United Kingdom Vol. 17 No. 5 2015 - UK-HiT PDF

Health Systems in Transition
Vol. 17 No. 5 2015
Jonathan Cylus Erica Richardson

Lisa Findley Marcus Longley
Ciaran O' Neill David Steel
Jonathan Cylus and Erica Richardson (Editors) and Ellen Nolte and Ewout van Ginneken
(Series editors) were responsible for this HiT
Editorial Board
Series editors
Reinhard Busse, Berlin University of Technology, Germany
Josep Figueras, European Observatory on Health Systems and Policies
Martin McKee, London School of Hygiene & Tropical Medicine, United Kingdom
Elias Mossialos, London School of Economics and Political Science, United Kingdom
Ellen Nolte, European Observatory on Health Systems and Policies
Ewout van Ginneken, Berlin University of Technology, Germany
Series coordinator
Gabriele Pastorino, European Observatory on Health Systems and Policies
Editorial team
Jonathan Cylus, European Observatory on Health Systems and Policies
Cristina Hernndez-Quevedo, European Observatory on Health Systems and Policies
Marina Karanikolos, European Observatory on Health Systems and Policies
Anna Maresso, European Observatory on Health Systems and Policies
David McDaid, European Observatory on Health Systems and Policies
Sherry Merkur, European Observatory on Health Systems and Policies
Dimitra Panteli, Berlin University of Technology, Germany
Wilm Quentin, Berlin University of Technology, Germany
Bernd Rechel, European Observatory on Health Systems and Policies
Erica Richardson, European Observatory on Health Systems and Policies
Anna Sagan, European Observatory on Health Systems and Policies
Anne Spranger, Berlin University of Technology, Germany
International advisory board
Tit Albreht, Institute of Public Health, Slovenia
Carlos Alvarez-Dardet Daz, University of Alicante, Spain
Rifat Atun, Harvard University, United States
Johan Calltorp, Nordic School of Public Health, Sweden
Armin Fidler, The World Bank
Colleen Flood, University of Toronto, Canada
Pter Gal, Semmelweis University, Hungary
Unto Hkkinen, Centre for Health Economics at Stakes, Finland
William Hsiao, Harvard University, United States
Allan Krasnik, University of Copenhagen, Denmark
Joseph Kutzin, World Health Organization
Soonman Kwon, Seoul National University, Republic of Korea
John Lavis, McMaster University, Canada
Vivien Lin, La Trobe University, Australia
Greg Marchildon, University of Regina, Canada
Alan Maynard, University of York, United Kingdom
Nata Menabde, World Health Organization
Charles Normand, University of Dublin, Ireland
Robin Osborn, The Commonwealth Fund, United States
Dominique Polton, National Health Insurance Fund for Salaried Staff (CNAMTS), France
Sophia Schlette, Federal Statutory Health Insurance Physicians Association, Germany
Igor Sheiman, Higher School of Economics, Russian Federation
Peter C. Smith, Imperial College, United Kingdom
Wynand P.M.M. van de Ven, Erasmus University, The Netherlands
Witold Zatonski, Marie Sklodowska-Curie Memorial Cancer Centre, Poland
Health Systems
in Transition
Jonathan Cylus, European Observatory on Health Systems
and Policies
Er ica Richar dson, European Observatory on Health Systems
and Policies
Lisa Findley, Editorial Consultant
Marcus Longley, Welsh Institute for Health and Social Care,
University of South Wales
Ciar an ONeill, NUI Galway and Queens University Belfast
David Steel, University of Aberdeen, (formerly Chief Executive,
NHS Quality Improvement Scotland)
United Kingdom:
Health System Review
2015
The European Observatory on Health Systems and Policies is a partnership between the
HO Re ional O ice or Europe the overnments o ustria el ium inland reland
orway Slovenia Sweden the nited in dom and the eneto Re ion o taly the European
ommission the orld an
rench ational nion o Health nsurance unds
the ondon School o Economics and Political Science and the ondon School o Hy iene
Tropical edicine The European Observatory has a secretariat in russels and it has
hubs in ondon at SE and SHT and at the Technical niversity o erlin
Keywor ds:
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The views e pressed by authors or editors do not
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Suggested citation:
1 1 12
ol 1
o 5
Contents
Pr eface
Acknowledgements
List of abbr eviations
List of tables and figur es
Abstr act
Executive summar y
1 Intr oduction
v
vii
ix
xiii
xv
xvii
1
Or ganization and gover nance
13
3 Financing
41
4 Physical and human r esour ces
63
5 Pr ovision of ser vices
77
6 Pr incipal health r efor ms
99
7 Assessment of the health system
105
8 Conclusions
113
9 Appendices
115
Preface
Acknowledgements
List of abbreviations
bbreviation
P
ny uali ied Provider

ritish ental ssociation
ritish edical ssociation
PT
est Practice Tari s
ritish Social ttitudes survey

omplementary and lternative edicines
linical ommissionin
roup
ommunity Health ouncil
HP
ommunity Health Partnerships
OP
hronic Obstructive Pulmonary isease
ontinuin Pro essional evelopment
ompetition and
ar ets uthority
are uality ommission

ommissionin
S
or uality and nnovation
ommissionin Support nit

isability d usted i e ears
R
H
HSSPS
octors and entists Remuneration Review ody

epartment o Health
epartment o Health Social Services and Public Sa ety
E T
Electroconvulsive Therapy
EE
European Economic rea
European edicines
EPS
Electronic Prescription Service
European nion
ency
reedom o n ormation
oundation Trust
eneral ental ouncil
P
ross omestic Product

eneral
edical ouncil
bbreviation
S
eneral
edical Services
eneral Practitioner
Ph
eneral Pharmaceutical ouncil
HE T
Health improvement E iciency
HS
Healthcare mprovement Scotland
ccess Treatment
Healthcare nspectorate ales
Healthy i e E pectancy
H R
Her
HR
Healthcare Resource roup
HS
Health and Social are ct 2012
HS
Health and Social are n ormation entre
HT
Health Technolo y ssessment
iT PP
nnovative Technolo y doption Procurement Pro ramme
a estys Revenue and ustoms
ocal ommissionin
roup
ocal Health oard
HR
edicines and Healthcare products Re ulatory
ember o Parliament
ar et orces actor
inimum Practice ncome uarantee
HS
ational Health Service
ency
ational nsurance ontributions

E
ational nstitute or Health and are ormerly linical E cellence
P T
ational Pro ramme or n ormation Technolo y
ational Screenin
S E
ational Service ser E perience
ommittee
OE
Or anisation or Economic o operation and evelopment
O S
O ice or ational Statistics
OOH
Out o hours
OT
Over the ounter
P P
Pay or Per ormance
Picture rchivin and ommunications Systems
Patient dvice and iaison Service
Pa S
Procurement and o istics Service
PbR
Payment by Results
P T
Primary are Trust
Public ividend apital
Private inance nitiative
P S
Personal
PO
Prescription Only
PP
Personal and Public nvolvement
edical Services
edicines
bbreviation
PP E
Public
PPP
Public Private Partnership
Patient nvolvement
PPRS
Pharmaceutical Price Re ulation Scheme
PS
Public Service
PS
Public Services oards
Royal olle e o
E perience
reements
ursin
Re ulation and uality mprovement uthority
RTT
Re erral to Treatment
SH
Strate ic Health uthority
Strate ic nvestment oard
Scottish
Tuberculosis
Trust evelopment uthority

nits o
edicines onsortium
ental ctivity
nited ations
H
oluntary Health nsurance
HO
orld Health Or ani ation
TO
orld Trade Or ani ation

ears o
i e ost
HS
List of tables and figures
Tables
Table 1 1
pa e
Trends in population demo raphic indicators selected years
Table 1 2
acroeconomic indicators selected years
Table 1
ortality and health indicators selected years
Table 1
Healthy years o li e
Table 1 5
Standardi ed death rates selected years
Table 1
orbidity and actors a ectin health status selected years
10
Table 1
aternal child and adolescent health indicators selected years
11
Table 1
Table 1
Trends in health e penditure in the nited in dom 1 5 to 201

ia nostic ima in in the nited in dom 2012
Figures
pa e
11
ap o the nited in dom
21
Overview o the health system
Health e penditure as a share
Total health e penditure as
15
o
P in the
P
HO European Re ion latest available year
HO estimates
Health e penditure in PPP per capita in the

latest available year
Health e penditure rom public sources as a percenta e o total health e penditure

in the HO European Re ion latest available year
i
i
i
HO European Re ion
inancial lows
Hospital beds by type per 100 000 population 200 200 and 201
cute care hospital beds per 100 000 population
vera e len th o stay acute care hospitals only
i
i
Physicians per 100 000 population

5
urses per 100 000 population

Physicians and nurses per 100 000 population
entists per 100 000 population
Pharmacists per 100 000 population
0
1
2
Abstract
Executive summary
Introduction
Organization and governance
Financing
Physical and human resources
Provision of services
Principal health reforms
Assessment of the health system
1.1 Geography and sociodemography
1. Introduction
1. Introduction
ig 1 1
ap o the nited in dom
Source: http www map o u com
able 1 1
Trends in population demo raphic indicators selected years
1
2000
2005
2010
51
51 0
50
50
50
50
50
1 0
1 5
1 0
1 5
1 5
15
15
15
1 0
1 2
1 5
5 1
5 2
5 5
51
51
52
5 1
5 0
irth rate crude

per 1 000 people
12
11 5
12 0
12
12
12
12 2
eath rate crude

per 1 000 people
11
11 2
11 1
10
Population total
5 2
5 0
Population emale
o total
51
51
51
01
Population a ed
01
o total
21 0
Population a ed 5
and above
o total
e dependency
ratio
o wor in
a e population
Population rowth
annual
Population density
people per s m
o land area
rban population
o total
Source:
orld an 2015
2 2
25
2011
2012
201
201
2 15
2 50
21
1.2 Economic context
able 1 2
acroeconomic indicators selected years
1
2000
2005
2010
2011
2012
201
201
10
12
15
2 12
2 0
25 2
2 15
10 0
1 22
1 10
20 5
2 255
2 12
2 52
2 525
P per capita
current S
10 0 2
1 0 5
21 2
2 2
1 051
5 0
P per capita
PPP current
international
21 0
525
5 20
20 2
21
20
P current
S billions
5 5
P PPP current
international
billions
P rowth
annual
05
25
1 0
1 1
52
Ta revenue
o
P
entral overnment
debt total
o
P
ndustry value
added
o
P
riculture value
added
o
P
Services etc value

added
o
P
abour orce total

millions
eneral overnment
inal consumption
e penditure
o
P
22
20
ash surplus de icit

o
P
1 5
2 1
15
1
2 5
Per cent at ris o

poverty or social
e clusion
total
population
20
20
coe icient
O icial e chan e
rate
per S
period avera e
Sources:
orld an 2015
25
25 2
2
25
255
20
20 1
55
25
2 0
20
21 0
20 5
20 1
European ommission 2015
1
0
2
0
20
22
nemployment
total
o total
labour orce
modelled O
estimate
Real interest rate
12
2
0
2 2
22
2 1
02
11
12
05
1.3 Political context
1.4 Health status
able 1
ortality and health indicators selected years
1
i e e pectancy at birth
emale years
male years
orld an 2015
2005
02
12
5
1 1
12
25
11
5
10
2011
2012
201
5
0
2010
ortality rate adult emale

per 1 000 emale adults
Source:
2000
total years
ortality rate adult male

per 1 000 male adults
5
5
0
5 5
12
1
10
55
5
2
10
able 1
Healthy years o li e
2005
200
200
200
200
11
2010
2011
2012
e ales
t birth
ta e 5
55
11
11 1
11
11
10
10
10
5
11
52
11
5
10 5
ales
t birth
ta e 5
2
10
Source: European ommission 2015
50
50
10
50
10
52
11 0
10 5
able 1 5
Standardi ed death rates selected years
ndicators
o
2000
2005
55
2010
unicable diseases
S R in ectious and parasitic diseases

all a es per 100 000
S R tuberculosis all a es per 100 000

onco
50
51
05
05
unicable diseases
S R diseases o circulatory system all a es

per 100 000
S R mali nant neoplasms all a es
per 100 000
21 0
S R disease o enitourinary system

12 52
S R trachea bronchus lun cancer all a es

per 100 000
220
20 1
2
5 1
S R cancer o the cervi uteri all a es

per 100 000
5 1
10
1 0
S R ischaemic heart disease all a es

per 100 000
25 0
S R cerebrovascular diseases all a es

per 100 000
115
1 0
1 0
10
11
0 22
S R mental disorders diseases o nervous

system and sense or ans all a es
per 100 000
211 2
10
S R mali nant neoplasm emale breast

S R diabetes all a es per 100 000
2 02
0
10
01
2
11
2 2
215
25 2
1 21
15
S R diseases o respiratory system all a es

per 100 000
1 15
S R diseases o di estive system all a es

per 100 000
2 5
2 0
12 0
10 02
5 1
110 2
2
5
2
1 0 1
25
5 2
10 1
5
25
2 11
105
21
1 1
E ternal causes
S R transport accidents all a es
per 100 000
S R suicide and sel in licted in ury all a es
per 100 000
S R symptoms si ns and ill de ined
conditions all a es per 100 000
Source:
1
2
1
25
HO Re ional O ice or Europe 2015 Health or ll http data euro who int h adb
5
1
2
2
2 0
10
able 1
orbidity and actors a ectin health status selected years
1
Hospital dischar es all neoplasms

per 100 000
ncidence o cancer per 100 000
05
2000
520
ncidence o trachea bronchus and

lun cancer per 100 000
ncidence o emale breast cancer
per 100 000
ncidence o cervi uteri cancer
per 100 000
111
120
o re ular daily smo ers in the

population a ed 15
Pure alcohol consumption litres

per capita a ed 15
10 0
Source:
HO Re ional O ice or Europe 2015
22
52
2011
2012
52
10 5
11 5
155
0
10 5
15 2
5
20
201
5
0
15
1
2010
01
11
Prevalence o diabetes mellitus
2005
1 02
51
20
10
20
11
able 1
aternal child and adolescent health indicators selected years
1
dolescent ertility rate births
per 1 000 women a ed 151
aternal mortality rate
national estimate per 100 000
live births
ortality rate in ant
per 1 000 live births
ortality rate under5

1 1
orld an 2015
10
10
11
12 0
ortality rate neonatal

Source:
1
5
2000
2
2005
2
11
12
2010
2011
2012
201
25
25
25
25
11
51
52
2
50
201
2015
5
2
25
2
2
2. Organization and governance
2.1 Overview of the health system
2.2 Historical background
NHS ngland
Department of Health
UK Parliament
NI
Pu lic Health
ngland
rms length odies
ig 2 1
Overview o the health system
Monitor
are uality
ommission
eneral
Medical ouncil
Regulators
Regulatory role
Managerial relationship
Financial flows
MHR
entral o ernment
HM reasury
NHS Scotland
NHS ales
Healthcare Inspectorate
ales
Department of Health
Social Ser ices and Pu lic Safety
Northern Irish ssem ly
NHS Northern Ireland
Regulation
uality
Impro ement uthority
Minister for Health and

Social Ser ices
Health and Social are

Directorates
Healthcare Impro ement

Scotland
National ssem ly
for ales
Scottish Parliament
Barnett formula
2.3 Organization
United Kingdom Gover nment
NHS in England
NHS in Scotland
NHS in Wales
Health and Social Car e in Nor ther n Ir eland
National Institute for Health and Car e Excellence (NICE)
Medicines and Healthcar e pr oducts Regulator y Agency (MHRA)
Tr ade unions
Royal colleges
The pr ivate and not-for -pr ofit sector s
2.4 Decentralization and centralization
2.5 Planning
NHS in England
NHS in Scotland
NHS in Wales
Health and Social Car e in Nor ther n Ir eland
2.6 Intersectorality
2.7 Health information management

2.7.1 Information systems
2.7.2 Health technology assessment
2.8 Regulation
2.8.1 Regulation and governance of third party payers
2.8.2 Regulation and governance of providers
England
Scotland
Wales
Nor ther n Ir eland
2.8.3 Regulation and planning of human resources
2.8.4 Regulation and governance of pharmaceuticals
2.8.5 Regulation of medical devices and aids
2.8.6 Regulation of capital investment
2.9 Patient empowerment

2.9.1 Patient information
2.9.2 Patient choice
2.9.3 Patient rights
2.9.4 Complaints procedures
2.9.5 Public participation
2.9.6 Patients and cross-border health care
3. Financing
3.1 Health expenditure
able 1
Trends in health e penditure in the nited in dom 1 5 to 201
ndicators
2000
2005
Total health e penditure THE

ross omestic Product
P
Total e penditure on health capita at
Purchasin Power Parity
per S
vera e annual rowth rate in per capita

e penditure
Private insurance as
2010
2011
1
2 11
1
o PvtHE
2012
201
2
22
00
22
0
2 5
11
20
20 1
1 1
1 1
1 1
1 1
20
1 0
1 0
1 5
51
1 0
15 1
15 2
15
1 1
1 2
1 2
eneral overnment e penditure on health

as o
P
55

cap rate
11
25
00
01
00

cap Purchasin Power Parity
per S
11 0
1 50
2 20
2 0
Private e penditure on health PvtHE as

Out o poc et e penditure as
o THE
Out o poc et e penditure as
o PvtHE
HE as
o THE
10
eneral overnment e penditure

HE as o THE
Source:
HO 201
HO lobal Health E penditure atabase
11 1
2 1
0
2
5
ig 1
Health e penditure as a share
Source:
P in the
HO European Re ion
ig 2
Total health e penditure as
HO estimates
12
France
Germany
EU members before May 2004
10
Sweden
EU
United Kingdom
EU members since May 2004
4
1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
Source:
ig
Health e penditure in PPP per capita in the HO European Re ion
Source:
ig
Health e penditure rom public sources as a percenta e o total health e penditure
in the HO European Re ion latest available year
Source:
3.2 Sources of revenue and financial flows
ig 5
inancial lows
GOVERNMENT
Local health
social care boards
evolved nations
HM Treasury
epartment o Health
National
taxes
NH England
Clinical
commissioning group
Public Health
England
Local Authority
Public health
Community
service
Mental health
Hospital services
Primary care
pecialist
services
Enterprises
Private medical
insurance companies
Private health
care acilities
out-o -poc et payments
Population
PR V TE
Community
pharmacies
ERV E PROV ER
Governmental financing system
Private financing system
Out-of-pocket financing
Transfers within system
3.3 Overview of the statutory financing system

3.3.1 Coverage
3.3.2 Collection
3.3.3 Pooling of funds
England
The Bar nett for mula
Nor ther n Ir eland, Scotland and Wales
3.3.4 Purchasing and purchaserprovider relations
3.4 Out-of-pocket payments
3.4.1 Cost-sharing (user charges)
3.4.2 Direct payments
3.5 Voluntary health insurance
3.6 Other financing
3.7 Payment mechanisms
3.7.1 Paying for health services
Payment by Results (PbR) in England
Pay for Per for mance (P4P) in England
3.7.2 Paying health workers
GPs
Consultants/Specialists
Junior doctor s
Nur ses, midwives and other NHS staff
NHS dentistr y
Phar macists
4. Physical and human resources
4.1 Physical resources

4.1.1 Capital stock and investments
Cur r ent capital stock
Investments
4.1.2 Infrastructure
ig 1
Hospital beds by type per 100 000 population 200 200 and 201
Source:
ig 2
cute care hospital beds per 100 000 population
800
700
600
Germany
500
400
300
EU
France
200
United Kingdom
Sweden
100
Source:
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
ig
vera e len th o stay acute care hospitals only
14
12
10
EU
Germany
United Kingdom
Sweden
France
2013
2011
2012
2010
2009
2008
2007
2006
2005
2004
2003
2001
2002
2000
1999
1998
1997
1996
1995
1994
1993
1991
Source:
1992
1990
4.1.3 Medical equipment
able 1
ia nostic ima in in the nited in dom 2012
er
illion population
E a s per 1 000
R units
T scanners
55
Source: OE
201 OE Health at a lance http www oecdilibrary or dobserver download 11 211ed
Note: E ams outside hospital are not included
4.1.4 Information technology
4.2 Human resources

4.2.1 Health workforce trends
ig
Physicians per 100 000 population
450
400
Sweden
Germany
350

EU
France
300
United Kingdom
250
200
150
100
50
2013
2011
2012
2010
2009
2008
2007
2006
2005
2004
2003
2001
2002
2000
1999
1998
1997
1996
1995
1994
1993
1991
Source:
1992
1990
ig 5
urses per 100 000 population
1400
Germany
1200
1000
800
France
United Kingdom
EU
600
400
200
0
2000
2001
Source:
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
ig
Physicians and nurses per 100 000 population
Source:
ig
entists per 100 000 population
100
90
Sweden
Germany
80

EU
France
70
60

United Kingdom
50
40
30
20
10
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2001
2002
2000
1999
1998
1997
1996
1995
1994
1993
1991
Source:
1992
1990
ig
Pharmacists per 100 000 population
120
France
100

EU
United Kingdom
Sweden
80

Germany
60
40
4.2.2 Professional mobility of health workers
2013
2011
2012
2010
2009
2008
2007
2006
2005
2004
2003
2001
2002
2000
1999
1998
1997
1996
1995
1994
1993
1991
Source:
1992
1990
20
4.2.3 Training and career paths of health workers
Physicians
Dentists
Nur ses and midwives
Phar macists
5. Provision of services
5.1 Public health
5.2 Patient pathways
5.3 Primary/ambulatory care
5.4 Specialized ambulatory care/inpatient care
5.5 Emergency care
5.6 Pharmaceutical care
5.7 Rehabilitation/intermediate care
5.8 Long-term care
5.9 Services for informal carers
5.10 Palliative care
5.11 Mental health care
5.12 Dental care
5.13 Complementary and alternative medicine
6. Principal health reforms
6.1 Analysis of recent reforms
England
Nor ther n Ir eland
Scotland
Wales
6.2 Future developments

England
Nor ther n Ir eland
Scotland
Wales
7. Assessment of the health system
7.1 Stated objectives of the health system
7.2 Financial protection and equity in financing

7.2.1 Financial protection
7.2.2 Equity in financing
7.3 User experience and equity of access to health care

7.3.1 User experience
7.3.2 Equity of access to health care
7.4 Health outcomes, health service outcomes and

quality of care
7.4.1 Population health
7.4.2 Health service outcomes and quality of care
7.5 Health system efficiency

7.5.1 Allocative efficiency
7.5.2 Technical efficiency
7.6 Transparency and accountability
8. Conclusions
9. Appendices
9.1 References
Workforce planning in the NHS
Public payment and private provision:

The changing landscape of healthcare in the 2000s
Best practice tariffs and their impact
Accident and Emergency Statistics

Social care cap to be set at 75,000
Edwin Poots: Prescription charges could buy cancer drugs
Scotland Decides
The four health
systems of the United Kingdom: how do they compare
Four hundred-plus deprived area GP practices face MPIG withdrawal
General Practitioners Committee: MPIG Changes
Pay for doctors
BMA Annual Report Financial Statements for the year ended 31 December
2014
). EWTD for junior doctors
Out-of-hours care
Personal Medical Services (PMS) Agreements
. Health Systems
in Transition
Delayed discharges in England reach record high
The Mortality Effects of

Long-Term Exposure to Particulate Air Pollution in the United Kingdom.
BMJ
Mirror, Mirror On The Wall: How the
Performance of the U.S. Health Care System Compares Internationally
Code of Conduct for Payment by Results in 201314
Government agrees breakthrough drug pricing deal with

pharmaceutical firms
The Mandate explained
Hard Truths: The Journey to Putting Patients First
NHS buildings: obstacle or opportunity
Whats behind the drop in A&E performance
Health inequalities in the EU Final report of a consortium
Eurostat Database
Integrated care in Northern Ireland,
Scotland and Wales: Lessons for England
The NHS under the coalition government. Part one: NHS reform
Integrated Care Partnerships
The Barnett Formula
Pulse
An alternative guide to the new NHS in England.
The New NHS
Medical workforce
The Francis Inquiry report.

Making best use of the Better Care Fund
The UK private health market
). Whats going on in A&E? The key questions answered

News
Letter
Public Money and Management

The Better Care Fund: do the sums add up?
The NHS payment system: evolving policy and

emerging evidence.
The Lancet
Financial failure in the NHS: What causes it and how
best to manage it.
Pay Modernisation: A New Contract for NHS Consultants in

England
The National Programme for IT in the NHS: an update on the
deliver y of detailed care records systems
The financial sustainability of NHS bodies
Palliative Care Explained

The Operating Framework for the NHS in England 2012/13
Complaints about the NHS up by 8%.
How much will I pay for NHS dental treatment

Patient choice of GP practices
Key statistics on the NHS
Quality and outcomes framework
NHS England Business Case Approvals Process for Capital

Investment, Property, Equipment and ICT
Transforming Participation in Health and Care
Transforming Participation in Health and Care, Guidance for

Commissioners
Commissioning for Quality and Innovation (CQUIN):
2014/15 guidance. London, NHS England
NHS England publishes outcomes of GP Personal Medical Services
review. London, NHS England
Technical Guide to the formulae for 201415 and 201516 revenue
allocations to Clinical Commissioning Groups and Area Teams
Understanding the new NHS.
NHS standard contract

Working in the NHS
The Healthcare Quality Strategy for NHS Scotland
Public and Patient Involvement and Experience in NHS Wales
Pharmaceutical spending. London, Organisation for Economic Co-operation

and Development
Health at a Glance 2013: OECD indicators
Health at a glance: Europe 2014.
Health at a glance 2015: OECD indicators
. Health Systems in Transition,

Table 2 2011 Census: Usual resident population and population density, local
authorities in the United Kingdom
Internet Access Households and Individuals, 2014.
Mortality in the United Kingdom, 19832013

Public Sector Employment, Q2 2014
Trend in life expectancy at birth and at age 65 by socioeconomic position based

on the National Statistics Socio-economic Classification, England and Wales,
19821986 to 20072011
). Personal and Public Involvement (PPI).
Tuberculosis (TB) in the UK: annual report
Bulletin of the World Health Organization

BMJ
The 2022 GP Compendium of Evidence
About the Act
Patient Focus and Public Involvement
Waiting times in NHS at worst for six years
The Telegraph
Tory MP Redwood leads calls for English Parliament
Health Systems
in Transition
The Lancet
The future of devolution in Wales
New system for emergency ambulance services to prioritise

patients in most need of care.
European Health for All database
The Telegraph
World Development Indicators Online (WDI) database
9.2 Useful web sites

Agenda for Change: http://www nhsemployer s or g/
your -workfor ce/pay-and-r ewar d/pay/agenda-for -change-pay/
how-agenda-for -change-works
Br itish Medical Association: http://bma or g uk/
Gener al Medical Council: http://www gmc-uk or g/about/UK_health_
and_social_car e_r egulator s asp
Healthcar e Impr ovement Scotland:
http://www healthcar eimpr ovementscotland or g/about_us aspx
HSCIC: http://www hscic gov uk/suppor tandguidance
Independent Community Phar macist:
http://www independentphar macist co uk/aboutus cfm
Integr ated Car e and Suppor t Exchange:
http://www icase or g uk/pg/dashboar d
MATCH: http://www match ac uk/
MHR A: https://www gov uk/gover nment/or ganisations/

medicines-and-healthcar e-pr oducts-r egulator y-agency/about
NHS Choices: http://www nhs uk/Pages/HomePage aspx
NHS Dir ect Wales: http://www nhsdir ect wales nhs uk/
NICE: http://www nice or g uk/
NI Dir ect: http://www nidir ect gov uk/
NIHR: http://www nihr ac uk/
Office for National Statistics: http://www ons gov uk/ons/index html
Pr ivate Healthcar e UK:
http://www pr ivatehealth co uk/health-insur ance/
RQIA: http://www rqia or g uk/home/index cfm
The Scottish Char ter of Patient Rights and Responsibilities:
http://www gov scot/Resour ce/0039/00390989 pdf
SHOW Scotland: http://www show scot nhs uk/
Spine Ser vices: http://systems hscic gov uk/spine
Univer sal Cr edit: http://www nhs uk/NHSEngland/Healthcosts/Pages/
univer sal-cr edit aspx
9.3 HiT methodology and production process
9.4 The review process
9.5 About the authors

Jonathan Cylus
Er ica Richar dson
Lisa Findley
Mar cus Longley
Ciar an ONeill
David Steel
The Health Systems in Transition profiles

A series of the European Observatory on Health Systems
and Policies
How to obtain a HiT
Eurohealth
info@obs eur o who int
www.healthobservatory.eu
HiT country profiles published to date:

Albania (1999, 2002a )
Republic of Kor ea (2009)
Andor r a (2004)
Republic of Moldova (2002 , 2008 , 2012)
Ar menia (2001 , 2006, 2013)
Romania (2000 , 2008)
Austr alia (2002, 2006)
Russian Feder ation (2003 , 2011 )
Austr ia
(2001e,
2006e,
2013)
Slovakia (2000, 2004, 2011)
Azer baijan (2004 , 2010 )
Slovenia (2002, 2009)
Belar us (2008 , 2013)
Spain (2000h, 2006, 2010)
Belgium (2000, 2007, 2010)
Sweden (2001, 2005, 2012)
Bosnia and Her zegovina (2002 )
Switzer land (2000, 2015)
Bulgar ia (1999, 2003b, 2007 , 2012b)
Tajikistan (2000, 2010 l)
Canada (2005,
2013c)
Cr oatia (1999, 2006, 2014)
The for mer Yugoslav Republic of

Macedonia (2000, 2006)
Cypr us (2004, 2012)
Tur key (2002 i, 2011)
Czech Republic (2000, 2005 , 2009, 2015)
Tur kmenistan (2000)
Denmar k (2001, 2007 , 2012)
Ukr aine (2004 , 2010 , 2015)
Estonia (2000, 2004 , 2008, 2013)
United Kingdom of Gr eat Br itain and

Nor ther n Ir eland (1999 )
Finland (2002, 2008)

Fr ance (2004c , 2010, 2015)
Geor gia (2002d , 2009)
Ger many (2000e, 2004e , 2014e)
Gr eece (2010)
Hungar y (1999, 2004, 2011)
Iceland (2003, 2014)
Ir eland (2009)
United Kingdom (England) (2011)

United Kingdom (Nor ther n Ir eland) (2012)
United Kingdom (Scotland) (2012)
United Kingdom (Wales) (2012)
United States of Amer ica (2013)
Uzbekistan (2001 , 2007 , 2014)
Veneto Region, Italy (2012)
Isr ael (2003, 2009)

Italy (2001, 2009)
J apan (2009)
ll HiTs are available in En lish

hen noted they are also available in other lan ua es
Kazakhstan (1999 , 2007 , 2012 )
Kyr gyzstan (2000 , 2005 , 2011 )
lbanian
ul arian
Latvia (2001, 2008, 2012)
rench
Lithuania (2000, 2013)
eor ian
Luxembour g (1999)
erman
Malta (1999, 2014)

Mongolia (2007)
Romanian
Russian
Nether lands (2004 , 2010)
h Spanish
New Zealand (2001)
i Tur ish
Nor way (2000, 2006, 2013)

Poland (1999, 2005 , 2012)
Por tugal (1999, 2004, 2007, 2011)
Estonian
Polish
l Ta i
ISSN 1817-6127
HiTs are in-depth profiles of health systems and policies, produced using a standardized approach that allows comparison across countries. They provide facts, figures and analysis and
highlight reform initiatives in progress.
The European Observatory on Health Systems and Policies is a partnership, hosted by the WHO Regional Office for Europe, which includes the Governments of Austria, Belgium,
Finland, Ireland, Norway, Slovenia, Sweden, the United Kingdom and the Veneto Region of Italy; the European Commission; the World Bank; UNCAM (French National Union of Health
Insurance Funds); the London School of Economics and Political Science; and the London School of Hygiene & Tropical Medicine. The European Observatory has a secretariat in Brussels
and it has hubs in London (at LSEand LSHTM) and at the Technical University of Berlin.

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Health Systems in Transition

Vol. 17 No. 5 2015

Jonathan Cylus Erica Richardson

World Health Organization 2015 (acting as the host

The desi nations employed and the presentation o the

Or ganization and gover nance

4 Physical and human r esour ces

5 Pr ovision of ser vices

6 Pr incipal health r efor ms

7 Assessment of the health system

ny uali ied Provider

est Practice Tari s

ritish Social ttitudes survey

ommunity Health ouncil

ommunity Health Partnerships

hronic Obstructive Pulmonary isease

ontinuin Pro essional evelopment

are uality ommission

or uality and nnovation

ommissionin Support nit

octors and entists Remuneration Review ody

European Economic rea

Electronic Prescription Service

ross omestic Product

eneral Pharmaceutical ouncil

Health improvement E iciency

Healthcare mprovement Scotland

Healthcare nspectorate ales

Healthcare Resource roup

Health and Social are ct 2012

Health and Social are n ormation entre

Health Technolo y ssessment

nnovative Technolo y doption Procurement Pro ramme

a estys Revenue and ustoms

ocal Health oard

edicines and Healthcare products Re ulatory

inimum Practice ncome uarantee

ational Health Service

ational nsurance ontributions

ational nstitute or Health and are ormerly linical E cellence

ational Pro ramme or n ormation Technolo y

ational Service ser E perience

Or anisation or Economic o operation and evelopment

O ice or ational Statistics

Over the ounter

Pay or Per ormance

Picture rchivin and ommunications Systems

Patient dvice and iaison Service

Procurement and o istics Service

Primary are Trust

Public ividend apital

Private inance nitiative

Personal and Public nvolvement

Public Private Partnership

Pharmaceutical Price Re ulation Scheme

Public Services oards

Re ulation and uality mprovement uthority

Strate ic Health uthority

Strate ic nvestment oard

Trust evelopment uthority

oluntary Health nsurance

orld Health Or ani ation