Max Warner

NEW PODCAST: Why isn't the NHS improving faster?

@helenmiller.bsky.social, @maxwarner.bsky.social and Olly Harvey-Rich examine the latest data on NHS performance, progress on waiting lists and the big challenges around staffing, winter and flu cases.

🎧 Listen here: ifs.org.uk/articles/why...

DHSC published its impact statement for the 10 Year Health Plan this week (yes, that is 6 months after it published the plan)

It's more measured and clear-eyed than the original document and quite a contrast to some of the effusive optimism in the plan

Some of the things that caught my eye 👇

There's now data out about the resident doctor strikes last month

So how disruptive did they end up being? And what can we say about how the NHS is responding to ongoing strikes?

Short 🧵👇

This is important as last month's OBR forecast (no monthly breakdown of this yet) expects a big increase in receipts by 2029/30 from higher inflation, boosting the public finances.

That may materialise, but it’s concerning that it hasn’t yet - one watch out for in the new year

New ONS public finance data today shows central government revenues are still lagging significantly below March expectations.

Given inflation has been higher than forecast, this is surprising - even VAT receipts, which one might expect to rise with inflation, are below forecast

A short seven years (!) after I started writing the code, it’s great to see this paper published.

We use high-frequency NHS to data show that short-staffed, less experienced nursing teams deliver worse outcomes – with the largest mortality impacts for patients with sepsis.

NEW: How did the introduction of the Ultra-Low Emissions Zone (ULEZ) change London’s geography of work?

In a new @theifs.bsky.social paper, @joelkariel.bsky.social, Fizza Jabbar and I have taken a look – and it turns out people adapt in surprising ways. A thread.

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What's going on? Could productivity in individual trusts really be bouncing around so much? Definitely raises questions about how informative this measure is - we've always found it surprising how high and low some of the changes are
[2/2]

Chart showing there is no correlation between productivity growth in English hospitals between Q1 2024 to Q1 2025 and Q2 2024 to Q2 2025

NHS England has now produced two sets of productivity growth rates for each NHS acute trust. These are year-on-year growth rates, only 3 months apart (so have a 9 month overlap). But what's striking is that they are essentially uncorrelated!?
[1/2]

Yes I think that's very fair. The government used to make a defence price index, but stopped publication a number of years ago.

I think another nuance here is that we often talk about defence spending in terms of % of GDP. That makes sense for some types of questions. But (real) GDP is also much higher, so in real-terms we already spend lots more on defence - and that's probably closer to what matters for capabilities

We made that exact chart for our recent IFS Green Budget chapter on defence spending
(ifs.org.uk/publications...)

Chart showing that the NHS currently has more beds occupied with patients with flu than at the same points in recent years. But the current level is below the peaks of past years

Hospitals currently have a lot more people admitted with flu than at the same time in recent years. It remains to be seen how the peak will compare to previous years. (Half the IFS healthcare team are also currently laid low with it...)
www.bbc.co.uk/news/live/c6...

It also matters for how we think about productivity. The NHS is rightly focused on delivering hospital activity more productively, but it should also ensure that the right activity is being delivered for patients to complete their pathways, rather than simply more activity.
11/11

Ultimately, this matters for two reasons. First, for a govt focused on elective waits, it is clearly a concern that increases in hospital productivity and elective activity are not corresponding to equivalent falls in waits. More is needed to understand what is driving this.
10/11

On the other hand, hospitals faced strong incentives to increase activity and productivity in this period, which could be driving this pattern. But other policy efforts, like patient-initiated follow-up appointments (PIFU) pushed in the opposite direction.
9/11

This growth in the amount of activity happening before a patient leaves the waiting list is not obviously driven by patients being more complex to treat, but that could play a role. It could also be hospitals are delivering better quality treatment.
8/11

Chart showing that 2024-25 is the first year in recent years where elective activity has grown much faster than completed waiting list pathways

Chart showing almost all clinical specialties have seen elective activity grow much faster than completed waiting list pathways

It’s not clear why patients are receiving more hospital activity before they leave the waiting list than the year before. This divergence hasn’t been so large in recent years before 2024–25, and we see it happening for almost all medical specialties.
7/11

For example, the number of outpatient appts grew by 9% in 2024–25 yet the number of patients leaving the waiting list only grew by 4%. This is a big deal: if the number leaving the waiting list had grown at the same rate, the waiting list would be ~1 million lower by now.
6/11

Chart showing that growth in new referrals has been low, while elective activity growth has been high. But the number of patients leaving the waiting list has been lower than this growth in activity

It also isn’t the case that lots of patients are joining the waiting list, counteracting increases in activity. Demand growth remains muted. Instead increases in elective activity have failed to translate into similarly large increases in patients leaving the waiting list.
5/11

Chart showing that over the last year NHS funding and resources have increased. Hospital activity has also increased, driven by elective not emergency activity

So what explains this difference? We can quickly rule a few factors out. Productivity hasn’t come from squeezing hospital resources, nor has it all gone to increasing emergency activity. Hospitals delivered a lot more elective activity in 2024–25 than in 2023–24.
4/11

Chart showing there is little correlation between productivity growth and change in 18 weeks waiting time performance at the trust level in 2024-25 compared with 2023-24

This divergence between productivity growth and waiting list performance is visible at the trust level too. Lots of hospitals have seen productivity growth in 2024–25, for example, without a corresponding improvement in waiting times.
3/11

NHS England figures suggest that productivity grew by 2.7% in 2024–25. But the waiting list fell from 7.5 million to just 7.4 million between Mar 2024 and Mar 2025, and the % of patients waiting <18wks increased from 57.2% to 59.8%. This is not stellar progress.
2/11

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.
1/11

Associate Director (Health/Healthcare) Background to the role   The Institute for Fiscal Studies (IFS) is Europe’s leading centre for research on the microeconomics of public policy. It is a politically independent registered educational c...

Would you like to lead our @theifs.bsky.social work on healthcare? We are looking to recruit an outstanding economist to become an Associate Director and lead a programme of economic research on health and/or healthcare. Job advert here: app.beapplied.com/apply/jfzr0z...

NEW: What are Rachel Reeves’ options if she decides to change departmental spending at next week’s Budget?

📗 @beeboileau.bsky.social, @benzaranko.bsky.social and @maxwarner.bsky.social explain: ifs.org.uk/articles/cha...

The IFS has calculated that the effective carbon price on household use of gas is negative, thanks to its lower VAT rate.

ifs.org.uk/articles/tax....

This obviously sets back the carbon transition. Let's hope the Government is looking to make this better!

Can the government achieve its 18-week elective waiting time target? | Institute for Fiscal Studies Simulation modelling of NHS elective waiting times in England shows that the government’s 18-week target is unlikely to be met in this parliament.

We have done much more detailed modelling of how plausible the target is, and what steps the government might need to take to achieve it, available here: ifs.org.uk/publications...