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BREAKING: Tories slashed spending on NHS and service cratered

Apparently Britain's National Health Service is having problems these days. What's the solution? More privatization? More accountability?  More doctors from overseas?

I don't want to pretend that the NHS's problems aren't complex. But at least one of them is pretty simple. Consider this chart from a couple of years ago:

This is plain enough. In 1997 Tony Blair and his Labour government took power and increased NHS funding growth to 6% per year (in real terms). In 2009, Labour lost power and Conservatives slashed NHS funding, approving real growth in its budget that averaged about 1.5% per year.

Remember those dates: 1997 and 2009. Now let's look at a chart showing public satisfaction with the NHS:

The bright red line indicates patients who are very or quite satisfied with the NHS. This number started to go up around 1997, peaked around 2010, and has been going down ever since then.

(It's gone down even further since 2018, but that's largely due to COVID-19 and a change in survey methodology. It's unfair to include that, so this chart stops at 2018.)

This shows a pretty simple picture: When Conservatives slashed spending growth from 6% to ~1.5%, service levels dropped and patient satisfaction went down. In absolute terms, that growth rate of 1.5% from 2009-18 compares to a real growth rate of about 3% for Medicare in the US. By any measure, the NHS is pretty starved for funds.

You can usually get away with this for a while, but eventually it all catches up to you. In Britain, "eventually" is now.

Any other questions?

26 thoughts on “BREAKING: Tories slashed spending on NHS and service cratered

  1. painedumonde

    1. Strangle.
    2. Stand over the body and exclaim, "Lazy, wasteful agency!" 3. Present your conveniently distanced friend's private solution.

    4. Relish profits

    1. Salamander

      That's about what I intended to write but you did it in a tiny fraction of the words! Thanks!

      Yes, NIH funding levels are having the intended effects. Huzzah.

  2. antiscience

    Gosh I wonder whether there was any sort of concurrent increase in outsourcing, use of agencies for "overflow" doctors and nurses, etc. B/c that's a great way of taking an organization that's strapped for cash (and hence can't hire full-timers) and turning it into an organization that's bleeding cash thru both orifices as it has to spend money like water to staff units that are overflowing with patients -- robbing Peter to pay Paul. And gosh, wouldn't it be convenient if the agencies that were chosen for these overflow staffing contracts were run by ... Tory donors ? Grandees ? Spouses of Tory grandees ?

    The Tories would never do that though, would they?

  3. J. Frank Parnell

    The cost reductions will continue untill patient satisfation scores increase. Whatever works for the US IRS will work for the British NHS.

  4. jte21

    But Brits were promised that after Brexit, the NHS would be all flush again as billions of pounds that were being wasted on lavish crepes bars for EU bureaucrats in Brussels would be brought home again an invested in health care. Are you suggesting the "leave" campaigners were being disingenuous about this?

    1. jte21

      You have a job that has earned you $50k a year for a long time. You lose it and have to settle for some job that pays you $30k now. Then you get a raise that brings you to $35k. Hey, a big raise! Are you any better off, though, than when you made 50k? That's essentially what's happened to the NHS. They've been massively underfunded for the past decade, then had to cope with Covid, and now they have a little bit more, but nowhere near enough to restore the level of service that they could provide in the 00s.

      1. rick_jones

        Kevin's chart shows continuous, positive growth beyond inflation in NHS funding. So that isn't going from $50K to $30K to $35K. That is, if anything, going from $30K to $50K to $55K.

    2. J. Frank Parnell

      Medical care costs typically increase faster than inflation. This is because new surgical and drug based interventions are continuously being developed that allow treatment of conditions that in the past weren't treated. Should society ration such new treatments to those who can afford them? One can argue rationing makes some sense to avoid skyrocketing health care costs for minimal gains, but we shouldn't kid ourselves about what we are doing.

      1. Jasper_in_Boston

        Medical care costs typically increase faster than inflation.

        Right. Both the aging of the population and the imperviousness of healthcare to automation (Baumol effects) tend to mean healthcare's share of GDP will increase over the long term—add to this the natural tendency of societies to spend more on superior goods as they grow wealthier.

        In fairness, the UK has done a better job than most rich countries at holding down healthcare costs, but there's no free lunch, and holding such costs below a certain point cannot fail to result in a deterioration in service.

          1. Jasper_in_Boston

            Not spending enough money to maintain staffing levels will inevitably reduce service. Again, Baumol effects and the aging of the population suggest countries generally have to increase healthcare spending by more than the growth of the economy if they want to avoid reductions in quality of service*. That's arguably good if you're concerned about holding in check healthcare's share of GDP. Not so good if you want knee surgery and don't have the funds to go private.

            *Ironically, the US might be the one country were this trend can be bucked. There's fat that can be squeezed out of US healthcare, I think. But the UK has long run a pretty lean health service by rich country standards.

    1. Salamander

      Seriously? Up until I hit Medicare age, my monthly premiums were increasing by a minimum of 20% per year - sometimes 50%. And I always had one of the high deductible policies.

        1. Jasper_in_Boston

          Still scary, even after the arrival of Obamacare. I'm an expat, and one of the single biggest impediments to returning home is healthcare coverage. I wouldn't have to find a job with an employer if not for concerns about coverage: I could easily consult/free lance. But that means buying a policy on the exchange, and, as you know, the ACA's community rating provision allowed age-based premium discrimination up to a significant multiple. I'm afraid to look it up, but I strongly suspect someone in my shoes (50s) is looking at an extra 10K a year just for a bronze plan, plus whatever out of pocket costs might accompany actually needing healthcare. Do-able, sure, but a royal PIA, and one consideration that weighs in favor of staying abroad until I'm 65.

          1. Salamander

            Yes, I found that being over 50 was apparently a "pre-existing condition" before ObamaCare, and the local Good Health Insurance carrier refused to insure me at all. (So I ended up with Blue Cross, which was very bad.)

  5. surplus_newt

    I actually do have another question. I cannot for my life remember where I read this, but I thought Thatcher and Major had introduced "reforms" to the NHS that caused spending to get tilted towards management and administration. Do you know if that's correct or if there's data on how this ratio changed between governments?

  6. Mark

    The first chart in England only while the second is Great Britain.
    Not sure this make much difference, could it be that Scotland, Northern Ireland and Wales are significantly more/less satisfied with the health system.

  7. AdamD

    The other underappreciated part of this is that the NHS becomes the public service of last resort because of huge cuts to other parts of the social safety net.

    Compared to other departments, Health spending was actually protected even though it took a real terms cut (they claim to have increased it every year so are making a misleading, if technically accurate, argument).

    But over the same period the government slashed funding for local government and social care and any other service that Conservative voters tend not to interact with.

    Which means that you have a situation where thousands of people who should have been discharged into the social care system can't be and therefore take up space in hospitals.

    It's similar with schools where that's the bit that politically you can't cut too much (because more middle class parents would revolt) but schools end up having to pick up the slack for huge cuts elsewhere to anti-poverty programmes which all compound over time.

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