Max Warner

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...

Chart showing 18 week performance and trend since the election

Elective waiting times in the NHS have improved since Labour came to office, but relatively slowly. Improvements in 18 week performance will have to pick up speed considerably if the government are to hit their headline NHS target by the end of the parliament.

On the question of one vs two OBR forecasts per year...

The IMF said first best option would be to operate with more ‘headroom’. They did not call for one forecast. They suggested that the rules could be assessed only once per year, but explicitly said that two forecasts per year is best practice!

NEW PODCAST: The end of the peace dividend? UK defence in a changing world

🎧 @helenmiller.bsky.social, @maxwarner.bsky.social & @rusi.bsky.social's Matthew Savill chat all things defence spending: what it covers, how it's changed and what reaching 3.5% of GDP would mean: ifs.org.uk/articles/end...

One of my favourite charts from our new report on defence spending:

For decades, the 'peace dividend' of falling defence spending as a share of GDP has allowed more spending on things like health without such a big rise in the size of the state. That is no longer the case

In new @theifs.bsky.social work, we examine the fiscal challenge of the UK's commitment to higher defence spending. If met, for the first time in a long time health and defence spending would likely rise simultaneously (as a % of GDP). This would change the shape and/or size of the state.

Some great charts in this report. This one is my favourite. The UK has signed up the new NATO commitment to spend 3.5% of GDP on defence. The scale of the increase is fiscally challenging, and we've given ourselves a decade. Poland, on the other hand, has done it in just two years.

We have a new @theifs.bsky.social report out today on UK defence spending. Defence spending commitments, if met, will have a large impact on the shape and/or size of the state. We cover lots of important aspects of defence spending, including international comparisons and impacts on growth

We have a new @theifs.bsky.social report out today looking at the government's ambitious plans for public sector productivity. If productivity growth disappoints, the govt will have to choose between worse public service performance than planned or topping up budgets

How ambitious are the government's plans for public sector productivity? | Institute for Fiscal Studies This event will present new analysis on the current government's plans for improving public sector productivity, with a response from Jeremy Hunt MP.

A key factor at the next election will be the state of Britain's public services. That will depend on whether the government can make those services more productive, to deliver more without huge cash injections.

Join our @theifs.bsky.social event on Friday to hear more: ifs.org.uk/events/how-a...

How ambitious are the government's plans for public sector productivity? | Institute for Fiscal Studies This event will present new analysis on the current government's plans for improving public sector productivity, with a response from Jeremy Hunt MP.

Govt plans for public service spending and performance rely on ambitious productivity plans. Next Friday we have an @theifs.bsky.social online event looking at these plans and their implications, with new analysis from us and reflections from @jeremyhuntmp.bsky.social.
ifs.org.uk/events/how-a...

When and how should the government protect existing claimants from benefit cuts? | Institute for Fiscal Studies Important trade-offs are involved when designing transitional protections for benefit cuts.

When and how should the government protect existing claimants from benefit cuts?

@eduinlatimer.bsky.social and @matthewoulton.bsky.social discuss trade-offs involved when designing transitional protections for benefit cuts & what it means for recent benefit reforms:

ifs.org.uk/articles/whe...

The merits of student loan forgiveness and pension changes for resident doctors | Institute for Fiscal Studies The government is reportedly considering changing student loans and pensions for resident doctors. We consider the merits of potential changes.

This is with my excellent colleagues Kate Ogden (expert on student finance) and @laurenceobrien.bsky.social
(expert on pensions). Read the full piece, with lots more detail and discussion, here: ifs.org.uk/articles/mer...

There are reports that the government is considering changing student loans or pensions for resident doctors. We've written a new @theifs.bsky.social comment on the potential merits of such changes. Here's a summary:

@benzaranko.bsky.social and I have a new paper out in the Oxford Review of Economic Policy on the future of health and social care provision in the UK. It sets out the challenges and opportunities for increasing inputs and productivity in the NHS and adult social care in the coming decades

NEW: A response to government commitment to spend 5% of GDP on national security

@beeboileau.bsky.social‬ and @maxwarner.bsky.social‬ set out what this could mean for government spending and future fiscal events: ifs.org.uk/articles/res...