Some facts on the NHS seem to be important to inform debate. Try these:
- New Accident and Emergency waiting times figures are the worst since targets were introduced in 2004, with one in six patients waiting longer than four hours for an appointment.
- 83.6% of patients were treated in four hours or less in October, down from 89.1% in October 2018
- Cancer waiting times are the worst on record
- Health spending has risen by an average of 3.7% per year since the NHS was founded, but only by 1.5% since 2010.
- Cuts to public services spending in other departments - of 25% per head since 2010 - have added to pressures on the NHS, as has the UK's ageing population.
- A major increase in health investment spending is needed to bring the UK up to the OECD average.
- There are £3bn of critical maintenance issues to fix, including basic building problems such as collapsing ceilings and leaking sewage.
- It is estimated that £5.6bn per year of additional investment is needed - an 80% increase in annual spend - over the next five years to bring our spending on health capital per head up to the OECD average.
- Spending on public health has fallen by £850m since 2014, hitting the poorest areas the hardest. These cuts increase pressures on health and other public services, and make little economic sense given the high rates of return on public health spending.
It's pretty dispiriting. And that's before Brexit privatisation is considered.
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You are so negative. My mate Bojo will increase spending on the NHS in cash terms even though it will not fully compensate for the underfunding since 2010. He has committed to the funding of 40 new hospitals even though in the next parliament he will deliver just 6. He will deliver 51,000 new nurses including 13,000 who can be ‘persuaded to stay’ . Just imagine if everyone in the NHS was ‘persuaded to stay’ he will have doubled the workforce. Words fail me.
Me too
If 100,000 nurses had been expected to leave instead of 19,000, would the Tories have promised 131,000 more nurses?
You know I don’t ‘do’ numbers, but a commentator on R4 the other day was crunching some numbers and pointed out that Tory plans for ‘increased spending’ on the NHS barely keep pace with anticipated growth in demand which is expected to be around 3% for purely demographic reasons in an ageing population.
No allowance for catching-up on the slippage of under-spending of the past nine years, and no allowance for any growth or expansion of service at all.
The Johnson election pledge in effect is, if elected ‘We will continue to chronically under-fund the NHS.”
You are right
I think it may be simplistic to state “The NHS: some facts” The facts are all different because there is the Scottish NHS, English NHS ,Welsh NHS and NI NHS. They are most certainly not the same. I saw figures detailing the differences in performance not long ago but one thing the have not yet managed is to do something about my memory! Perhaps someone can help out?
Fair comment!
Willie John, prof John Robertson reports lots on the Scottish NHS (because it takes a battering from the BBC news team in Scotland) and often does comparisons;
https://talkingupscotlandtwo.com/2019/12/03/the-buffoon-who-would-take-control-of-nhs-scotland-allows-no-winter-funding-for-nhs-england-and-tempts-the-perfect-storm/
The link is to an article about how maybe the uk government has forgotten to allocate winter funding to the English NHS this year ,,, things may be more dire than they seem ,,,
With regard to A&E waiting times. In England there are three Types of A&E Departments: Type 1 are major A&E Departments – A consultant led 24 hour service with full resuscitation facilities and designated accommodation for the reception of accident and emergency patients. Type 2 are specialists A&E units and Type 3 are only for minor injuries etc. When discussing A&E services people are generally referring to Type 1 Departments.
For Type 1 Departments the statistics are even worse:
“79.1% of patients were seen within 4 hours in type 1 A&E departments compared to 77.1% in April 2019 and 84.9% for the same month last year. ” (report for May 2019 https://www.england.nhs.uk/statistics/wp-content/uploads/sites/2/2019/06/Statistical-commentary-May-2019-msyqw-1.pdf )
Contrast the situation in Scotland where for Type 1 Departments:
“In June 2019, 90.3 per cent of patients waited less than 4 hours” (https://www2.gov.scot/About/Performance/scotPerforms/NHSScotlandperformance/AE-LDP)
Scotland has been subjected to the same brutal austerity measures in its overall budget as England so why the remarkable difference?
Good question…
NHS Digital provides a similar comparison and (based on the same like-for-like data) also shows that the English NHS has 10 times as many A&E patients waiting more than 12 hours than the Scottish NHS. This was true for 2 consecutive years.
I’m sure there are several reasons why, but I strongly suspect the most important difference is that the Scottish NHS had no top-down re-organisation, and does not have a bidding process for provision of medical services.
You may well be right
A government for the many, not the few?
If you were talking about the tories surely the phrase should be:
“A government for the monied… not for the many”
Hi,
I’m trying to understand the effect of government spending on the money supply. If government creates new money when it spends, and if the subsequent tax revenue inflow does not increase, does that mean the money supply would grow?
So when the UK government runs a deficit “net lending/(borrowing) as % of GDP” as described in the national accounts, would I expect to see the growth rate of M4 to increase?
I plotted net lending/borrowing of Governement vs Non financial private sector, and indeed i see an inverse relationship.
but when i overlayed M4 growth data from BoE across the same graph, i see the growth rate fall substantially when the government has a deficit, e.g. in 2009 when it fell to 11% deficit, the M4 growth rate also fell in a very proportionate way.
what am i missing? I’m using the B.9N table from the ONS quarterly sector accounts, and BoE M4 12 month quarterly growth rate data.
thank you.
You are missing the fact that there are many measures of money – most rooted in what the Bank of England described in April 2014 as ‘out of fate textbooks’.
I would describe M4 as exactly that type of thinking
“I would describe M4 as exactly that type of thinking”
I would describe it as the motorway that goes to Wales if you have the misfortune to be setting off from near London.
Inform debate?
Let’s hope so.
The problem I have with all this is at a personal level – to explain:
The NHS had a good go at killing my wife in 2001 as they were unable to diagnose a burst appendix for 5 days. She checked out & was rescued by a BUPA hospital the next day 30 mins from peritonitis killing her. Fortunately I could afford this. NHS at it’s worst.
On the other side – she had a fast track bowel cancer investigation 2 years ago which had her tested and diagnosed (fortunately clear) within about 3 weeks. NHS at it’s best.
So – on a personal level, the NHS is better now than in 2001.
Also – the ‘for sale’ meme is ridiculous – GPs, Opticians & so on contract to the NHS as private companies. Who makes ambulances, beds, and all the drugs – NHS will nationalise these?
Respectfully, please do not write such nonsense
The NHS did not try to kill your wife: a doctor did not a diagnosis right
Later as matters developed another one did. Both were NHS trained and both probably worked most of the time in the NHS
I can’t be bothered to deal with your last question given how insulting your first comment is
And don’t presume the first doctor did not care: I promise you they do
Always worth reminding people that the NHS is one of the most efficient (pound-for-pound) healthcare systems in the world.
Next time anyone hears people talking about the NHS in its current form being unaffordable, and in need of ‘modernisation’ and (market) reform, they should have this graph rammed down their throat.
The NHS is EXCELLENT value for money, but is being starved of the resources it needs to deliver.
In America, the government spends MORE than the UK Government on healthcare as a share of GDP. On top of that, the expenditure on private healthcare in the US is even higher than what the Government spends. Overall, America spends more than DOUBLE what the UK does on healthcare as a % of GDP. It has by far the highest expenditure on healthcare in the OECD. Meanwhile, it is one of only three countries in the OECD that does not guarantee a core set of near-universal health services for all citizens. The other two countries are Turkey and Mexico, who spend the least on healthcare in the entire OECD.
Labour, and anyone else with an interest in the NHS and healthcare, need to be shouting this from the rooftops. The American model is appallingly bad. The NHS is the best value there is. To improve it and deliver better value and public health, it needs more investment. I can’t think of a better investment.
https://www.oecd.org/media/oecdorg/satellitesites/newsroom/44222075health%20expenditure.jpg
The efficiency of the NHS is the point; even after decades of corruption and salami expropriation, it fails to provide the super-profits to the favoured few that a commercial system does. The economies of scale, redistribution of working-class money from generations rather than to profits and limited opportunities to loot, are what the state is trying to rectify. The US system is ideal for its purpose.
There’s a disingenuousness about the NHS debate which hides whats really happening. Of course they wont put the whole NHS up for sale so that can easily be denied.
What will happen and is already happening:
– continuing to fragment and move NHS functions into the private sector
– continuing to starve the NHS of funds so service degrades and more people go private as the only way to get knees, hips, cataracts and the rest done in reasonable time
– rationing or eliminating service so going private is the only way to get the care needed
– Trade deals with the US which will force the NHS to pay massively higher prices for drugs
Perhaps thats too detailed a message for the public but just saying ‘NHS for sale’ is not helpful.
Our nearest A&E is similarly constantly overrun – a GP friend had some conversations at the hospital as to why they did not send people away who did not need A&E. The response was that the hospital got paid for every punter that came through their doors….
The next nearest A&E department has brought in GP’s as part of the triage process, dealing with minor cases more efficiently. it is rated very highly and I suspect staff are happier too.
Similarly we have two GP surgeries in the locality – the one closest seems unable to provide an appointment at any time. The one further away deals with almost all cases on the day. The difference? The second one uses the telephone to ring patients back and in many cases can advise over the phone whether to come in or ‘give it a few days and let me know’.
So, more funding – yes, and better processes (joined up thinking), absolutely.
Yeah – this approach is common in Holland as well. At my surgery, you can call on the morning and if it is urgent, they will usually fit you in that morning.
If you are unsure, each GP has a ‘conversation hour’ each morning where you can phone the GP and ask quick questions. Sometimes this can be enough to put your mind at rest, issue a prescription, or if the dr is in doubt, bring you in a for an urgent appointment that afternoon. It saves a huge amount of time and effort getting people in for appointments unnecessarily
To me, that seems a much better approach than having receptionists doing all of the screening and filtering of people’s demands for appointments.
This happens in some UK surgeries
But not all
All of that happens at my GP surgery in Edinburgh, the only difference being that you log an issue with the surgery and the GP will phone you back if necessary. So there is still a filter at reception, which seems to work in my experience.
Re A&E “waiting times”
I do not know how it works elsewhere, but in Scotland what is measured is the time from initial presentation until discharge or transfer to another department/ward. This metric is a useful management tool (cost-effectiveness and resource allocation), but what matters clinically and to the patient is time until treatment commences.
Someone’s immediate treatment may have been concluded, but it is deemed undesirable for them to be discharged because e.g. they have been sedated (perhaps for an investigative procedure) and live alone or afar. The sensible approach is to give them a hot drink, sandwiches and leave them under observation in a waiting area until the effects wear off. This is a good case for missing a target. It is not the same as, and should be regarded differently from, being kept in an ambulance awaiting admission.
To add to the data, there has been an increase in both adult and infant mortality, which is I understand unprecedented amongst developed countries.
For example: https://www.theguardian.com/society/2018/mar/15/concern-at-rising-infant-mortality-rate-in-england-and-wales
Or see BMJ and elsewhere.
One of the key researchers in the field, now working with Danny Dorling, is a personal friend. The suggested causes are the intuitively obvious ones. Cuts in services, longer waiting times, crowded and overloaded hospitals, increased poverty etc, all disproportionately affecting the most vulnerable – the old and the very young.
Deeply ironic and depressing that it is the elderly, probably grandparents, who are overwhelmingly voting for more of the same.
(And I’m a 70 year old grandparent…)
I agree, deeply depressing
And the right deny the data, much of it by Danny Dorling, who I happen to know
I believe the data
[…] published in Tax Research UK, 3 December […]
Further to the question of why NHS Scotland outperforms the other NHS services in the UK. The article “Scotland’s NHS outperforms the rest of the UK — here’s why” (link below) gives some interesting insights:
https://www.businessforscotland.com/scotlands-nhs-outperforms-the-rest-of-the-uk-heres-why/