014/15
March 2016 Looking ahead: the state of finances in health and
social care
• A higher proportion of its staff spending is accounted for by
agency staff
• A higher proportion of income is paid through the national PbR
tariff
• Staff at the hospital are less happy for a friend or relative to be
treated there
• The trust received a rating of ‘inadequate’ following an inspection
by the CQC
• Not being a specialist provider
• Providing services from fewer sites
(Sample is 151 acute and specialist trusts, r^2 = 0.4597)

10. Association between 66 hospitals’ financial position and their
CQC risk inspection rating, 2014/15
March
2016
Looking ahead: the state of finances in health and social
care

11. Number of nurses employed in acute, general and
elderly sectors, excluding bank and agency staff
March
2016
Looking ahead: the state of finances in health and social
care

12. Trends in nurse-to-patient ratio,
admissions and length of stay, 2010 to 2015
March
2016
Looking ahead: the state of finances in health and social
care

13. Flow of nurses into and out of the NHS
workforce 2014
March
2016
Looking ahead: the state of finances in health and social
care
Source: National Audit Office analysis of data from Health Education England, the Health and Social care
Information Centre, The King’s Fund and NHS Professionals

14. Qualified nursing and midwifery – leavers
2011/12 to 2014/15
March
2016
Looking ahead: the state of finances in health and social
care
Source: Joint CSR Briefing the Health Fund, Kings Fund and Nuffield Trust

15. Number of training places commissioners for clinical staff,
2004/05 to 2014/15
March
2016
Looking ahead: the state of finances in health and social
care

16. The public-private hourly pay differential
for workers with similar characteristics
March
2016
Looking ahead: the state of finances in health and social
care

17. A comparison of estimates of NHS
efficiency and productivity improvement
March
2016
Looking ahead: the state of finances in health and social
care
Scope Annual
average
change
University of
York, 2016
England, NHS-wide Total Factor Productivity
(TFP) with quality adjusted output, 2004/05-
2011/13
1.4%
ONS, 2015 UK NHS-wide TFP with quality adjusted
output, 1995-2013
0.8%
Deloitte, 2014 English NHS acute hospital efficiency frontier
shift, 2008/09-2012/13
1.2%
The Health
Foundation,
2015
Acute care in English NHS hospitals,
2009/10-2013/14
0.4%
Monitor 2016 English NHS acute hospital trend efficiency
2008/09 -2013/14
1.4%

18. Annual change in hospital productivity
index, 2009/10 to 2014/15
March
2016
Looking ahead: the state of finances in health and social
care

19. Employment status of chief executive of NHS
providers by type as of September 2015
March
2016
Looking ahead: the state of finances in health and social
care