FactCheck: What’s really going on with the NHS?
The background
With Labour leader Ed Miliband on the attack on the controversial Health and Social Care Bill, the government’s record on the NHS was under the spotlight at this week’s Prime Minister’s Questions.
Bitter accusations flew around the Commons chamber as both Labour and the coalition attacked each other’s respective records on hospital waiting times and other measures of performance. Let’s try and unpick some of the key claims.
“The figures are these: inpatient waiting times down, outpatient waiting times down…”
David Cameron
You can read the latest Department of Health (DoH) figures on waiting times, from November 2011, here.
Mr Cameron is right, in May 2010 the average waiting times were 8.4 and 4.3 weeks respectively, and in November 2011 they were 8.1 and 4.0 weeks.
It may not be sensible to compare November with May like that, since there will always be more sick people in winter, but there’s a year-on-year fall too: from 8.3 and 4.2 to 8.1 and 4.0.
Mr Cameron also said that the numbers of patients waiting for more than six months or a year have fallen, along with the total number of patients on the list. And he’s right about all those things too, according to Department of Health figures.
So far so good for the Prime Minister. But there’s a big but.
“The key test that was set for the health service was the number of people waiting more than 18 weeks, and that number is up 43 per cent since the general election.”
Ed Miliband
That target of treating patients within 18 weeks of them being referred isn’t just a “key test”, it’s a right enshrined in the NHS constitution.
The government’s own target is that 92 per cent of patients should be treated within 18 weeks. The latest figures show that hospitals are now missing that target, as far as inpatients are concerned, by 1 per cent. [*See update]
The percentage of admitted patients treated within the deadline was 91 per cent in November 2011, 92 per cent in November 2010, and 92.9 per cent in May 2010. Those are pretty small differences, so what’s Mr Miliband’s figure of 43 per cent all about?
The Labour leader has chosen to look at the raw number of patients who are not being treated within 18 weeks. That number has indeed risen by around 43 per cent, from just over 20,000 people to just over 29,000.
But that number doesn’t tell the whole story. For a start, we’re comparing November 2011 with May 2010, and as we said, more people get sick in winter than in summer.
The year-on-year change, from November 2010 to November 2011, is much smaller – an increase of just over 13 per cent. And remember that we’re talking about a raw number of individuals, something that doesn’t take into account the fact that the total number of patients seeking treatment went up too.
Expressed as a percentage, the difference is a far less dramatic 1 per cent.
“Let’s look at the figures: 100,000 patients treated more every month…”
David Cameron
It’s true that there were more patients on the books in November 2011 than at the time of the election: 117,073, to be precise.
But this is probably explained by seasonal changes. In May 2010 the total number of inpatients and outpatients seen was 1,151,000, compared to 1,174,698 in May 2011 . And the year-on-year figures from November 2010 to November 2011 are also virtually static: 1,266,628 and 1,268,073.
So that “every month” is misleading. It’s a seasonal variation, not a permanent increase in patient intake.
“…4,000 extra doctors since the (election); the number of clinical staff up; the level of hospital-acquired infections down.”
David Cameron
The staff numbers are here and they prove the PM right. There were indeed just over 4,000 more NHS doctors in October 2011, when the latest statistics were compiled, than in May 2010.
And unlike waiting times, this seems to be a consistent year-on-year upward trend rather than a seasonal change.
Mr Cameron was also right on hospital-acquired infections. The latest analysis from health think-tank the King’s Fund show that incidents of C difficile and MRSA infection have been falling over the last three years.
MRSA made a bit of a comeback in November 2011 but not enough to buck the general trend.
Of course, Mr Cameron can’t take credit for the downward trend since it began before the coalition came to power, but it’s fair to say that the superbug problem is still in decline under the coalition.
The verdict
The Prime Minister threw everything but the kitchen sink into the row over NHS performance today, and he got a lot of things right.
But he can’t hide the fact that the gold standard measure of treatment within 18 weeks has deteriorated both since the election and year-on-year.
Does that mean the NHS is falling to pieces under the coalition?
Clearly not. The deterioration is pretty minuscule, and a 91 per cent success rate is still almost as good as things have ever been since 2008.
To put things in perspective, less than 50 per cent of inpatients were being treated within 18 weeks in 2007.
We haven’t seen any evidence that the NHS is on the verge of collapse and we don’t think Mr Miliband’s “43 per cent increase” figure tells the whole story.
By Patrick Worrall
[*Update: DoH has asked us to clarify that the 18-week targets are unchanged at 90 per cent for admitted and 95 per cent non-admitted patients. So performance on this measure has been falling, but it is still within government targets. The 92 per cent figure is a newer target for clearing the backlog of patients who still haven't beeen treated. This isn't very clear from government policy documents but we are happy to put it right.]
There are 18 comments on this post
Has anyone investigated the criterion of “on the waiting list” it can mean different things. For example…… a referral from a doctor might mean you are waiting an initial assessment and not be on the official waiting list despite waiting 3/6 months for said initial assessment. What is the criterion or criteria and have they changed during the periods under comparison. Statistics are always manipulated due to subtle changes of definition.
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Don’t know about the fact check team, but generally speaking I’ve always assumed that as a rule journalists don’t care enough about outcomes to bother with the sort of ‘subtleties’ you outline. [I wonder what the budget for investigating, as opposed to regurgitating think tanks is?]. But I know the general public, particularly those who are marginalised and demonised by England’s political/economic culture, will experience the downside of the machinations you describe.
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Just 1 point on the number of doctors… It takes more than 18 months to train a doctor, any spike in numbers now has nothing to do with the current governments policies or stewardship of the NHS.
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“There were indeed just over 4,000 more NHS doctors in October 2011″
This is a ridiculous measue to use in this way by any statistical good standards practice measure and if you consider yourself to be in that league, you should add the obvious caveat that it takes many years to train a doctor, not just the time between an election and today, so for this increase to have occurred, a decision must have been taken some years ago to train more doctors to meet future requirement.
Or to spell it out for you, Cameron can take very little if any credit for this.
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Just seen the minister on Newsnight. Faced with a growing list of health professionals opposing the bill, he said they had rigged the vote and implied that the few tories who still believe in the bill know better.
Such arrogance and from a party who say they want to give power to the doctors and teachers because they know best. Apparently they only know best when they agree with the government.
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Then again we haven’t got the privatisation kicking in yet. What all these figures say is that as a nationally-owned entity the NHS is doing rather well.
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Well both Milliband and Cameron seem to agree… the NHS is in good fetter…. might be slipping slightly but still fit for purpose…
So the real question is….WHY? change something that seem fit for purpose…. WHY? waste millions on reforms?
In fact I say… SCRAP THE REFORM BILL NOW!
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I was in Kings A&E today,so was channel 4. The place was very clean and all the staff very helpful. I was also there a few days ago shouting for help, in extreme pain,no one to help?
The police was called, I could not walk, was very sick,staff refused to treat me. The police was very kind,made sure I got home safe. Called the police to thank the officers involved. Yesterday my legs gave way while trying to climb the stairs, fell down the stairs backwards, lucky to be alive,( I am disabled) with a spine injury among other serious health problems.
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You should probably have pointed out that he can’t claim credit for the numbers of doctors either, it takes 5 years to train a doctor, he’s been in power for under 2.
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Cathy/Patrick,
What’s going on with the NHS is obvious: the Tory wet dream of privatisation along the lines of the American model.
However, they won’t dare do it in one fell swoop – hence the “salami” approach, hence traditional Tory lies when they claim the NHS is “safe” in their hands, hence the gradual media assault on the NHS every time a fault is found. Cameron and co simply lie their head off when it comes to their “commitment.”
The current assault has nothing to do with efficiency. It is an attempt to separate the GPs from sociomedical responsibility and their Hippocratic oath.
If they can transform doctors into financial dealers it is the first step to instilling a personal profit motive as per the unconscionable American model. It has absolutely nothing to do with better medical care and delivery of services. Doctors are not and should never be accountants. The moment they abandon that position the NHS is in grave danger.
When it comes to the NHS the Tories have always been liars and always will be. Anyone who trusts them on health is a dupe.
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Cameron knows that by quoting masses of statistics it diverts from the real challenges he and his goverment present to the NHS.
They are determined to break up one of the main institutions of the Welfare State, something which has served this country very well, despite ups and downs.This so called reform is for their idealogical ends and I dont believe it will stop there, soon their friends will own the state structures which make up Britain.
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Really do wish someone would call out Cameron on his remarks about more doctors and less infections. That is completely due to previous government. Becoming a doctor takes 7 years, how is he allowed to take the credit for it. As for hospital infection that is solely due to the programme on deep cleansing that previous government did
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I can’t believe how poor this government is at PR. They have let the opposition to health reform set the agenda all over the media and yet Cameron is accused of being a PR man!
As to the health service I know people in England are envious of the Scottish position but they have no idea of how inadequate much of the provision is up here.The SNP it seems is better at getting its story across.
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As a number of people have pointed out, it takes years to train a doctor, so if Cameron is claiming credit, they must all be immigrants. Wonder how that would go down with his backbenchers?
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If they are white, Sam, it would be fine.
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According to my doctor, the criteria for referring patients has changed. He is no longer allowed to refer as he would have done before. That could account for many people not appearing on the lists.
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Nothing changes: the 1943 government was blackmailed by the private health practitioners and we still have a large sector manned by privateer practitioners milking general taxation. This gang cant wait to wallow in the £110,000,000,000 cash trough the privateering partisan polititians are about to fill for their alies in the health and insurance business.
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It would be interesting to hear Tory comment on waiting list times for the conversion of Mental Health intervention referals into therapetic appointments.
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