Analysing changes to the flow of public funding within local health and care systems: an adaptation of the System of Health Accounts framework to a local health system in England

Moss, C., Anselmi, L., Morciano, M., Munford, L., Stokes, J. and Sutton, M. (2023) Analysing changes to the flow of public funding within local health and care systems: an adaptation of the System of Health Accounts framework to a local health system in England. Health Policy, 137, 104904. (doi: 10.1016/j.healthpol.2023.104904) (PMID:37717554)

Abstract

Financial flows relating to health care are routinely analysed at national and international level. They have rarely been systematically analysed at local level, despite sub-national variation due to population needs and decisions enacted by local organisations. We illustrate an adaptation of the System of Health Accounts framework to map the flow of public health and care funding within local systems, with an application for Greater Manchester (GM), an area in England which agreed a health and social care devolution deal with the central government in 2016. We analyse how financial flows changed in GM during the four years post-devolution, and whether spending was aligned with local ambitions to move towards prevention of ill-health and integration of health and social care. We find that GM decreased spending on public health by 15%, and increased spending on general practice by 0.1% in real terms. The share of total local expenditure paid to NHS Trusts for general and acute services increased from 70.3% to 71.6%, while that for community services decreased from 11.7% to 10.3%. Results suggest that GM may have experienced challenges in redirecting resources towards their goals. Mapping financial flows at a local level is a useful exercise to examine whether spending is aligned with system goals and highlight areas for further investigation.

• Item Type: Articles
• Additional Information: This research was funded by the National Institute for Health and Care Research Applied Research Collaboration Greater Manchester [NIHR200174]. Laura Anselmi was funded by UKRI-MRC grant MR/S022554/1.
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Stokes, Dr Jonathan
• Authors: Moss, C., Anselmi, L., Morciano, M., Munford, L., Stokes, J., and Sutton, M.
• College/School: College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > MRC/CSO SPHSU
• Journal Name: Health Policy
• Publisher: Elsevier
• ISSN: 0168-8510
• ISSN (Online): 1872-6054
• Published Online: 07 September 2023
• Copyright Holders: Copyright © 2023 The Authors
• First Published: First published in Health Policy 137:104904
• Publisher Policy: Reproduced under a Creative Commons License