Author: Christopher Mackie
Date: 20/01/2010
Organisation: The Scotsman
Extract:
Scotland has suffered the highest levels of poor health in the UK in the years since devolution despite seeing the greatest level of National Health Service spending, a new report has revealed.
The Nuffield Trust found Scotland spent the most per head on health, as well as having the highest number of hospital doctors, GPs and nurses per person in the United Kingdom.
But it also found the health of Scots was worse than elsewhere in the UK and the productivity of Scotland's doctors and nurses the lowest of the four NHS divisions.
The report, which analysed performance before and after devolution, with the latest figures from 2006-7, said: "In 2006, Scotland had the highest levels of poor health, the highest rates of expenditure, the highest rates of hospital doctors, GPs and nurses, and yet the lowest rates of inpatient admissions and crude productivity for hospital doctors and nurses."
The trust found Scotland "appears to perform less well than anywhere else on almost every measure examined" and noted "striking and puzzling" differences between the NHS in Scotland and its adjacent NHS region in the north-east of England, despite them being of similar size and with similar characteristics.
The report says that in 2006 – the last available set of figures to the researchers on the launch of their study – expenditure per 100,000 people in Scotland was £180 million.
That paid for 250 hospital doctors, 1,100 nurses, 730 non-clinical staff and 81 GPs performing 89,300 outpatient appointments, 7,600 day cases, and 13,500 inpatient admissions.
In the English region, meanwhile, expenditure of £170m paid for 180 hospital doctors, 740 nurses, 420 non-clinical staff and 71 GPs performing 105,000 outpatient attendances, 10,500 day cases and 20,700 inpatient admissions.
In a study of the productivity of staff, the authors found a hospital doctor in Scotland cared for 357 outpatients, 30 day cases and 54 inpatients. Their equivalent in the north-east saw 584 outpatients, 58 day cases and 115 inpatients. A nurse in Scotland cared for 70 outpatients, seven day cases and 12 inpatients but their English counterparts saw 142 outpatients, 14 day cases and 27 inpatients.
According to the report, the findings raised "troubling features" about governance and accountability following devolution, including the fact that, despite the UK taxpayer funding health services across the UK, only the English health boards were held to account by the Treasury.
A Scottish Government spokeswoman said there had been "significant improvements" since 2006-7 in areas such as cancer treatment, and waiting times for in and out patients.
She also claimed the measure of doctor productivity failed to take into account the complexity or severity of cases before treatment, nor the quality of outcomes.
"These measures also only cover a narrow range of hospital procedures and do not reflect the shift in the balance of care from the acute sector into the community in Scotland," she said.
"Even with a significantly more peripheral and sparse population than the rest of the UK – which affects the numbers of medical staff and facilities needed – the latest information shows £1,986 was spent per person in Scotland in 2008-9, less than in London and marginally less than the north-east of England."
Dr Hamish Meldrum, chairman of council at the British Medical Association, said: "Measuring the performance of any health system, and achieving meaningful comparisons with others, is always difficult.
"While 'productivity' is important, it is by no means the only measure of how well the NHS is performing."
Labour's health spokeswoman Jackie Baillie added: "Scotland has the unenviable record of having some of the highest levels of poor health across the UK. It is therefore not surprising that we spend more to address the consequences of that poor health."
View article on The Scotsman website
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