Stuart Hoddinott

NEW: Hospital productivity growth is beating the government’s targets. So why hasn't the NHS made more progress on cutting elective waiting times?

In a new @theifs.bsky.social comment, we examine what’s driving the divergence between two of the government’s biggest NHS priorities.
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WEBINAR | How can the government make a success of the abolition of NHS England?

This webinar will explore the risks and opportunities associated with abolishing NHS England. @markgdayan.bsky.social @sjanereed.bsky.social @nuffieldtrust.org.uk

www.instituteforgovernment.org.uk/event/govern...

Performance Tracker 2025: NHS | Institute for Government NHS performance is improving, but a complex and haphazardly planned reform package might slow progress.

The NHS section of Performance Tracker 2025 by @stuarthoddinott.bsky.social is live on the @instituteforgovernment.org.uk's website, with new analysis on general practice and hospital performance in England.

www.instituteforgovernment.org.uk/publication/...

Week in Public Services: 5th December 2025 This week: jury trial restrictions, place-based budgeting pilots, and warnings from Ofsted on the children’s social care market.

The @instituteforgovernment.org.uk’s Week in Public Services blog is back! This week I looked at the Budget’s place-based budget pilots, jury trial restrictions, and Ofsted’s concerns on children’s social care. Some thoughts below.

medium.com/week-in-publ...

15% of local authority run primary schools were in debt in 23/24, compared to 8% in 18/19

Our analysis suggests that the rise in unfilled primary places accounts for nearly two-fifths of that increase

Our recent work supports this, the number of net joiners to the NHS from outside the UK and EEA has collapsed since 2024

It's happened among both hospital doctors and nurses, but the fall has been much sharper for nurses. On current trends, it wouldn't be surprising to see a net outflow soon

Central government’s takeover of SEND deficits raises the stakes for SEND reform | Institute for Government At the budget the chancellor announced a significant change to SEND funding arrangements

Last week the Chancellor announced a central government takeover of special educational needs deficits.

I write about the potential impacts of this move on SEND reform, including on governance of the system, local innovation and trust

It is so odd that there seems to be no critical thought about why NHSE might be saying this or whether it's worth looking for other explanations

Hope you enjoyed! Annoyingly didn't find many strong relationships, absence rate was strongest. But tested it against: 18-wk, RTT additions, 4-hr, 12-hr, A&E attendances, emergency admissions, diagnostic 6-wk and others

But no controls and lots of other ways to cut data if you have suggestions!

Haven't read the Re:State reports yet! Will have a look

But this point about geography is something we hear a lot as well. Coastal ICBs argue that they're underfunded given complexity of need

Same goes for general practice as well - hard to recruit GPs into those areas

Completely agree. I imagine that the higher absence rate in more deprived areas (particularly mental health absences) reflects higher and more complex demand

Performance Tracker 2025: Hospitals | Institute for Government Hospital performance is trending gently upwards. But tight finances in hospital trusts will constrain further efforts.

You can read more about these trends in our recent Performance Tracker

www.instituteforgovernment.org.uk/publication/...

As the article points out, there are fewer GPs per patient in the more deprived parts of the country

That's a pretty good indicator of capacity in primary care, and likely means that people who cannot access care end up in hospitals

This is an interesting piece. Analysis we've done support some of the findings

First, staff absences are higher on average in trusts that serve more deprived populations, and the effect is larger for mental health absences than for other conditions

Completely agree with Ben here. The NHS press release is even weirder, describing the NHS as "under siege" from these minor conditions

Shows a complete unwillingness in the NHS to engage with the actual reasons for long A&E waiting times

The Office for Value for Money has been a success | Institute for Government In its short lifetime the OfVM made valuable proposals for change.

A slice of positive budget news last week was some important improvements to the spending framework
I've written about how the Office for Value for Money helped drive this, and why I think others in government could learn from its unusual set-up
www.instituteforgovernment.org.uk/comment/offi...

The Office for Value for Money has been a success | Institute for Government In its short lifetime the OfVM made valuable proposals for change.

In my Budget chat for @instituteforgovernment.org.uk I flatteringly compared it to a complex artwork you must spend hours with to see all the details

www.instituteforgovernment.org.uk/comment/offi...

The work of the OfVFM provides an example: @drbenpaxton.bsky.social explains why it is good.

Performance Tracker 2025: Hospitals | Institute for Government Hospital performance is trending gently upwards. But tight finances in hospital trusts will constrain further efforts.

You can read more about these trends (and many more!) in the hospitals chapter of our recently-published Performance Tracker 👇

www.instituteforgovernment.org.uk/publication/...

For context, the independent sector still carries out a small proportion of NHS elective cases nationally: <10%

And though London has grown more than any region since 2019, it is still the region with the lowest proportion overall at ~5%

To be clear, I have no view on the appropriateness of these drugs or whether it makes sense to provide them through the independent sector

It is just a startling, rapid explosion in activity from one provider, so large it skews regional and national trends

NHS begins mass rollout of weight-loss jabs to patients in England About 220,000 patients expected to receive Mounjaro over three years as GPs can prescribe the drugs for the first time

The NHS started providing weight loss drugs from June this year (I don't know why Oviva was providing care in Apr and May)

It is difficult to know from NHS data which providers are offering this service, but Oviva appears to be one of the main suppliers

www.theguardian.com/society/2025...

Who are Oviva and what care are they providing?

The NHS classifies the activity as "Other - Medical Services". V unhelpful

But their website shows they provide "Weight loss medication and expert care"

More speficically, they advertise "Weight loss injections on the NHS"

Looking deeper, one provider drove a lot of London's recent activity: Oviva Ltd

Before April 2025, they carried out 0 NHS elective activity. In August 2025, they were responsibile for >50% of NHS elective cases completed by independent providers in London and 8% of that activity nationally (!!!)

Short 🧵on a strange trend in NHS data that I found

This chart shows change in NHS elective cases completed by the independent sector since 2019

Independent sector usage increased everywhere

But London is a jaw-dropper: activity almost *doubled* with a huge recent rise. What's going on?

Some further clarification over where money to cover SEND costs will *not* be coming from in 2028/29, in case DfE's punchy blog last week (see screenshot) was not clear enough

Still a lack of clarity over where the money will in fact come from

Abolished to perfection? Building a better centre for the NHS | Institute for Government The abolition of NHS England creates both risks and opportunities.

NEW REPORT: abolishing NHS England could help simplify accountability, improve prioritisation and create savings. But the change could also lead to increases in policy incoherence and blame culture, as well as the loss of skills, capacity and focus on areas outside the day-to-day NHS.

The latest Public Services Performance Tracker from @instituteforgovernment.org.uk on the NHS is long but well worth a read. It is full for good skeptical analysis and some absolute crackers. Some quotes below: ...

Nuffield Trust responds to reports that NHS will pay more for branded new medicines Sally Gainsbury responds to reports that the NHS will pay a higher price for branded new medicines.

We've responded to reports that the NHS will pay a higher price for branded new medicines as a condition of a UK-US trade deal.

Read the statement from @sallygainsbury.bsky.social 👇

Suggestion Rachel Reeves exaggerated fiscal pressures is absurd Chancellor was instead far too optimistic about public finances and government’s ability to secure cuts

Feel like I'm going mad. The Budget's 'headroom' is based on frankly irresponsible and wildly optimistic claims about what Labour will do in the final year of the forecast, and on ignoring a bunch of upward pressures on spending, and the claim is that she was being exaggeratedly *pessimistic*?

Mostly, I wish govt better communicated the trade offs. Voters want lower immigration? Ok, it means:
- not helping people from Ukraine and Hong Kong
- higher taxes to pay British carers more
- higher uni fees/grants to keep HE afloat

Instead govt makes incompatible promises which infuriates voters