Barry Gardiner, Labour politician, December 9 2019
The photo of four-year-old Jack Williment-Barr waiting on the floor in Leeds General Infirmary has captured a key election issue: the NHS. Labour politician Barry Gardiner claimed on BBC's Newsnight that the NHS has become "remarkably worse" and suggested the photo resonated with the British public as it echoes their experience of the NHS, but has the NHS really got worse under a Tory government?
There are many ways to measure the performance of the NHS including the number of procedures and operations undertaken, the number of patients waiting and their waiting times (its ability to meet demand), and NHS staff vacancies and staff satisfaction.
We know that waiting times across the NHS in A&E, cancer care and routine care are at their worst since targets were announced. In April 2010, 2.5 million people were waiting for elective treatment. In nine years, that figure nearly doubled. As of September 2019, 4.5 million people were waiting for elective procedures.
But over the years, the NHS has increased its activity, there are more operations, more hospital admissions and more people attending A&E. Notably it is managing this with fewer beds, which suggests that, over time, the nature of hospital care has changed. There are now more day cases than inpatient stays.
Efficiency would appear to be improving and the NHS is delivering more care, but it has struggled to meet the increase in demand from a growing older population.
On the supply side there is a growing number of staff vacancies (there are more than 100,000 vacancies in the NHS) and staff satisfaction is low. And in a recent survey, nearly 40% of NHS staff felt sick from the stress of the job.
Patient satisfaction is also on the decline - patients are reporting increasing problems getting GP appointments and contacting their GP practice - so Gardiner was probably correct that the photo chimes with the public's experience.
A challenge for any government
All major parties in Thursday's general election are promising more funding for the NHS, but is money the solution? The UK has experienced years of austerity under the Conservative government, and all budgets in the public sector have been limited. Annual growth in healthcare spending under Labour (1997-2010) averaged 5.6%, while the independent thinktank the Institute for Fiscal Studies estimates that public health spending grew in real terms by an average of 1.3% a year between 2010 and 2016, an era of the Conservative-Liberal Democrats coalition followed by a Conservative government.
But what people forget is that the end of the Labour government coincided with the global financial crisis. Indeed, healthcare spending retracted in 2009 (annual growth in spending was -0.2%). The UK is also experiencing unprecedented demographic change, in 50 years it is projected that there will be be 8.2 million people aged over 65 in the UK.
The NHS (like other healthcare systems) is a victim of its success. Healthcare is now so effective that people are surviving once-fatal diseases such as cancer, living longer but with several health conditions. Given the growing demand for healthcare and the preceding global economic climate, it may be that the NHS's performance would have been challenged under any government. Hindsight is a wonderful thing.
Barry Gardiner's statement that people's experience of the NHS has got remarkably worse is probably true.
Checking the Facts is a series by The Conversation in which experts review claims made on the 2019 general election campaign trail. If you have any claims for an expert to check, you can: email firstname.lastname@example.org tweet us @ConversationUK with #checkingthefacts DM us on Instagram @theconversationdotcom
Author: Paula Lorgelly - Professor of Health Economics, UCL