by Georgina Lee and Martin Williams
The health secretary, Jeremy Hunt, clashed with Professor Stephen Hawking over the weekend about the NHS.
The exchange saw claims and counter-claims scattered across the pages of the weekend papers, with each accusing the other of ignoring evidence.
So, who’s right? FactCheck looks at the four biggest points of contention between the pair.
Professor Hawking said in a Guardian article on Friday that “the balance of power in the UK is with private healthcare companies”.
Mr Hunt replied via an article in the Telegraph the following day. “As for use of the private sector, well last year it was 7.7 per cent of NHS spend – up just 0.1 per cent on the previous year,” he said.
Mr Hunt is right that 7.7 per cent of total NHS spending went to private healthcare providers in 2016-17. He’s also right that, as a proportion of NHS spending, that figure is up 0.1 per cent on the previous year. Department of Health annual accounts back him up on these claims.
But when we look at how these figures have changed over time, a different picture emerges.
Analysis of the Department’s accounts shows Mr Hunt is right that there has been only a tiny change in the overall proportion of NHS spending going to private providers in the last year.
However, he has presided over more significant increases in NHS privatisation since he became health secretary in 2012.
(We can only use figures from 2013-14 onwards because the government changed its data methods in that year).
And what about the types of care that are being privatised?
According to a 2017 report by the British Medical Association (BMA), 44 per cent of the money spent on private sector care in the NHS now goes on community health services. The BMA calculates that this represents a 271 per cent increase in privatisation of community healthcare since 2010-11.
The same report estimates that 25 per cent of NHS privatisation spending is on “general and acute care”, while just over 10 per cent goes on mental health and learning disability care.
The seven-day NHS and the weekend effect
Mr Hunt and Professor Hawking also clashed over the so-called “weekend effect” – the purported increase in mortality among patients admitted to hospital at the weekend.
The health secretary has made tackling this issue one of his main objectives, saying he wants to “deliver a 7 day NHS so we can promise NHS patients the same high quality care every day of the week”.
One of the main ways Mr Hunt has tried to achieve this is through changes to staffing, which prompted the biggest walkout in NHS history last year when junior doctors accused him of imposing unfair contracts on them.
Professor Hawking accused him of “cherry-picking” the evidence to support these controversial changes.
“[Hunt] had claimed that thousands of patients died unnecessarily because of poor hospital care at the weekend, and used this to argue that we needed to implement a seven-day NHS,” he said.
Rebuffing the accusation, Mr Hunt claimed that Professor Hawking was wrong about the lack of evidence.
He said: “You do have to make a judgement – and I based mine on the Fremantle [sic] study of 2015 because it was quite simply the most comprehensive and detailed paper ever done on the topic. No responsible health secretary could have ignored it.”
The Freemantle study in question, which was published in the British Medical Journal (BMJ), compared the outcomes of patients admitted on weekdays with those admitted at the weekend. It suggested that there is a higher mortality rate among the second group.
But the research behind it has since been questioned. Academics at Oxford University found that the “weekend effect” may be more to do with bad data than bad care.
They explained that most studies have relied on hospitals to record each patient’s experience using a code. But analysis suggests that those codes may not be wholly accurate.
For instance, the Oxford researchers found that some hospitals were recording stroke patients arriving for pre-planned follow-up appointments with the same code as emergency stroke admissions.
Pre-booked appointments are much more likely to be scheduled for a weekday. They are also far less likely to result in the patient’s death.
This could downplay the mortality rate for weekday admissions, and give the false impression that weekend rates were comparatively higher.
The Oxford academics suggested that the Freemantle study lacked “basic due diligence”, while Professor Freemantle stood by his work, saying: “I’ve been accused of being in the Government’s pocket by junior doctors, but it’s not true, I’m just a statistician.”
But the concerns do not end there. Since publishing the research, the BMJ has had to make a correction to the Freemantle study, pointing out: “One of the authors … is medical director of NHS England, [and] is a long standing proponent of improving NHS services seven days a week.”
It’s also important to remember that this is just one study. For scientists and statisticians, a fuller and more rounded understanding of any issue will generally come from a range of studies and reviews.
Indeed, one further problem for Mr Hunt is that even if the Freemantle study provided reliable evidence for the weekend effect, it does not explain why it might be happening.
How many people in the UK have private health insurance?
In his article, Professor Hawking also claimed that UK is moving towards a “US-style insurance system”. Mr Hunt tried to rebut this in a tweet by pointing out that the proportion of people with private medical insurance has gone down by 9.4 per cent since 2009.
We asked the Department for Health where this figure comes from. They haven’t got back to us, but we’ll update if they do.
In the meantime, our best estimates suggest Mr Hunt is probably right that the number of people with private medical insurance is lower now than it was eight years ago.
Research by health economists at LaingBuisson shows that in 2008, 4.35 million people had private insurance. The most recent data from 2015 shows around 4 million people were covered. That’s a drop of about 8 per cent.
But what’s not clear is whether this is a reflection of the government’s NHS policy, or whether there are wider factors at play. Indeed, the same report suggests that Brexit and recent rises in insurance premium tax are bigger problems for this industry than any changes to government health policy.
And although it hasn’t reached its 2008 peak, the number of people with private medical cover has crept back up in recent years, rising by 2.1 per cent between 2014 and 2015.
Ultimately, it’s very difficult to draw a clear link between the government’s health policy and the number of people with private medical insurance.
More money, doctors and nurses than ever?
Mr Hunt tweeted: “NHS under Cons has seen more money, more docs and more nurses than ever in history.”
These are claims we hear time and again.
The absolute numbers have gone up over time. However, the more revealing thing is how this compares with patient demand.
Here’s how health spending and staffing numbers have changed in comparison to the population since 2010.
Health spending in England has risen by £93.50 per person. Proportionate to the population, there are slightly more doctors, but fewer nurses.
And it’s not just overall population that matters; the proportion of older people is going up. That’s important because the NHS needs to spend more per head on older people, as this graph from the Department of Health shows.
The IFS predicts that the number of people aged 65 and over in England will increase by 9.2% between 2016 and 2021.
Furthermore, it is worth bearing in mind that even though health spending is higher than before, the rate of increase is slow compared to long run averages. Historically, UK health spending has risen by four per cent each year, in real terms.
Analysis by the IFS ahead of this year’s election showed that Conservative policy for NHS spending is well below the historic average of four per cent.
Therefore, while Mr Hunt’s claims are technically correct, they don’t give us the full story.
A Department of Health spokesperson said: “This government is committed to a world-class health service that is free at the point of use now and in the future.”