NHS breaking point?

[IvanV]

Pay for nurses is already higher in Slovenia and will be in Poland as well in a few years (along the current trajectory). The same applies to many of the other European states that fifteen years ago British policymakers could assume would supply all the skilled healthcare workers that Britain would need.

For clarity, that's not exactly what it says. It compares nurses' wages with the average wage in that country. To say that a nurse's wage is higher in one country than another, then the most suitable comparison would probably be to compare the after-tax wages at purchasing power parity exchange rates.

Also, it doesn't say whether it has adjusted for taxation. In the absence of a comment, I assume it probably hasn't. But given that it is comparing nurses' wages with average wages, it probably makes little difference if you adjust for taxation or not. But in making cross-country comparisons of absolute wage levels, it becomes more important to adjust for taxation.

Another complication is that a nurse's job may vary from country to country, and the plausible wage accordingly. What is a nurse's job in Britain is very different in the past from today. My mother trained as a state registered nurse, leaving school at 16 with 3 O-levels (what GCSEs were called then). Now you need a degree. In her day, many of the tasks she carried out would today be performed by a worker with lower status than a nurse.

This is not to deny the conclusions, as much other information points in the same direction. Just to say that this particular statistical comparison doesn't really clearly show it on its own.

[Woodchopper]

Pay for nurses is already higher in Slovenia and will be in Poland as well in a few years (along the current trajectory). The same applies to many of the other European states that fifteen years ago British policymakers could assume would supply all the skilled healthcare workers that Britain would need.

For clarity, that's not exactly what it says. It compares nurses' wages with the average wage in that country. To say that a nurse's wage is higher in one country than another, then the most suitable comparison would probably be to compare the after-tax wages at purchasing power parity exchange rates.

Also, it doesn't say whether it has adjusted for taxation. In the absence of a comment, I assume it probably hasn't. But given that it is comparing nurses' wages with average wages, it probably makes little difference if you adjust for taxation or not. But in making cross-country comparisons of absolute wage levels, it becomes more important to adjust for taxation.

Another complication is that a nurse's job may vary from country to country, and the plausible wage accordingly. What is a nurse's job in Britain is very different in the past from today. My mother trained as a state registered nurse, leaving school at 16 with 3 O-levels (what GCSEs were called then). Now you need a degree. In her day, many of the tasks she carried out would today be performed by a worker with lower status than a nurse.

This is not to deny the conclusions, as much other information points in the same direction. Just to say that this particular statistical comparison doesn't really clearly show it on its own.

Thanks Ivan for the clarification, I should have read it more carefully.

As the thread and article make clear the job is very different in other countries. The problem for Britain is that people who have moved abroad report that the working environment in the NHS is far worse than in their new country.

Overall, this is what 15 years of economic stagnation looks like. Pay and conditions are or will be worse than in places from which Britain used to get skilled workers from.

[Sciolus]

This was discussed a few weeks ago on More or Less, and the overall conclusion was that nurses' pay in the UK was roughly in the middle of the pack by European standards, worse than typical northern and western countries, better than eastern and southern countries -- but the latter are fast catching up. Unfortunately, their discussion conspicuously didn't address the issue of "title deflation", where nurses these days do jobs that doctors would have done a couple of decades ago; my suspicion is that this has been greater in the UK than elsewhere, which would make UK pay even worse.

Pay is probably not the primary motivator for most people to leave the NHS or its failure to recruit, but it's a simple indicator of overall government commitment to the NHS and its staff. Which is sh.t.

[TimW]

The PM is announcing a 15 year plan to increase NHS staffing by 300,000.
Presumably this hinges on the Conservative Party becoming the opposition.
https://www.bbc.co.uk/news/live/health-66064502

[Formerly AvP]

The PM is announcing a 15 year plan to increase NHS staffing by 300,000.
Presumably this hinges on the Conservative Party becoming the opposition.
https://www.bbc.co.uk/news/live/health-66064502

The plan itself was largely developed with internal NHS input and external expert guidance, and probably would have been fairly similar under a Labour government - Labour are claiming that the Tories have stolen their plans to some extent. There are significant long term spending committments, though - I read the Plan as promising that the number of Foundation doctor posts in the NHS will be increased to cope with '10,000' UK medical students PLUS the intenational doctors who also apply. That will be expensive in, say, 5 years time, and I can imagine the Treasury backing away from that one when the time comes to deliver.
Laura Kuessenberg has an article on the BBC website which I read as saying "Everyone is either too stupid or too scared to say that the NHS should be scrapped". I did wonder if scrapping the NHS was her personal view.
https://www.bbc.co.uk/news/uk-politics-66068224


Disclosure: I provided input to the discussion about novel medical student routes, including APEL, apprenticeships, and internships.

[IvanV]

Laura Kuessenberg has an article on the BBC website which I read as saying "Everyone is either too stupid or too scared to say that the NHS should be scrapped". I did wonder if scrapping the NHS was her personal view.
https://www.bbc.co.uk/news/uk-politics-66068224

The original version of the graph in that article at King's Fund makes it look even worse. Has some other interesting graphics and a link to the full report.

But there is another attempt to make a similar graph, a couple of years older, from Eurostat, which potentially doesn't make us look quite as bad. The UK is missing, but if we assume the UK number is similar to the one in the other graph, then there are clearly several other countries, mainly in central & eastern Europe, which are rather worse than the UK. That graph also makes Germany look rather bad. As they include several nearby countries in that graph, including NO, IS, CH, TU and RU, I guess the reason UK is missing is due to our present government playing anti-EU politics and refusing to give them any data.

Certainly what LK points to draws attention to a disconnect.

According to researchers at the King's Fund, the public gave the NHS its worst rating since records began 40 years ago. Just 29% said they were satisfied with the NHS in 2022.

And yet we still love it. A whopping 90% of the public agrees the service should be free and available to everyone.

But it doesn't imply that the NHS, as an overall concept, is a bad idea. And we shouldn't laugh at people thinking that more money should be spend on the NHS when, hurr, hurr, there's no more money. There is potential for more money, both from taxes and from increasing co-payments. There is substantial scope for increasing taxes in Britain - they are lower than in many nearby countries - although we should not forget the many other things that are underfunded and need more funding from increased taxes. But if the British electorate is heavily wedded to our relatively low tax environment, then we will have to prioritise what we spend our taxes on to avoid the present attempt to spread them too widely and making everything sh.t. Another option is increased co-payments. We already have some co-payments in our health services in the form of prescription charges, and basic charges for dental and optical care which everyone must pay. There is scope for extending that, especially for separating out more things like dental and optical.

I was interested to read recently that in NZ you have to pay a basic charge for a GP appointment, which successfully deters many time-wasters, and gives GPs enough time to have longer patient appointments, which is a very good thing. I understand the disadvantages of GP charges. But if NZ can have much better overall outcomes than us, and have a GP charge, then it seems it isn't necessarily a bad mistake. The balance of advantage might be good - further thought needed.

[bjn]

How much ‘time wasting’ actually happens because the service is free at the point of use? Would bringing in charging deter people from seeking early interventions and so lead to worst and more expensive outcomes? (Which happens in the USA already, due to under insurance or expensive co-pays).

[dyqik]

How much ‘time wasting’ actually happens because the service is free at the point of use? Would bringing in charging deter people from seeking early interventions and so lead to worst and more expensive outcomes? (Which happens in the USA already, due to under insurance or expensive co-pays).

The general feeling I get from being over here is that copays make it more expensive to run a healthcare system, for these reasons, plus the cost of running a billing and collections system. But insurance companies don't see the general cost, so they remain.

You also have to have some degree of means testing, if the copays are going to be high enough to pay for implementing a copay system, and that adds even more cost, and adds a bureaucratic barrier to access on top of the cost one.

[Fishnut]

How much ‘time wasting’ actually happens because the service is free at the point of use? Would bringing in charging deter people from seeking early interventions and so lead to worst and more expensive outcomes? (Which happens in the USA already, due to under insurance or expensive co-pays).

Anecdote alert - once when I lived overseas the healthcare system was a pay for one that I didn't really understand. I got sick, decided not to go to the doctor because of the cost, then ended up collapsing at a shopping centre unable to breathe. I was taken to hospital in an ambulance, had various tests and was told I had a chest infection that needed antibiotics and steroids. It took a couple of months before I felt properly well again. Fortunately it turned out it didn't cost me anything because of reciprocal healthcare agreements, but it really brought home to me how making people pay at the point of use is a bad idea.

Prevention is better than cure, a stitch in time saves nine, and getting people early interventions saves money in the long-term.

[IvanV]

How much ‘time wasting’ actually happens because the service is free at the point of use? Would bringing in charging deter people from seeking early interventions and so lead to worst and more expensive outcomes? (Which happens in the USA already, due to under insurance or expensive co-pays).

The general feeling I get from being over here is that copays make it more expensive to run a healthcare system, for these reasons, plus the cost of running a billing and collections system. But insurance companies don't see the general cost, so they remain.

You also have to have some degree of means testing, if the copays are going to be high enough to pay for implementing a copay system, and that adds even more cost, and adds a bureaucratic barrier to access on top of the cost one.

There is a widespread error of thinking that the US is the only alternative.

It is widely demonstrated that you can have co-pays which avoid the US problem. Britain already has co-pays which avoid the US problem. I suggested extending them, not creating new US-type co-pays. There are co-pays widely on the continent which do not have the US problem.

Some of the UK co-pays are subject to means testing, such as free prescriptions for people in receipt of state benefits. This doesn't have to be a problem. People who qualify for them usually do not have difficulty accessing them. Usually they are defined in terms of another means-tested benefit, so you already have the evidence to wave at the pharmacist.

[IvanV]

How much ‘time wasting’ actually happens because the service is free at the point of use? Would bringing in charging deter people from seeking early interventions and so lead to worst and more expensive outcomes?

The ex-UK, now NZ, GP suggested that the "time-wasters", or more politely people he can do nothing for, that he has to repeatedly explain the same thing to them, are a material factor in taking up a GP's time (and patience) in the UK.

There is a debate in NZ about the deterrence effect of fees. It seems that there is a system rather like UK dentistry that there are state-subsidised GPs where the maximum charge for a consultation is quite modest. But in wealthier areas, these doctors are thin on the ground and if you go to an unsubsidised GP you have to pay the full cost which is about 3 times as much. There are also people who are exempt from the fees.

All I can say is that health outcomes are much better in NZ than UK. There would need to be some kind of a detailed study to assess the various reasons for the differences in outcome.

There is a strong argument that if you have means-tested charges, why not just tax the rich more? It seems to be difficult to get elected if you propose this. If it is hard charging higher taxes, maybe it is easier to get the money out of people by making people pay for something, while exempting the poor. We all pay the same prescription charges, save children, the old and those who are exempt on income grounds. Yet there are few complaints about it. And if the better off have an option to pay more and get a better version, as with UK dentistry and opticians, then maybe you can get even more out of them.

[discovolante]

How much ‘time wasting’ actually happens because the service is free at the point of use? Would bringing in charging deter people from seeking early interventions and so lead to worst and more expensive outcomes? (Which happens in the USA already, due to under insurance or expensive co-pays).

The general feeling I get from being over here is that copays make it more expensive to run a healthcare system, for these reasons, plus the cost of running a billing and collections system. But insurance companies don't see the general cost, so they remain.

You also have to have some degree of means testing, if the copays are going to be high enough to pay for implementing a copay system, and that adds even more cost, and adds a bureaucratic barrier to access on top of the cost one.

There is a widespread error of thinking that the US is the only alternative.

It is widely demonstrated that you can have co-pays which avoid the US problem. Britain already has co-pays which avoid the US problem. I suggested extending them, not creating new US-type co-pays. There are co-pays widely on the continent which do not have the US problem.

Some of the UK co-pays are subject to means testing, such as free prescriptions in England for people in receipt of state benefits. This doesn't have to be a problem. People who qualify for them usually do not have difficulty accessing them. Usually they are defined in terms of another means-tested benefit, so you already have the evidence to wave at the pharmacist.

Fixed that for you.

[IvanV]

...free prescriptions in England for people in receipt of state benefits...

Fixed that for you.

Of course, that's free for everyone in Scotland.

[discovolante]

And Wales and NI.

[dyqik]

How much ‘time wasting’ actually happens because the service is free at the point of use? Would bringing in charging deter people from seeking early interventions and so lead to worst and more expensive outcomes? (Which happens in the USA already, due to under insurance or expensive co-pays).

The general feeling I get from being over here is that copays make it more expensive to run a healthcare system, for these reasons, plus the cost of running a billing and collections system. But insurance companies don't see the general cost, so they remain.

You also have to have some degree of means testing, if the copays are going to be high enough to pay for implementing a copay system, and that adds even more cost, and adds a bureaucratic barrier to access on top of the cost one.

There is a widespread error of thinking that the US is the only alternative.

It may be widespread, but it's not an error I made.

It is widely demonstrated that you can have co-pays which avoid the US problem. Britain already has co-pays which avoid the US problem. I suggested extending them, not creating new US-type co-pays. There are co-pays widely on the continent which do not have the US problem.

Some of the UK co-pays are subject to means testing, such as free prescriptions for people in receipt of state benefits. This doesn't have to be a problem. People who qualify for them usually do not have difficulty accessing them. Usually they are defined in terms of another means-tested benefit, so you already have the evidence to wave at the pharmacist.

As I have family members who have had that and other means tested benefits taken away from them, despite no change in material circumstances or benefits rules, and who then got them back after two years of legal action and the intervention of two MPs, at a significant cost to the state for legal fees and administrative investigations, you are wrong when you imply that this isn't barrier to healthcare access in the UK, and likely wrong that it pays for itself, given the known error rate.

[discovolante]

The general feeling I get from being over here is that copays make it more expensive to run a healthcare system, for these reasons, plus the cost of running a billing and collections system. But insurance companies don't see the general cost, so they remain.

You also have to have some degree of means testing, if the copays are going to be high enough to pay for implementing a copay system, and that adds even more cost, and adds a bureaucratic barrier to access on top of the cost one.

There is a widespread error of thinking that the US is the only alternative.

It may be widespread, but it's not an error I made.

It is widely demonstrated that you can have co-pays which avoid the US problem. Britain already has co-pays which avoid the US problem. I suggested extending them, not creating new US-type co-pays. There are co-pays widely on the continent which do not have the US problem.

Some of the UK co-pays are subject to means testing, such as free prescriptions for people in receipt of state benefits. This doesn't have to be a problem. People who qualify for them usually do not have difficulty accessing them. Usually they are defined in terms of another means-tested benefit, so you already have the evidence to wave at the pharmacist.

As I have family members who have had that and other means tested benefits taken away from them, despite no change in material circumstances or benefits rules, and who then got them back after two years of legal action and the intervention of two MPs, at a significant cost to the state for legal fees and administrative investigations, you are wrong when you imply that this isn't barrier to healthcare access in the UK, and likely wrong that it pays for itself, given the known error rate.

Plus one billion, sorry your family have had to go through that. As has been pointed out before, there aren't many other legal processes where the 'punishment' is applied before you've been given the opportunity to challenge it.

[Millennie Al]

How much ‘time wasting’ actually happens because the service is free at the point of use?

I expect that it's the same as in so many public-facing services: they are few in number but make up for that by their persistence.


One of the ways we should be helping the NHS is by persuading people that its service is not very good and that you should go private instead. That way the people who can afford to pay would be much more likely to pay and leave the free NHS services for poorer people. Another way would be have different classes of service. Basic service would be just the essential healthcare, while for a fee you could get a more luxurious service. For example, for hospital stays you would get a private room, newspapers delivered, a fancy menu etc. The price of these could be set at significantly higher than the cost of providing them, thereby effectively colecting a subsidy for the basic service. A bit like how airlines charge extra for lots of stuff.

[IvanV]

As I have family members who have had that and other means tested benefits taken away from them, despite no change in material circumstances or benefits rules, and who then got them back after two years of legal action and the intervention of two MPs, at a significant cost to the state for legal fees and administrative investigations, you are wrong when you imply that this isn't barrier to healthcare access in the UK, and likely wrong that it pays for itself, given the known error rate.

I'm sorry to learn this.

It wasn't like this before the present government came to power. It doesn't have to be like this.

Rather, the present government has - some would say deliberately - created a hostile administrative and legal environment for gaining the means-tested benefits that are in its own laws. It creates a mythology of "scroungers" to justify this to a Mail-reading audience.

So, whilst this is a sad reality of the present situation, it is not an inherent criticism of the proposal.

[discovolante]

As I have family members who have had that and other means tested benefits taken away from them, despite no change in material circumstances or benefits rules, and who then got them back after two years of legal action and the intervention of two MPs, at a significant cost to the state for legal fees and administrative investigations, you are wrong when you imply that this isn't barrier to healthcare access in the UK, and likely wrong that it pays for itself, given the known error rate.

I'm sorry to learn this.

It wasn't like this before the present government came to power. It doesn't have to be like this.

Rather, the present government has - some would say deliberately - created a hostile administrative and legal environment for gaining the means-tested benefits that are in its own laws. It creates a mythology of "scroungers" to justify this to a Mail-reading audience.

So, whilst this is a sad reality of the present situation, it is not an inherent criticism of the proposal.

It was difficult under Labour too. Labour changed Incapacity Benefit to Employment Support Allowance, which made it more difficult to get, for example. Jobseekers Allowance sanctions (stopping benefits and having to appeal before you get them back, which doesn't just apply to JSA but were common with that benefit) existed under Labour. The 'bedroom tax' was effectively in place for private rented accommodation under Labour. To give a few examples. The Tories just took all that and kept running with it way past the finish line.

[Woodchopper]

The original version of the graph in that article at King's Fund makes it look even worse. Has some other interesting graphics and a link to the full report.

The most obvious cause of the UK's poor record appears to be that Britain is spending less per capita on healthcare than most of the other countries looked at in the King's Fund report. Here's a link to the OECD figures: https://www.oecd-ilibrary.org/sites/154 ... 54e8143-en#

British spending is slightly higher than Italy or Spain, but then those two countries have healthier populations. If the UK wants to have healthcare systems similar to other countries in Northern Europe then spending would need to increase a lot. For example, spending per capita in Ireland is about USD 1000 higher, in Denmark its circa 1400 higher, and in the Netherlands its circa 1650 higher.

As I have family members who have had that and other means tested benefits taken away from them, despite no change in material circumstances or benefits rules, and who then got them back after two years of legal action and the intervention of two MPs, at a significant cost to the state for legal fees and administrative investigations, you are wrong when you imply that this isn't barrier to healthcare access in the UK, and likely wrong that it pays for itself, given the known error rate.

I'm sorry to learn this.

It wasn't like this before the present government came to power. It doesn't have to be like this.

Rather, the present government has - some would say deliberately - created a hostile administrative and legal environment for gaining the means-tested benefits that are in its own laws. It creates a mythology of "scroungers" to justify this to a Mail-reading audience.

So, whilst this is a sad reality of the present situation, it is not an inherent criticism of the proposal.

It was difficult under Labour too. Labour changed Incapacity Benefit to Employment Support Allowance, which made it more difficult to get, for example. Jobseekers Allowance sanctions (stopping benefits and having to appeal before you get them back, which doesn't just apply to JSA but were common with that benefit) existed under Labour. The 'bedroom tax' was effectively in place for private rented accommodation under Labour. To give a few examples. The Tories just took all that and kept running with it way past the finish line.

This is the problem with wanting to introduce Nordic style copayment into a state healthcare system. Having people pay circa €20 when they visit the GP works in Finland or Sweden because the benefits systems are set up to provide assistance to people on low incomes rather than to punish people for being poor. Copayment isn't a huge social problem in, for example Norway, because people on benefits are exempt. But that only works so long as people who wouldn't be able to afford to go to the doctor are going to be covered by the social welfare system anyway, and the welfare and healthcare systems are set up so they people who are exempt can easily be identified.

[El Pollo Diablo]

Just wanted to muddy the waters by pointing out that Kwarteng is promising genuinely huge tax cuts and "growth opportunities" in about 6 weeks time, I just wanted this thread to be nice and warmed up to welcome the news.

Ha, haven't looked at this thread for ages and this was the oldest unread post. An evergreen one, I'm sure we can agree.

[TimW]

Just wanted to muddy the waters by pointing out that Kwarteng is promising genuinely huge tax cuts and "growth opportunities" in about 6 weeks time, I just wanted this thread to be nice and warmed up to welcome the news.

Ha, haven't looked at this thread for ages and this was the oldest unread post. An evergreen one, I'm sure we can agree.

Sounds like you must be a member of the Anti-Growth Coalition.

[Woodchopper]

The NHS is losing senior doctors to countries including Ireland, Australia and the United Arab Emirates because they can double their salary and enjoy better working conditions.

Medical leaders are concerned about a growing exodus of hugely experienced doctors and surgeons to foreign healthcare systems, the Guardian has been told. Rising numbers of middle-aged consultants are opting for a new life abroad, which is exacerbating the NHS workforce crisis.

[…]

Global medical recruiters have for years been able to tempt junior doctors away from the NHS, because they are younger and have fewer reasons to remain in the UK.

But medical leaders are increasingly worried about an emerging trend of senior doctors, in some cases people with several decades of experience, quitting the NHS and the UK altogether.

Simon Walsh, the deputy chair of the British Medical Association consultants’ committee, said rising numbers were being tempted to take jobs abroad because of how much more money they could earn and often superior working conditions.

[…]

Global medical recruiters are directly targeting picket lines. At the Queen Elizabeth hospital in Birmingham this week, a recruitment agency handed out bottled water to striking consultants and offered them new roles in Ireland paying up to £233,000.

https://www.theguardian.com/society/202 ... re-systems

[Woodchopper]

The original version of the graph in that article at King's Fund makes it look even worse. Has some other interesting graphics and a link to the full report.

The most obvious cause of the UK's poor record appears to be that Britain is spending less per capita on healthcare than most of the other countries looked at in the King's Fund report. Here's a link to the OECD figures: https://www.oecd-ilibrary.org/sites/154 ... 54e8143-en#

British spending is slightly higher than Italy or Spain, but then those two countries have healthier populations. If the UK wants to have healthcare systems similar to other countries in Northern Europe then spending would need to increase a lot. For example, spending per capita in Ireland is about USD 1000 higher, in Denmark its circa 1400 higher, and in the Netherlands its circa 1650 higher.

Back to this, and I recall an obscure discussion during Covid times. To recap, the UK doesn’t have a population register and relies upon the census to know the population size. There was a discussion about vaccination as the figures for total population used by the NHS - National Immunisation Management Service (NIMS) - were much higher than the population estimates produced by the office for national statistics (ONS)

See for example here: http://www.eecs.qmul.ac.uk/~norman/pape ... accine.pdf

According to the NIMS vaccination survey the population of England is 61,941,471, whereas the ONS population survey estimate is 56,550,138.

Certainly the NIMS numbers could be an overestimate. But if the ONS numbers are an underestimate then spending per capita would be even lower.

[Woodchopper]

IFS report on the NHS staffing plan.

The plan aims to increase the number of staff employed by the English NHS from around 1.5 million in 2021–22 to between 2.3 and 2.4 million in 2036–37. This would be equivalent to average growth in the size of the NHS workforce of between 3.1% and 3.4% per year. For context, we estimate that NHS staffing numbers grew by around 1.1% per year between 2009–10 and 2019–20.

If this increase in the NHS workforce is delivered, we estimate that almost half (49%) of public sector workers in England will work for the NHS in 2036–37, compared with 38% in 2021–22 and 29% in 2009–10. By 2036–37, we estimate that one in eleven (9%) of all workers in England will work for the NHS, compared with one in seventeen (6%) in 2021–22 and 2009–10.

While the plan included £2.4 billion of additional funding for the training of new staff, it did not consider the (much larger) medium-term implications of this large increase in staffing for the NHS paybill, nor the required increase in other inputs if the NHS is to treat substantially more patients. This will mean difficult fiscal decisions at future Spending Reviews.

Increasing the size of the workforce so rapidly will likely require NHS wages to become more generous in real terms and – potentially – match or even exceed growth in wages in the rest of the economy. It will also likely require an increase in non-staffing inputs to healthcare (most obviously things such as drugs and equipment).

Under a central set of assumptions, the workforce plan implies annual NHS budget increases of around 3.6% per year in real terms (or 70% in total by 2036–37). This would be in line with the long-run average real-terms growth rate in UK health spending (3.6% per year from 1949–50 to 2022–23), but higher than the 2.4% per year seen since 2009–10.
[...]

In the central case, spending on the NHS in England would be around 2% of GDP higher by 2036–37, relative to 2021–22 (the starting point for the workforce plan). That is similar to the increase in UK health spending over the 15 years to 2008–09 (2.2% of GDP) and equivalent to around an extra £50 billion in today’s terms. To give a sense of scale, raising that sort of sum would require increasing the standard rate of VAT from 20% to around 27% by 2036–37 or increasing all income tax rates by around 6 percentage points. Other funding options would of course be available.

By the NHS’s own estimates, the staffing increases contained in the plan will only be enough to meet NHS demand if productivity can be increased by between 1.5% and 2% per year: an extremely ambitious target well above what the NHS is estimated to have achieved in the past. The Office for National Statistics estimates that quality-adjusted productivity in the NHS increased by an average 0.8% per year between 1995–96 (when the data series starts) and 2019–20, and 1.2% per year between 2009–10 and 2019–20. While not perfectly comparable to the measure of labour productivity used in the workforce plan, this gives a sense of the scale of the ambition – particularly as, since the onset of the pandemic, measured productivity performance in the NHS has been even weaker.

https://ifs.org.uk/publications/implica ... force-plan