Productivity growth in the English National Health Service from 1998/1999 to 2013/2014

Productivity growth is a key measure against which National Health Service (NHS) achievements are judged. We measure NHS productivity growth as a set of paired year-on-year comparisons from 1998/1999–1999/2000 through 2012/2013– 2013/2014, which are converted into a chained index that summarises productivity growth over the entire period. Our measure is as comprehensive as data permit and accounts for the multitude of diverse outputs and inputs involved in the production process and for regular revisions to the data used to quantify outputs and inputs. Over the full-time period, NHS output increased by 88:96% and inputs by 81:58%, delivering overall total factor productivity growth of 4:07%. Productivity growth was negative during the first two terms of Blair’s government, with average yearly growth rate of 1:01% per annum (pa) during the first term (to 2000/2001) and 1:49% pa during the second term (2000/2001– 2004/2005). Productivity growth was positive under Blair’s third term (2004/2005–2007/2008) at 1:41% pa and under the Brown government (2007/2008–2010/2011), averaging 1:13% pa. Productivity growth remained positive under the Coalition (2010/2011–2013/2014), averaging 1:56% pa

Spatial analysis of urban material stock with clustering algorithms: A Northern European case study

A large share of construction material stock (MS) accumulates in urban built environments. To attain a more sustainable use of resources, knowledge about the spatial distribution of urban MS is needed. In this article, an innovative spatial analysis approach to urbanMS is proposed. Within this scope, MSindicators are defined at neighborhood level and clusteredwith k-mean algorithms. The MS is estimated bottom-up with (a) material-intensity coefficients and (b) spatial data for three built environment components: buildings, road transportation, and pipes, using sevenmaterial categories. The city of Gothenburg, Sweden is used as a case study. Moreover, being the first case study in Northern Europe, the results are explored through various aspects (material composition, age distribution, material density), and, finally, contrasted on a per capita basis with other studies worldwide. The stock is estimated at circa 84 million metric tons. Buildings account for 73% of the stock, road transport 26%, and pipes 1%. Mineral-binding materials take the largest share of the stock, followed by aggregates, brick, asphalt, steel, and wood. Per capita, the MS is estimated at 153 metric tons; 62 metric tons are residential, which, in an international context, is a medium estimate. Denser neighborhoodswith a mix of nonresidential and residential buildings have a lower proportion of MS in roads and pipes than low-density single-family residential neighborhoods. Furthermore, single-family residential neighborhoods cluster in mixed-age classes and show the largest content of wood. Multifamily buildings cluster in three distinct age classes, and each represent a specific material composition of brick, mineral binding, and steel. Future work should focus on megacities and contrasting multiple urban areas and, methodologically, should concentrate on algorithms,MS indicators, and spatial divisions of urban stock

Regional variation in the productivity of the English national health service

Variation in the provision of health care has long been a policy concern. We adapt the framework for productivity measurement used in the National Accounts, making it applicable for sub-national comparisons using cross-sectional data. We assess the productivity of the National Health Service (NHS) across regions of England, termed Strategic Health Authorities (SHAs). Productivity is calculated by comparing the total amount of healthcare output to total inputs for each region, standardised to the national average. Healthcare output comprises 6500 different categories, capturing the number and type of NHS patients treated and the quality of care received. Healthcare inputs include NHS and agency staff, supplies, equipment and capital. We find that productivity varies from 5% above to 6% below the national average. Productivity is highest in South West SHA and lowest in East Midlands, South Central and Yorkshire and The Humber SHAs. We estimate that if all regions were as productive as the most productive region in England, the NHS could treat the same number of patients with £3.2bn fewer resources each year. The methods developed lend themselves to investigate variations in productivity in other types of healthcare organisations and health systems

Food beyond the City – Analysing Foodsheds and Self-Sufficiency under different Food System Scenarios in European Metropolitan Regions

The debate on urban resilience and metabolism has directed increasing attention to the ecological footprint of food consumption, self-sufficiency as a means of food security, and regionalisation of food systems for shortening supply chains. Recently, metropolitan regions have proposed food policies that aim to foster local food systems connected to their cities. Our research thus focused on the relationship between urban food demand and metropolitan land use.We have developed the Metropolitan Foodshed and Self-sufficiency Scenario (MFSS) model, which combines regional food consumption and agricultural production parameters in a data-driven approach to assess the spatial extent of foodsheds as well as the theoretical self-sufficiency of the communities they serve. The model differentiates between food groups, food production systems, levels of food loss and waste as well as food origin. With regard to future urban growth, we applied the model to current and future population projections.Results show substantial variations in the spatial extent of metropolitan foodsheds and self-sufficiency levels between the case study regions London, Berlin, Milan and Rotterdam, depending on population density and distribution, geographical factors and proximity to neighbouring urban agglomerations. The application of the model as a food planning tool offers a new perspective on the potential role of metropolitan regions for strengthening urban self-sufficiency. It also enables the ex-ante assessment of spatial consequences of changes within metropolitan food systems, on both demand and supply sides. In particular, we discuss possible dietary and consumption changes, but also production and supply chain alternatives.</p

Growth in Environmental Footprints and Environmental Impacts Embodied in Trade: Resource Efficiency Indicators from EXIOBASE3

Most countries show a relative decoupling of economic growth from domestic resource use, implying increased resource efficiency. However, international trade facilitates the exchange of products between regions with disparate resource productivity. Hence, for an understanding of resource efficiency from a consumption perspective that takes into account the impacts in the upstream supply chains, there is a need to assess the environmental pressures embodied in trade. We use EXIOBASE3, a new multiregional input-output database, to examine the rate of increase in resource efficiency, and investigate the ways in which international trade contributes to the displacement of pressures on the environment from the consumption of a population. We look at the environmental pressures of energy use, greenhouse gas (GHG) emissions, material use, water use, and land use. Material use stands out as the only indicator growing in both absolute and relative terms to population and gross domestic product (GDP), while land use is the only indicator showing absolute decoupling from both references. Energy, GHG, and water use show relative decoupling. As a percentage of total global environmental pressure, we calculate the net impact displaced through trade rising from 23% to 32% for material use (1995¿2011), 23% to 26% for water use, 20% to 29% for energy use, 20% to 26% for land use, and 19% to 24% for GHG emissions. The results show a substantial disparity between trade-related impacts for Organization for Economic Cooperation and Development (OECD) and non-OECD countries. At the product group level, we observe the most rapid growth in environmental footprints in clothing and footwear. The analysis points to implications for future policies aiming to achieve environmental targets, while fully considering potential displacement effects through international trade

Unknown is unloved? Diversity and inter-population trust in Europe

With more than 400,000 trust evaluations, we examine inter-population trust in the European Union. We focus on social capital theory explanations in a context where European inhabitants from 20 countries rate trust in the populations of 27 other European countries and in their own national population. We emphasize the role of ethnic heterogeneity, but we extend the research by studying the importance of the presence of specific European migrants in a country for trusting this population as a whole. Moreover, we consider the relation with the citizen’s country and characteristics of the trusted populations’ country. We use the European Election Studies, showing that diversity is important for explaining trust in other populations and trust in one’s own population – but opposite to what is expected by Putnam

Can productivity growth measures identify best performing hospitals? Evidence from the English National Health Service

Health care systems around the world face limited financial resources, England is no exception. The ability of the health care system in England to operate within its financial resources depends in part on continually increasing its productivity. One means of achieving this is to identify and disseminate throughout the system the most efficient processes. We examine the annual productivity growth achieved by 151 hospitals over five financial years, using the same methods developed to measure productivity of the National Health Service as a whole. We consider whether there are hospitals which consistently achieve higher than average productivity growth. These could act as examples of good practice for others to follow and provide a means of increasing system performance. We find that the productivity growth of some hospitals over the whole period exhibits better than average performance, but there is little or no evidence of consistency in the performance of these hospitals over adjacent years. Even the best performers exhibit periods of very poor performance and vice versa. We therefore conclude that accepted methods of measuring productivity growth for the health system as a whole do not appear suitable for identifying good performance at the hospital level

Airports and ageing passengers: A study of the UK

Globally, improved standards of living, nutrition and medical treatment are extending human life expectancy and enhancing quality of life with the result that an increasing number of ageing passengers are using airports. This ‘grey boom’ presents both challenges and opportunities for airports as older travellers exhibit distinct and different travel characteristics concerning their propensity to fly, their travel purpose, trip duration, destination, surface access preferences, dwell time, retail habits, familiarity with airport automation and self-service technologies, and use of terminal facilities such as airport information desks, adaptive and assistive technologies and special assistance support. The aim of this paper is to use publicly available data to undertake an exploratory investigation into the use of UK airports by older travellers and make recommendations for future policy and practice. Overall, the study finds that the impact of this observed demographic change varies by individual airport and thus future policy and management of an ageing passenger profile needs to reflect the operational challenges on a location-by-location basis

A sub-national economic complexity analysis of Australia’s states and territories

© 2017 Regional Studies AssociationA sub-national economic complexity analysis of Australia’s states and territories. Regional Studies. This paper applies economic complexity analysis to the Australian sub-national economy (nine regions with 506 exported goods and services). Using a 2009 Australian multi-regional input–output table for base data, we determine the number of export goods or services in which each state and territory has a revealed comparative advantage, and visualize the complexity of Australia’s interstate and international exports. We find that small differences in industrial capability and knowledge are crucial to relative complexity. The majority of states (especially Western Australia) export primarily resource-intensive goods, yet interstate trade has many complex products that are not currently internationally exported

Female labour force participation, fertility and public policy in Sweden

This paper analyzes the role of public policy for Sweden's combination of high female labour force participation and high levels of fertility in the late 1980s and early 1990s. We present the central elements in the tax and family policies and use a disaggregated approach to assess their impact on Swedish fertility and female labour force participation. We show that these policies stimulate both fertility and women's paid work by reducing the costs of having children while requiring parents to be employed to collect full benefits. Cet article analyse le rôle des politiques sur le lien entre une forte participation féminine au marché du travail et de hauts niveaux de fécondité en Suède, à la fin des années 1980 et au début des années 1990. Nous présentons d'abord les principaux éléments des politiques fiscales et parentales. Puis nous utilisons une approche désaggrégée pour mettre en évidence leur impact sur la fécondité suédoise et la participation féminine au marché du travail. Nous montrons que ces politiques stimulent à la fois la fécondité et le travail féminin rémunéré en réduisant les coûts en vue d'élever les enfants tout en demandant aux parents d'être actifs pour en recueillir les pleins bénéfices.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/42731/1/10680_2005_Article_BF01797210.pd