I gave her fluids because she was borderline hypotensive and tachycardic. I put her on oxygen because her sats were in the low 90s. Her chief complaint, according to the triage note, was shortness of breath. I recently took care of a patient with squamous cell carcinoma that had metastasized to her heart, lungs, liver, and bones. We are so quick to work-up a chief complaint, categorize, and act, that we forget to ask, “How can I help you today?” I think we would be surprised how many times our own perceived goals misalign with the patients’. We do anyone a disservice if we do not feel their concerns as our own. On p.24, the number of FTEs in 2000 was 874,000, not 849,000 we have added a footnote to explain that the growth in workforce is based on an adjustment arising from a discontinuity in the series.What we often forget is that most people come to the ER because they are scared. On p.22, we stated that output per person grew by 4.1% per year, 4.9% between 2000/01 to 2009/10 and 2.7% thereafter this has been corrected to 3.9% overall, 4.6% between 2000//11 and 2.8% thereafter. In the executive summary (p.4), we incorrectly stated that activity growth had moderated from 4.8% per annum to 2.7% this has been removed. This has been corrected to 6.0% and 1.3% in the current version of the report. With thanks to The Strategy Unit who provided the detailed analysis and modelling of activity in chapter 4 of the report, alongside guidance and comments.Ī framework for understanding health care activityĪn earlier version of this report referred to health spending in England growing by 6.6% per year in the first decade and 1.2% in the second decade of the 20th century. Social care, too, is beyond the scope of this initial report but will be the focus of subsequent analysis by the REAL Centre. We take an in-depth look at emergency and planned hospital care, mental health, community and primary care, but do not look in detail at areas such as high cost drugs or highly specialised services. We then explore what drives the remaining change, unexplained by demography.Īlthough we focus on England, many of the lessons may be relevant to the other countries of the UK. Where possible, we estimate the proportion of any change that can be explained by four demographic factors: population size, age, gender, and proximity to death. We look at the overall trends in activity and how specific services have changed. We describe how supply and demand side factors interact, and how policy can influence the care the NHS provides.
Seeing the bigger picture example drivers#
We provide a framework for understanding the drivers of health care activity. In this, the REAL Centre's first report, we look back at the care and treatment provided by the NHS in England over the past two decades – as measured by health care activity. There is little sign of this policy goal being achieved.Īn understanding of the past helps us to prepare for the future. Across the past two decades, much of the policy narrative was about shifting the focus of care away from acute services towards community and primary care to prevent avoidable admissions and manage care more proactively.This has produced a major shift in the composition of spend towards hospital-based care and away from other areas. While overall health care activity has grown substantially, this growth has not been shared equally between services. Consultations in general practice have grown just 0.7% per year, while planned procedures increased 9.6%.This means that more than three quarters of the growth in NHS care since 2000/01 is the result of other factors relating to demand, supply, political priorities and health care policies.
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