Doctor Doctor! Money and the NHS

Unless the next Government allocates more money to the NHS, health services in England will lose 16 per cent of per person funding by 2020, compared to historic funding rates. That’s £1 in every £6. 

There’s a lot of local variation in health spending, so we made NHScuts.org.uk to show the local impacts of changes in funding. Pop in your postcode

These stats are based on NHS England figures (the organisation that heads up the NHS), and are echoed by the head of NHS England himself, Simon Stevens. Earlier this year, he told the Government’s public accounts committee ‘In 2018-19, real-terms NHS spending per person in England is going to go down, 10 years after Lehman Brothers [collapsed] and austerity began. We all understand why that is, but let’s not pretend that’s not placing huge pressure on the service.’ (source) As the most recent Department of Health Annual Report put it ‘2015-16 has been a challenging year for the NHS and for the wider Departmental Group. In financial terms, the NHS has faced significant pressures in meeting increased demand for services…’ (source).

Yet both health secretary Jeremy Hunt and PM Theresa May continue to repeat claims that the NHS will actually be getting more funding over the next few years. So what’s going on? The chair of the Government’s Health Committee, Conservative MP Sarah Wollaston, said that the Government’s claim of extra money for the health service was wrong and ‘risks giving a false impression that the NHS is awash with cash’ (source). In fact, Anita Charlesworth of the Health Foundation, argues that not only is the health service being cut but ‘The pressures are bigger than even the per capita [figures] show[s]’ because they do not account for the ageing population and the higher heath care costs associated with older age (source).

Efficiency gains?

But perhaps all these falling budgets are actually just getting rid of the fat, rather than cutting to the bone. The National Audit Office (NAO), the government body that scrutinise public spending for Parliament, recently concluded that current spending plans meant the NHS had ‘an efficiency target of some £22 billion’ (source). Given that the Department of Health’s total budget (including the NHS) is around £120 billion, that’s an awful lot of efficiency. At the same time as these cuts bite, the NAO found that ‘Performance on a wide range of service indicators – including cancer referral to treatment times and ambulance response times – fell below national standards.’ (source). So it doesn’t look like budget cuts are translating into a less wasteful, better quality service. And this is all happening to the very same NHS that the the British Red Cross described as facing a ‘humanitarian crisis’ at the beginning of the year (source).

Take a number

As we show on NHScuts.org.uk, just under 1 in 3 people wait more than four months (18 weeks) for an operation and 1 in 5 cancer patients wait more than 2 months for treatment (see the end of the post for sources). Moreover, these numbers are going in the wrong direction. The proportion of people who are waiting more than 4 months (18 weeks) for an operation in England more than doubled from 12.6 per cent in 2013 to 29.1 per cent in 2017 (see chart below). The proportion of cancer patients waiting more than 2 months for treatment has also risen by nearly a half, from 12.7 per cent in 2011/12 to 17.6 per cent in 2015/16. NHS England estimates that in March of this year, just under 3.9 million patients were waiting to start some form of treatment (source). That’s a high number by NHS standards. In fact, waiting lists haven’t been this long since 2007.

waitsSource: NHS England’s statistical release series, Consultant-led Referral to Treatment Waiting Times Data 2016-17

It’s an emergency

It is not only surgery for which the queues are long and growing. Ambulance response times are also rising. ‘Red 1’ callouts are classed as ‘the most time critical, including cardiac arrest patients who are not breathing and do not have a pulse, and other severe conditions such as airway obstruction’. We found that more than 1 in 4 ambulances responding to Red 1 calls take more than 8 minutes to arrive. This figure has also risen, from 24.6 per cent in 2013 to 29.3 per cent in 2017, and is far off the government target. In fact, in 2015/16, only one ambulance trust met all three of their response time targets (source). It seems that this can be linked to lack of resources compared to demand. Between 2011/12 and 2015/16, funding for ambulance services increased by 16 per cent, while ambulance calls and NHS 111 transfers rose by 30 per cent. The NAO conclude that ‘Increased funding for urgent and emergency activity has not matched rising demand’ – and unfortunately it shows. 

Get through if you can 

Access to GPs isn’t going so well either. 1 in 4 people don’t find it easy to get in touch with their GP surgery. This figure has risen considerably: from 18.4 per cent in 2012 to 26.0 per cent in 2016 (see chart below). And for those that do get through to their surgery, the wait to see a doctor can be long. 1 in 5 people wait a week or more to see or speak to a doctor or nurse, a rise from 13.0 per cent in 2011/12 to 19.3 per cent in 2015/16. The previous (2015 – 2017) government made a fairly big deal of increasing access to healthcare, so it’s a bit of a surprise to see it falling.

gpsSource: NHS England’s GP Patient Survey: CCG report published in July 2016 

What we haven’t talked about

Mental health care, the poor cousin of physical health care, remains embattled. Despite talk of parity between physical and mental health care, there’s no sign of the resources needed to make it happen. To the contrary, more than half of mental health trusts in England reported a drop in income last year (source and also here) despite increasing demand. Funding for social care  – care services for people with needs arising from long term conditions or illness, particularly for older people – is also going in the wrong direction. Council budgets for adult social care fell by 7 per cent from 2009/10 to 2014/15 in real terms (source) while demand for care increased. As a result of repeated budget cuts, 80 per cent of councils who are responsible for social care see adult social care as their most pressing issue (source).

So what’s the take-away from all this? Health services are getting and will continue to get less money than they – and we – are used to. And it has most definitely started to show. If you don’t like what that means for your health services, ask your MP to do something about it.

 

About NHScuts.org.uk

The data: NHScuts.org.uk lets you see what’s happening to NHS services in your local area. It is powered by official statistics from NHS England (the head of the NHS in England) and NHS Digital (part of the Department of Health responsible for health and social care data). You can learn more about the data used in this blog and on the NHS Cuts site in the ‘data sources and methodology’ section here.

The backers: I worked on NHScuts.org.uk for Outlandish, a tech worker co-operative who, in their words, ‘want to unleash technology’s potential to make the world a fairer, better place.’  NHScuts.org.uk was funded by the workers of Outlandish. They co-budgeted their own money (and worked like hell to get it ready in time for the election!). It was modelled on an earlier Outlandish project, the very successful School Cuts site.

The challenge: Articulating the scale of the NHS crisis in numbers is very difficult. This is Outlandish’s first take; feedback very welcome, especially as they aim to build on this platform post election. You can contact me or Outlandish directly at nhscuts@outlandish.com

Note on our method

We calculated funding changes for health services using clinical commissioning group (CCG) allocations from 2015/16 to 2020/21. We compared NHS England’s projected funding allocations in 2020/21 with the amount that the CCG would receive in 2020/21 *if* funding were to keep up with historic (1955-2015) growth rates between 2015/16 and 2020/21. We use a historic growth rate of 3.7 per cent per capita, in real terms, as reported by the Institute for Fiscal Studies.

What if the previous level of funding were just too high? Well, maybe it was. It seems that no one really knows how much we should be spending on the NHS, and how that should change year on year. What we do know is that (a) there is increasing demand, (b) productivity gains (i.e. doing stuff better or faster or both, for less or the same cost) won’t drastically change funding needs in the immediate future, and (c) we all expect decent health care, and access to newly approved treatments. (For the full argument about funding, check out the King’s Fund independent Commission on the Future of Health and Social Care in England.) So, for now let’s agree that we need funding to rise to some degree to keep up with increasing demand without falling expectations. We’ve assumed 3.7 per cent. You could assume a lower growth rate. If you did, chances are it would still mean real terms cuts to funding.

Want to know more about the data?

I share data! If you’d like to access or use the full dataset that sits behind this analysis, or you have questions on the methods I’ve used, please get in touch.

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