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.]
