Social care, too, is beyond the scope of this initial report but will be the focus of subsequent analysis by the REAL Centre. We take an in-depth look at emergency and planned hospital care, mental health, community and primary care, but do not look in detail at areas such as high cost drugs or highly specialised services. We then explore what drives the remaining change, unexplained by demography.Īlthough we focus on England, many of the lessons may be relevant to the other countries of the UK. Where possible, we estimate the proportion of any change that can be explained by four demographic factors: population size, age, gender, and proximity to death. We look at the overall trends in activity and how specific services have changed. ![]() We describe how supply and demand side factors interact, and how policy can influence the care the NHS provides. We provide a framework for understanding the drivers of health care activity. In this, the REAL Centre's first report, we look back at the care and treatment provided by the NHS in England over the past two decades – as measured by health care activity. There is little sign of this policy goal being achieved.Īn understanding of the past helps us to prepare for the future. Across the past two decades, much of the policy narrative was about shifting the focus of care away from acute services towards community and primary care to prevent avoidable admissions and manage care more proactively.This has produced a major shift in the composition of spend towards hospital-based care and away from other areas. While overall health care activity has grown substantially, this growth has not been shared equally between services. Consultations in general practice have grown just 0.7% per year, while planned procedures increased 9.6%.This means that more than three quarters of the growth in NHS care since 2000/01 is the result of other factors relating to demand, supply, political priorities and health care policies. Our analysis suggests that the amount of care would have needed to grow by less than 1% a year to meet the demand pressures arising from demographic changes. ![]() Between 2000//18, the amount of NHS-funded care in England more than doubled – increasing by 114%, an annual average of 4.6% a year.Our lives are short against the span of cosmic history, but the fact that we contemplate our world and care about what happens to it brings meaning to our existence. But as emergent higher-level creatures, possessing thought and volition, we have the ability to construct purpose and mattering for ourselves. The wider cosmos does not judge us, nor does it provide any guidance on the distinction between right and wrong, or how to live a good life. The emergence of complicated, information-processing, self-aware structures such as ourselves is fascinating, but completely compatible with everything we understand about the underlying physical reality. That's just as true for the universe as a whole as it is for mixing cream into coffee. How do such complex, organized creatures such as human beings arise from the impersonal workings of undirected laws of physics? The universe goes from orderly to disorderly, but complexity naturally increases along the way – at least for a while, before gradually fading away. Different ways of talking about the world reveal fundamentally distinct kinds of concepts, each of which deserves to be called "real" if it accurately captures some part of the bigger picture. One of the most profound features of reality is that it appears to us in layers – self-contained emergent descriptions at one level are consistent with, but autonomous from, what is going on down below. The world we see is an image of macroscopic objects and causes. ![]() When we look at the world, we don't see individual atoms and particles. Future discoveries will teach us much about the nature of reality, but the basic picture of the particles and forces that make up you and me is secure. We are collections of vibrating quantum fields, obeying a set of laws known as the Core Theory. There is much that we don't know about the universe, but there is also much that we do know – and that knowledge includes a set of ingredients and rules that suffices to completely account for the stuff underlying our everyday experience. It is the specific history of our cosmos, from a smooth Big Bang to an expanding and cooling distribution of stars and galaxies, that gives time its sense of flowing. They are undirected patterns, relating one moment to another. Over the last several centuries, science has learned that the fundamental laws of nature don't work on the basis of cause and effect, and draw no distinction between past and future. There is a deep connection between the flow of time that we experience in our lives and the wider evolution of the universe. Cosmos, Time, Memory (no video, slides only)
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