Wednesday, February 17, 2016

On its last feet? NHS myths and reality

There's a lot about the NHS in the news recently, particularly given the BMA-organised strikes.  But what's the truth of the matter?  Where are the facts?  Both the government and the BMA have given us a poor grasp of the NHS reality so I sat down for a few hours and did some digging.  Here's what I found.

NHS starved of funding?

A constant claim is that the NHS is starved of funding.  Is it?  I trawled through 30 years of government funding and here's what I found.  I compared the growth of spending, adjusted for inflation, on a per person basis for the NHS, education and defence.  Here's the chart of the numbers.

Conclusion: Health spending today vs 1986 is over 2.75 times as much per person in real terms.  This compared with 1.8 times as much for Education and a reduction of over 20% for defence.  By any reasonable measure, the NHS is not starved of funding.

BMA taken over by the left wing?

There have been statements that the BMA (the British Medical Association or the medical trade union) is run by the left wing.  I've seen this both claimed and denied.  What are the facts?

  • Mark Porter, chairman of the BMA, describes his politics as left wing.
  • Dr Kailash Chand, deputy chairman of the BMA, made it on to the shortlist as a Labour parliamentary candidate.
  • Dr Jacky Davis, a member of the BMA council, has appeared at Marxist events and on a panel alongside Jeremy Corbyn and John McDonnell
  • Tom Dolphin, a member of the BMA council, is a member of the Labour Party.
None of the board are declared members of any other major UK political parties as far as I can tell (but please correct me if I am wrong).  Incidentally, it's clear that the BMA constantly cries wolf over funding: try Googling "BMA 2007 NHS crisis" and substitute different years: it appears that no matter what year, the BMA believes that the NHS has a funding crisis and no matter what government is in power.

Conclusion: It looks rather like the BMA leadership tends to be left-wing.  It seems statistically unlikely that this political stance is shared by its membership.

Is the government approach reasonable?

One of the key reasons the government has put forward for the changes is that the death rate is higher at weekends.  (Incidentally this appears to be the case in other countries, too.)  The statistics are complicated but in essence there appears to be about a 10% - 15% higher mortality rate at weekends leading to 11,000 excess deaths a year: a large absolute number, but small in percentage terms.

Surely 11,000 people a year are worth saving?

I suspect a problem with the government's approach has been unduly prescriptive in how to reduce these deaths.  It's also done poor job of explaining this to the general public: it can (and has) been argued that to reduce weekend death rate to the level of weekdays, you need the same level of service.

Conclusion: The government has identified a real problem but its approach to fixing this has been inept.

Do junior doctors work unreasonable hours?

The hours that doctors work in their final year or two of training has always been legendary (in a bad way), not just in the UK.

However, the essence of the unreasonable hours claim appears to be about work after qualifying.  There are cases where hours have been excessive: up to 90 hours a week have been reported.  However, part of the proposed settlement is that doctors' maximum allowed hours will be limited to 72 hours from the 91 allowed currently.  (In my view, even 72 hours is too high.)

Conclusion: Yes, some doctors do work excessive hours.  But the proposed settlement would reduce this.


The government and the BMA actually agree on most points.  It's a pity that they are letting relatively minor disagreements escalate.


Ian Allenbrook said...

An issue I have read about is that "they" want/expect the junior doctors to work the added hours at the same salary as before -i.e. Longer hours for same pay = lower hourly pay = not a great incentive? Probably a good idea if you are trying to reduce staff numbers, but not sure if this is the case here?

Sean Haffey said...

Hi Ian

The salary bill overall stays the same. Payment for "normal" hours goes up by 11%; to compensate, payment for overtime goes down.

So the doctors who work little overtime will be better off; the ones who work a lot of overtime will be worse off (and I suspect that there's a majority in the middle who will earn about the same).