Independent Investigation of the National Health Service in England: Technical Annex

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Table of Contents

• Independent Investigation of the National Health Service in England:Technical Annex 1
• Table of contents 2
• Notes on international comparisons 3
• I. The Health of the Nation 4
• 1. Life expectancy at birth in England 5
• 2. Trends in healthy life expectancy 6
• 3. International comparisons of avoidable mortality – preventable causes 7
• 4. International comparisons of avoidable mortality – treatable causes 8
• 5. Prevalence of long-term conditions by age band 9
• 6. Disease prevalence since 2004 10
• 7. Mental health prevalence is rising for adults and children 11
• 8. Real household income by income quintile 2001-2020 12
• 9. Poverty and deep poverty rates and children living in poverty and deep poverty 13
• 10. Food insecurity in the UK measured by emergency food supply distribution 14
• 11. Housing quality: damp problems by sector, 2019 and 2022 15
• 12. Physical inactivity among adults and children 16
• 13. Children’s use of social media and depression 17
• 14. Number of human diseases with a known genetic basis and genes known to cause human disease 18
• 15. Complexity of needs 19
• 16. Changes in NHS activity over time 20
• 17. Access to local authority supported adult social care 21
• II. Access to NHS services 22
• 1.1 NHS performance against Constitutional Standards 23
• 2.1 Performance of NHS 111: total call volume and split by speed of answer or abandoned 24
• 2.2 NHS 111 call handling 25
• 2.3 NHS app registrations and monthly usage 26
• 2.4 Use of the NHS app 27
• 3.1 Monthly GP appointment volumes 28
• 3.2 Patient reported waiting times for GP appointments 29
• 3.3 Patient-reported GP access and GP satisfaction 30
• 3.4 GP appointments per GP 31
• 3.5 Patients per GP over time 32
• 3.6 Variation in number of patients per GP 33
• 3.7 Association between number of registered patients per fully qualified GP and patient reported satisfaction 34
• 3.8 Waiting times for urgent treatment centres and walk-in centres 35
• 4.1 General dental practices availability to NHS patients 36
• 4.2 Units of Dental Activity 37
• 4.3. Proportion of adults and children registered with an NHS dentist 38
• 4.4 NHS Dentist availability to patients 39
• 5.1 Number of pharmacies in England 40
• 5.2 Walking distance to pharmacies 41
• 5.3 Community pharmacy funding 42
• 6.1 Number of new referrals to mental health services 43
• 6.2 Number of new referrals to mental health services (under 18) 44
• 6.3 Number of new referrals to perinatal mental health services 45
• 6.4 People in contact with mental health services 46
• 6.5 Size of waiting lists for mental health by weeks waiting (all) 47
• 6.6 Size of waiting lists for mental health services by weeks waiting (Under 18) 48
• 6.7 Size of waiting lists for mental health by weeks waiting (18-64) 49
• 6.8 Size of waiting lists for mental health by weeks waiting (65+) 50
• 6.9 Size of waiting lists for mental health by weeks waiting (CORE20 Aged 18+) 51
• 6.10 Patients on waiting lists for adult ADHD assessments and number in 2023 52
• 6.11 Neurodevelopmental conditions (excluding Autism) referrals since 2018 53
• 6.12 Waiting times for autism assessment for adults and children and young people 54
• 6.13 Waiting list for talking therapies 55
• 6.14 Waiting times for autism assessment for children and young people: patients with a first contact 56
• 7.1 Size of community health services waiting list, by weeks waiting (all) 57
• 7.2 Size of community health services waiting list, by weeks waiting (children and young people) 58
• 7.3 Size of community health services waiting list, by weeks waiting (all adults) 59
• 7.4 Size of waiting lists for MSK services by weeks waiting (working age adults) 60
• 8.1 Patient satisfaction with accident and emergency services 61
• 8.2 Ambulance response times by category 62
• 8.3 Demand for emergency care 63
• 8.4 Activity in emergency departments 64
• 8.5 Accident & Emergency attendances by duration of waits 65
• 8.6 All Types Accident & Emergency 4 Hour Performance 66
• 8.7 Proportion of A&E attendances by duration of waits 67
• 8.8 A&E waiting times (infants 0-2 years) 68
• 8.9 A&E waiting times (children 3-17 years) 69
• 8.10 A&E waiting times (adults 18-64 years) 70
• 8.11 A&E waiting times (adults 65 years and older) 71
• 8.12 A&E waiting times (CORE20 and rest of population) 72
• 8.13 A&E waiting times (mental health flag vs rest of population) 73
• 8.14 A&E waiting times – 12+ hour waits 74
• 8.15 Size of waiting lists by weeks waiting (all) 75
• 8.16 Size of waiting list by weeks waiting (children and young people) 76
• 8.17 Size of waiting lists by weeks waiting (working age adults) 77
• 8.18 Size of waiting lists by weeks waiting (older adults) 78
• 8.19 Size of waiting lists by weeks waiting (CORE20) 79
• 8.20 Duration of waiting times for elective activity 80
• 8.21 Elective inpatient spells for CYP and adults 81
• 8.22 Duration of waits for diagnostics 82
• III. Quality of care 83
• 1.1 Adult smoking rates 84
• 1.2 Deaths from alcohol and drug misuse 85
• 1.3. Alcohol-related deaths and affordability of alcohol 86
• 1.4 Obesity and physical inactivity 87
• 1.5 Depression diagnoses, 18+ (QOF) 88
• 1.6 Public Health Grant in real terms per capita 89
• 1.7 People in treatment for substance misuse or alcohol dependence 90
• 1.8 Reductions in public health expenditure by element of provision 91
• 1.9 Uptake of the NHS health check 92
• 1.10 Screening coverage – cancer screening programmes 93
• 1.11 Screening coverage – other adult screening programmes 94
• 1.12 Screening coverage – maternity and newborn screening programmes 95
• 2.1 Rates of onset of labour by induction, spontaneous and caesarean 96
• 2.2 Maternal BMI at first antenatal appointment 97
• 2.3 Maternal and infant mortality 98
• 2.4 Rates of stillbirth, neonatal mortality, preterm birth and serious brain injury occurring during or soon after birth 99
• 2.5. Rates of perineal tears 100
• 2.6 Babies born with low and very low birth weights over time 101
• 2.7 Inequalities in maternity outcomes 102
• 2.8 Inequalities in stillbirth and neonatal mortality rate and preterm birth rate by deprivation and ethnicity 103
• 2.9 Inequalities in maternal mortality rates by ethnicity 104
• 2.10 Deliveries per midwife 105
• 2.11 Maternity services reporting suspension of units, services or admissions in July 2024 106
• 2.12 Numbers of maternity outpatient attendances and number of maternity outpatient attendances per delivery 107
• 2.13 Universal health visiting reviews and breastfeeding prevalence at 6-8 weeks over time 108
• 2.14 Women’s reported perinatal experience 109
• 3.1 Childhood obesity prevalence 110
• 3.2 Childhood obesity prevalence by deprivation decile 111
• 3.3 Physical activity (averaging 60 minutes of activity per day) amongst 5 to 16 year olds 112
• 3.4 Smoking and vaping prevalence among children 113
• 3.5 Proportion of school pupils with education, health and care plans 114
• 3.6 Proportion of school pupils with social, emotional and mental health needs 115
• 3.7 Childhood vaccination coverage 116
• 3.7b Childhood vaccination coverage: CAGR tables 117
• 3.8 Children having 1+ emergency admissions to hospital per 10,000 children by local authority 118
• 3.9 Parents’ satisfaction with paediatric services and young people’s satisfaction with services 119
• 4.1 Referrals for outpatient appointments by source of referral 120
• 4.2 Average number of follow-up outpatient attendances per first attendance 121
• 4.3 Average length of stay by treatment function for elective overnight spells 122
• 4.4 Emergency readmissions to hospital within 30 days of discharge 123
• 4.5 Number of virtual wards beds 124
• 4.6 Impact on referrals of pre-referral specialist advice to GPs 125
• 4.7 Daily volumes of referrals and referrals diverted through use of specialist advice 126
• 4.8 Safety incidents reporting culture performance 127
• 4.9 Rates of harm-free care during NHS Safety Thermometer initiative 128
• 4.10 Number of surgical never events by type 129
• 4.11 Rates of healthcare acquired infections 130
• 4.12 Deaths from blood clot (VTE) related events within 90 days post discharge 131
• 5.1 Proportion of population with anxiety/depression entering NHS talking therapies 132
• 5.2 Recovery rate in NHS Talking Therapies 133
• 5.3 Estimated number of patients prescribed medication for ADHD 134
• 5.4 Restrictive interventions in mental health inpatient settings by age group 135
• 5.5 Numbers of inpatient mental health suicides and rate per occupied bed days  136
• 5.6 Active inappropriate out of area placements 137
• 5.7 Excess mortality in adults with serious mental illness 138
• 6.1 Daily count of Covid-19 patients in hospital 139
• 6.2 Daily count of Covid-19 patients in hospital (2024) 140
• 6.3 Uptake of autumn and spring Covid-19 vaccinations 141
• 6.4 Seasonal flu vaccination uptake (65+ years and <65 at risk) 142
• 6.5 Confirmed cases of measles 143
• 6.6 Laboratory-confirmed cases of Pertussis 144
• 6.7 Total number of newly diagnosed sexually-transmitted infections 145
• 6.8 Prevalence and treatment rates for Hepatitis C 146
• 6.9 Treatments for HCV by index of multiple deprivation decile 147
• 7.1 Prevalence of multiple long-term conditions 148
• 7.2 Care plan coverage for people with long-term conditions 149
• 7.3 Delivery of all 8 care processes for people with diabetes 150
• 7.4 COPD Patients Enrolled To and Completing Pulmonary Rehab 151
• 7.5 COPD Patients Enrolled To and Completing Pulmonary Rehab By IMD 152
• 7.6 Risk reduction for patients enrolled in NHS Diabetes Prevention Programme (DPP) 153
• 8.1 Same Day Emergency Care – Non-elective zero-day length of stay 154
• 8.2 Call-to-balloon time for higher-risk STEMI heart attacks 155
• 8.3 Variation in call-to-balloon times between ICBs 156
• 8.4 Median time from symptom onset to arrival at a stroke unit 157
• 8.5 Regional variation in median time from symptom onset to arrival at a stroke unit 158
• 8.6 Proportion of patients receiving CT or MRI brain scan < 1 hour of hospital arrival for stroke by ICB 159
• 8.7 30-day mortality for stroke survivors 160
• 9.1 Dementia prevalence 161
• 9.2 Mortality rates from dementia 162
• 9.3 Dementia diagnosis rate 163
• 9.4 People with dementia with a care plan produced or reviewed within the last 12 months 164
• 10.1 Proportion of people dying each year by place of death​ 165
• 10.2 International comparisons of people dying in hospital as a proportion of all deaths 166
• 10.3 Age-sex standardised admissions to hospital in the last 12 months of life by deprivation decile 167
• 10.4 Recording of end-of-life preferences on GP systems 168
• 11.1 NHS spend on nationally commissioned (specialised) services 169
• 11.2 Growth in rare and inherited disease genomic testing (Non-WGS and WGS) and associated turnaround times 170
• 11.3 NHS delivery of whole genome sequencing for rare diseases 171
• 11.4 Recommended medicines split by local or specialised commissioning 172
• 12.1 Cancer incidence over time 173
• 12.2 Cancer survival rates (all cancers) 174
• 12.3 Cancer survival rates by cancer site 175
• 12.4 International comparisons of cancer mortality 176
• 12.5 International comparisons of cancer survival 177
• 12.6 Cancer routes to diagnosis over time 178
• 12.7 Cancer routes to diagnosis by deprivation 179
• 12.8 Cancer diagnoses at stage 1 and 2 180
• 12.9 Cancer diagnosis in stage 1 or 2 by tumour type 181
• 12.10 Early diagnosis of lung cancer by indices of multiple deprivation quintile 182
• 12.11 Number of lung cancers diagnosed through the Targeted Lung Health Check (TLHC) Programme 183
• 12.12 Rollout of teledermatology to Urgent Suspected Skin Cancer pathways 184
• 12.13 Faecal immunochemical test (FIT) triage in primary care and low value colonoscopy rates 185
• 12.14 Impact of Faecal immunochemical test (FIT) rollout on Urgent Suspected Cancer lower GI referrals 186
• 12.15 Growth of cancer genomic test activity (including whole genome sequencing) and associated turnaround times 187
• 12.16 Cancer waiting times: 62-day standard – urgent suspected cancer 188
• 12.17 Radiotherapy waiting times 189
• 12.18 Time from approval to adoption for alpelisib & fulvestrant 190
• 12.19 Patient satisfaction with cancer care 191
• 13.1 Mortality rates from all circulatory disease 192
• 13.2 Under 75 mortality rate from circulatory diseases 193
• 13.2b Under 75 mortality rate from circulatory diseases 194
• 13.3 International comparisons of 30-day mortality for AMI 195
• 13.4 Premature (<75 years) deaths from heart disease by deprivation 196
• 13.5 International comparisons of 30-day mortality for stroke 197
• 13.6 Uptake of cardiac rehabilitation among eligible acute coronary syndrome patients 198
• 13.7 Variation in uptake of cardiac rehabilitation among eligible acute coronary syndrome patients across ICBs 199
• 13.8 Proportion of people at high risk of cardiovascular disease treated with lipid lowering therapies 200
• 13.9 Proportion of people with cardiovascular disease treated with lipid lowering therapies 201
• 14.1 International comparison of suicide rates 202
• 14.2 Suicide rate by year, sex, and age group for England  203
• 14.3 Suicide rate amongst adolescents aged 15-19 204
• 14.4 Suicide rate by year, sex, and age group for England  205
• 14.5 Number of suicides by mental health condition 206
• 15.1 International comparison of clinical negligence costs 207
• 15.2 Number of clinical negligence claims by clinical specialty 208
• 15.3 Clinical negligence costs by clinical specialty 209
• 15.4 Clinical negligence costs by damages value 210
• IV. Health and prosperity 211
• 1. Economically inactive people by main reason 212
• 2. Economically inactive people due to long-term sickness, by main reason 213
• 3. Recruitment to clinical research studies 214
• 4. International comparison of proportion of clinical research studies 215
• 5. International comparison of access to medicines 216
• 6. Number of technology appraisals split by recommendation 217
• 7. Technology appraisals split by cancer and non-cancer 218
• 8. Notifications of medicine supply issues and discontinuations 219
• V. Funding, investment and technology 220
• 1.1 Real terms spending on the NHS in England adjusted for population size and demographic profile 221
• 1.2 Real terms revenue expenditure on the NHS in England 222
• 1.3 Total government spending on health per person 223
• 1.4 International comparisons of health expenditure as a percentage of GDP 224
• 1.5 Total NHS surplus/deficit by year excluding central adjustments 225
• 2.1 International comparison of health expenditure per capita 226
• 2.2 International comparison of capital expenditure 227
• 2.3 NHS capital spending split by capital delegated expenditure limit and real outturn 228
• 2.4 NHS capital spending per person 229
• 2.5 Cumulative capital gap versus peers 230
• 2.6 Capital underspends and capital to revenue transfers 231
• 2.7 Capital intensity measured as ratio total capital to total revenue 232
• 2.8 NHS capital spend split by care setting 233
• 2.9 Assets to revenue by acute provider trust 2023/24 234
• 2.10 Assets to revenue by all non-acute trusts 2023/24 235
• 2.11 Age profile of the secondary care estate 236
• 2.12 Age profile of the primary care estate 237
• 2.13 Backlog maintenance by risk category 238
• 2.14 Clinical incidents caused by estates and facilities failures 239
• 2.15 Numbers of NHS beds 240
• 2.16 International comparison of bed numbers 241
• 3.1 International comparison of number of diagnostic scanners 242
• 3.2 NHS capital budget split by setting and by investment type 243
• 3.3 Capital funding for technology & data 244
• 3.4 IT capital investment per clinical FTE by NHS provider type 245
• 3.5 Digital maturity assessment of secondary care providers 246
• VI. The impact of the Covid-19 pandemic 247
• 1. Number of excess deaths in England during the pandemic years 248
• 2. International comparison of excess mortality during the pandemic 249
• 3. International comparison of health system capacity going into the Covid-19 pandemic 250
• 4. Changes in consultation rate by age and physical or mental health long-term condition status during the Covid-19 pandemic 251
• 5. Percentage of patients reporting not having seen a doctor in the last 12 months 252
• 6. Changes in hip and knee replacement surgeries from 2019 to 2020 253
• 7. Changes in cataract surgeries and mastectomy surgeries from 2019 to 2020 254
• 8. Changes in hospital discharges between 2019 and 2020 255
• VII. Staff Engagement 256
• 1. Staff satisfaction 257
• 2. Staff recommending their organisation as a place to work and staff recommending their organisation as a place to receive care 258
• 3. Changes in discretionary effort by role 259
• 4. Changes in average days lost to sickness per FTE pre and post pandemic 260
• 5. Reasons for sickness absence, average number of sick days per month 2019/20 and 2023/24 261
• 6. NHS practitioner health registrations by year 262
• 7. NHS practitioner health proportion of registration diagnosed with anxiety and/or depression 263
• 8. NHS Staff staying in post over the previous 12 months by staff group 264
• 9. NHS Staff with bank contracts 265
• 10. Total numbers of bank and agency shifts over time 266
• 11. Total annual spending on agency staff for acute trusts 267
• VIII. Where and how the money is spent 268
• 1.1 NHS resources by setting 269
• 1.2 Average NHS spend per NHS provider 270
• 1.3 Care integration 271
• 2.1 Overall NHS workforce over time 272
• 2.2 Overall NHS clinical workforce over time 273
• 2.3 Total factor productivity for the NHS in England and the whole UK economy 274
• 2.4 Total factor productivity for the NHS in England 275
• 3.1 International comparison of GPs per 1,000 population 276
• 3.2 Number of full-time equivalent GPs per 100,000 registered patients 277
• 3.3 Drivers of primary care drug spend 278
• 4.1 International comparison of nurses and midwives working outside hospitals 279
• 4.2 Changes in the community services workforce 280
• 4.3 Community nurses in post 281
• 4.4 District nurses in post 282
• 4.5 Change in the numbers of nurses by setting and by region 283
• 5.1 Changes in the mental health workforce 284
• 5.2 Mental health needs vs mental health nurses 285
• 5.3 Changes in mental health nursing staff and learning disabilities staff between 2010 and 2023 286
• 5.4 Overall mental health workforce 287
• 5.5 Mental health nursing workforce 288
• 5.6 Learning disabilities nursing workforce 289
• 5.7 Mental health medical workforce 290
• 5.8 Mental Illness and Learning Disability bed availability 291
• 6.1 International comparison of all healthcare workers employed in hospitals 292
• 6.2 International comparison of doctors, nurses and midwives employed in hospital 293
• 6.3 International comparison of specialist doctors 294
• 6.4 International comparison of nurses and midwives working in hospitals 295
• 6.5 Changes in the hospital workforce 296
• 6.6 Doctors and nurses per G&A available bed 297
• 6.7 Growth in acute hospital workforce 2019/20 – 2023/24 298
• 6.8 Total factor productivity of acute NHS provider trusts 299
• 6.9 Acute productivity gap between 2019/20 and 2023/24 300
• 6.10 Changes in staff per bed and activity per staff member 2001/02 – 2023/24 301
• 6.11 Clinical workforce productivity metrics 302
• 6.12 Size of the queue in A&E departments 303
• 6.13 Working days lost to ambulance handover delays 304
• 6.14 Bed occupancy over time 305
• 6.15 International comparisons of bed occupancy 306
• 6.16 Drivers of secondary care drug spend 307
• 6.17 Reasons for delayed discharges from acute hospitals 308
• 6.18 Delayed discharges over time and equivalent number of NHS beds 309
• IX. NHS Structures and Systems 310
• 1.1 NHS organisations created or existing during time periods 311
• 1.2 Cumulative number of NHS bodies created and abolished 312
• 1.3 Ratio of NHS provider trusts to all other NHS statutory bodies 313
• 1.4 Number of managers and senior managers moving within the NHS and leaving the NHS (turnover) 314
• 2.1 International comparisons of admin costs as a percentage of health spending 315
• 2.2 Managers and senior managers as a proportion of total NHS staff 316
• 2.3 Changes in managers per NHS employee since 2009 317
• 3.1 NHS staff working in NHS Support Organisations and Central Bodies in England 318
• 3.2 Number of NHS staff employed in non-clinical roles 319
• 3.3 Changes in the NHS infrastructure support workforce 320
• 3.4 Clinically qualified staff (FTE) working in NHS Support Organisations and Central Bodies 321
• 3.5 Employment in NHS England and other national entities relating to the NHS 322
• 3.6. National NHS organisations created and abolished since 2010 323
• 3.7 Employment in NHS England and the Department of Health and Social Care 324
• 3.8 The number of staff in NHS statutory bodies with ‘regulatory’ type functions 325
• 3.9 NHS England functions and scale 326
• 4.1 Completeness of datasets 327
• 4.2. NHS Planning, Commissioning and Improvement Data Sharing Agreements 328
• 4.3 NHS Data Sharing for Research 329
• 4.4 Combined surplus/deficit of trusts in England between 2010/11 and 2022/23 330
• 4.5 Numbers of NHS organisations authorised as Foundation Trusts for the first time 331