“Almost two thirds of the total health budget is now spent on treating patients with chronic conditions.” The Times, 25 May 2011
“Already three quarters of the health and care budget goes on long term chronic conditions – and the pressure is going to get bigger.” David Cameron, 16 May 2011
The pressure that an ageing population will bring to bear on the NHS was used last week by the Prime Minister to make the case for reforming healthcare in the UK.
Mr Cameron stated that as much as 75 per cent of health budgets are spent on the long-term care of chronic conditions.
The figure resurfaced in this morning papers in a slightly altered state; according to The Times two thirds of NHS spending was directed at treating chronic conditions.
So where do these figures come from, and why is there a difference between them?
According to the Department of Health’s website “the treatment and care of those with long term conditions accounts for 70 percent of the primary and acute care budget in England.” When we got in touch for the source of this estimate, we were pointed towards the Department’s own research in its ‘Improving the health and well-being of people with long-term conditions‘ release.
The paper also notes that “total long-term care expenditure is forecast to rise by 29% to £26.4 billion” by 2022. Working backwards, this would place the current expenditure on long-term chronic conditions at around £20.5 billion.
This clearly isn’t 70 per cent of the total NHS budget, which at the time of last year’s Spending Review was set at £103.8 billion for the 2010/11 financial year. So what does it refer to?
Looking at the funding allocations detailed by the Department of Health, we can see that large chunks of the NHS budget are spent on services that are difficult to pin on one particular group of users, such as nursing staff and research. In making its analysis, the Department of Health therefore seems to have limited itself to more specific areas of expenditure, such as residential care and drug costs.
Without being privy to the exact terms of reference being used by the Department, we cannot know what figure it has proposed for the total “primary and acute care budget” from which it has drawn the 70 per cent figure. We therefore have to take the Department at its word that the 70 per cent figure is a fair one.
But on this basis, the figure does seem to have a solid foundation. While Mr Cameron seems to have rounded this up to reach his three quarters, The Times seems to have been more conservative in rounding it down to two thirds.
However the £20.5 billion the Department says it is currently spending on the care of those with chronic conditions may only represent approximately one fifth of the total sum given to the Department of Health, and it is important to clarify that the 70 per cent figure refers to some specific areas of expenditure carried out by the NHS. By referring to the “health and care budget” rather than the “total health budget”, the Prime Minister seems to have done this better than the Times.
UPDATE: The Department of Health have provided us with some further details on how they arrived at their figures. As we suggested, the calculation seems to have been limited to those areas of expenditure to which finance data could be explicitly linked to patients. As a spokesperson explained to us:
“The methodology was to split spend on health and social care up based upon services where we get both activity and finance data, so GP practices, dentistry, pharmacy, community services, A&E, ambulances, outpatient care, inpatient care. Survey data was used on activity in each of these sectors as a proxy for dividing up the finance data between people with no LTC/ one LTC/ two LTCs/ 3+ LTCs. We then aggregated the estimates of spend by service/number of LTCs to give the total spend by number of conditions.”