The aim of this evidence scan was to identify lessons from six other international countries (Ireland, Spain, Portugal, Canada, The Netherlands, Denmark), which the NHS can apply in response to the required austerity measures. The authors used case studies from the countries, chosen for specific reasons described further on in the scan, to find the answers to the following:

1. What policies have each of the countries applied in response to the financial pressures?
2. Have these policies saved money and/or improved efficiency in the health system?
3. Has there been an impact on the quality of care with the implementation of these new policies?
4. What can the UK National Health Service learn from these case studies and the research evidence?

Key findings

The context is described, comparing each country’s financial situation in 2006 with 2012, including health expenditure. The findings are summarised in a table, providing the context and main features of the policy changes, for each of the six countries. The main focus of the scan was the supply of care, factoring in the financial contribution/cuts and the actual demand for care. Further on in the report, more information is provided about each country and the responses to the four questions described above.

The authors found that despite country differences and variations in service delivery, there were still similarities in the approaches taken to deal with the financial issues. The key themes are:

1. Changes, including cuts are being made without having impact measurement programmes in place.
2. The financial crisis is both a barrier and an opportunity to health service improvement.
3. More often short-term solutions have been applied rather than long-term change, but they “are unlikely to be sustainable.”
4. Communication and leadership have been key to “successful reform strategies.”
5. The case study evidence is limited in terms of the “impact of austerity measures” on cost and quality.

Measures taken

There is a useful table, which lists the measures taken by the other countries, the impact those measures have had on cost and quality, and their sustainability. The measures are:

1. Changing pay and working conditions
2. Setting priorities and reducing resource allocation
3. Spreading costs
4. Applying different models of care
5. Making changes to how providers are structured, owned, or paid
6. Negotiating costs through public tendering
7. Increased regulation and accountability
8. Making more use of market mechanisms

The final chapter looks at what the NHS can learn from these case studies.

Commentary

This is a very important document for commissioners, clinical commissioning groups, (CCGs), Clinical Support Groups (CSUs), policy-makers, and providers. For policy-makers, it provides details of austerity measures that have been successful in other countries, so NHS decision-makers have a head start on what works and what does not. Obviously, they do need to be adapted to suit the local economic climate, but that is where the expertise of the policy-makers should be applied together with relevant research evidence.

For commissioners, CCGs, CSUs, and providers, this document is useful because it describes in detail, the measures that the NHS might take to curb spending. Commissioners and providers need to read this document and see how these measures might affect your work, and use the information to come up with an action plan to support these measures. It will enable you to be proactive rather than reactive, and will enable you to work more closely with the Government and understand their pressures more effectively.

Link

Evidence scan 22: International responses to austerity (PDF)
J Ellins, S Moore, M Lawrie, O Jackson, D Mann, K Singh, R Dam
The Health Foundation
September 2014