Health Policy in Britain Chapter 4: Financing Health Services and the Rediscovery of Public Health

1. Health Policy in BritainChapter 4: Financing Health Services and the Rediscovery of Public Health Sallie Shipman AHE 560 Comparative Higher Education Nurse Education at the University of York Summer 2012

2. The Growth of NHS Expenditure False Assumption – expenditures on health services would decline when backlog of underserved was eradicated Public expenditures have steadily increased Reality – there is a potentially infinite demand for healthcare services

3. The Growth of NHS Expenditure International comparisons – UK healthcare spending was lower than other counties; however, recent increases have narrowed the spending gap Public/private mix in healthcare spending controversial (expensive cancer drugs) Debates about rationing of health services and denial of treatment to patients

4. The Wanless Review of the Long-Term Funding Needs of NHS • No evidence that tax financing of healthcare should be replaced by social insurance or private funding • UK lagged behind other countries because of low level expenditure on healthcare • Need for • stronger links between health and social care • Greater emphasis on health promotion and disease prevention

5. Raising and Spending Money in the NHS • NHS funding comes from: • Over three-quarters from taxation • Around one-fifth national insurance contributions • Remainder from charges and receipts (i.e., land sales, proceeds of income generation schemes) • 63% acute services, 14% mental health, 12% community health, 4% learning disability, and 3% maternity • Staff salaries and wages largest single item of expenditure

6. Public Health and Health Improvement • Policies in the 1970’s and 1980’s • Prevention and Health (1976)– first significant policy to focus on public health • White paper Prevention and Health (1977)– focused on safety during pregnancy, eating for health and avoiding heart attacks • Black report Inequalities in Health (1980) – Thatcher government not persuaded • Policies to limit spread of HIV/AIDS

7. Public Health and Health Improvement • The 1990’s White Papers • The Health of the Nation and Our Healthier Nation “To improved the health of the population as a whole b increasing length of people’s lives and the number of years people spend free from illness. To improve the health of the worst off in society and to narrow the health gap. (Secretary of State for Health, 1998a, p. 5) • Aims for 2010 • Heart disease and stroke - Reduce death rate by a third; • Accidents - Reduce by at least a fifth; • Cancer - Reduce death rate by at least a fifth; • Mental health - Reduce death rate from suicide and undetermined injury by a further sixth

8. Public Health and Health Improvement • The Wanless Public Health Review and the Smoking Ban • The NHS Plan (2004) – recommended a conceptual framework to forward public health issues • White Paper Choosing Health – key issues were reducing smoking, obesity, and encouraging health behaviors (i.e., exercise, sensible drinking) • The Health Act 2006 – ban on smoking in public places

9. Public Health and Health Improvement • Obesity • Promoting: • Children’s health • Healthier food choices • Building physical activity into daily lives • Supporting health at work • Providing effective treatment and support for overweight and obese people

10. Public Health and Health Improvement • Health Inequalities focuses • Supporting mothers, families, and children • Engaging communities and individuals • Preventing illness and providing effective treatment and care • Addressing the underlying determinates of health

11. What has Been Achieved? Independent analysis five years after the Wanless report– impossible to assess whether the fully engaged aspirations for doubling in public health funding had been met because no official figures on this were kept Solid progress on smoking prevention and actions to increase physical activity Great concern about rising trends in obesity No action on the development of the public health conceptual framework

12. Conclusion NHS budget is shaped by the state of the economy and government decisions on priorities between spending programs Since the Prime Minister’s commitment in 2000 to bring expenditure up to the European Union, spending has grown more rapidly and over a longer period of time Recession in UK and other priorities in government have squeezed public health funding

13. Reference Ham, C. (2009). Health policy in Britain. Houndsmills, Basingstoke, Hampshire: Palgrave Macmillian.