NHS Hyberbole

People
ViewsApril 14th, 2014

The NHS in Wales has become a political football in recent weeks, despite the publication of what ought to have been a definitive statement on Wales vs England in the health league.  The Nuffield Trust and Health Foundation report compares the NHS in the four nations of the UK. Its most striking conclusion is that devolution hasn’t made much difference:

“it does not appear that the increasing divergence of policies since devolution has been associated with a matching divergence of performance. In addition, there is little sign that one country is consistently moving ahead of the others” (p115)

This statement is a blessing and a curse whatever your political stand-point.   

Crucially, it means that the English approach of choice and competition is no better than Wales’s ‘socialist dictatorship’ – different, without question, and delivering better on some  indicators – but not, overall, a better system. Equally, it means that the systems in Wales and Scotland, with their emphasis on free prescriptions and free social care for older people respectively, are not better than that in England. You can pick and choose your ideology but the Nuffield Trust and Health Foundation report suggests that whichever you chose doesn’t make much difference at least as far as the crude outcomes covered in this report are concerned. 

The second issue is that the report is not comprehensive.  The authors admit that their work is constrained by differences in data. There blog_banner_helpare many issues on which they cannot compare like with like because each nation measures health activity in different ways. So great swathes of key indicators of how well the NHS is performing – such as the management of long-term conditions, survival rates after cancer, infant mortality or the gap between rich and poor – are simply not included in the report.  These measures are arguably just as important as those contentious waiting times for hip replacements or hospital-acquired infections which do feature.  So while we know how Wales is doing on a limited range of measures, we don’t have a full picture. 

Third, as the report recognises, there are very significant variations in health needs between the four nations. It quotes (on p.96) a National Audit Office assessment of need using indicators of age, disability and wealth, which found that the scores were as follows: England (0.91), Scotland (0.98), Wales (1.07) and Northern Ireland (1.11).  In other words, comparing Wales to England without taking account of differences in need is a bit like comparing how long it takes a hare and tortoise to run 100 metres.  It tries to overcome this problem by using data from the North-East of England, an area more like the devolved nations than England as a whole, but for the most part there simply isn’t enough data to make the more accurate comparisons. 

Fourth, with a health burden that is considerably greater than in England’s it might be expected that health spending in Wales would be greater too – but Wales’s spending per head is now 10% less than that in England (at £1,900 per person compared with £2,100 in England).  This reflects the lower increases in spending on the NHS in Wales and Scotland compared to England (the latter rose by 115 per cent 2000/01 to 2012/13) while expenditure in Scotland and Wales rose by 99 per cent and 98 per cent respectively). Indeed, one could argue that given England’s higher expenditure and lower level of health needs it is surprising that it does not do better than Wales on most indicators. 

What is crystal clear from the Nuffield report is that the NHS in Wales is in fact performing reasonably well given the demands made on it and the money allocated to it.

For sure, there are areas where it could do better, but equally there are those where the NHS in England – not least given its lower demands and higher resources – could do better too.  The differences that can be measured between the devolved nations appear not to be attributable to the particular health care system adopted, and owe more to public spending and the make-up of the population. 

But when was this ever good copy?

Victoria Winckler is Director of the Bevan Foundation. 

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