Stuart Hoddinott @StuartHoddinott Twitter profile

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Stuart Hoddinott

10 months

NEW REPORT: despite higher funding and more staff, hospitals are struggling to return to pre-pandemic performance, with most activity only just reaching levels achieved in February 2020 What's going on? Thread below

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Stuart Hoddinott

@StuartHoddinott

7 months

Thanks for highlighting Jeremy, we agree that low NHS productivity is a real problem A quick thread to explain the causes and why the strategies that led to productivity improvements during the 2010s likely contributed to some of the current problems 🧵👇

Jeremy Hunt

@Jeremy_Hunt

7 months

This is what much of the debate about our post-election spending plans is missing. NHS funding is also up by a third since 2010. The answer isn’t just more money, it has to be about productivity. If we can hit the 0.5% productivity growth increases we regularly got in the years

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Stuart Hoddinott

@StuartHoddinott

9 months

Completely agree that doctors and nurses lose too much of their time to admin work But that's mostly due to a lack of managerial staff and poor IT - e.g. computers that barely turn on Neither of those are fixed by investing in "AI"

HM Treasury

@hmtreasury

9 months

Our police, teachers and healthcare professionals lose too much of their time to admin. We want them to have more time to teach our kids, treat us when we’re sick and to keep us safe. Today we’re outlining key opportunities to cut admin and safely harness AI.

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Stuart Hoddinott

@StuartHoddinott

7 months

It also means a lack of equipment and poor IT systems The UK has half the number of CT scanners compared to the OECD average Staff are working with computers that struggle to turn on and which cannot communicate effectively across different parts of the NHS when they do

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Stuart Hoddinott

@StuartHoddinott

7 months

Govt achieved many of those productivity improvements in the 2010s by holding down inputs into the NHS e.g. freezing staff pay, reducing capital budgets, cutting support staff We wrote a paper on it, which you can read here, more details in thread below

'Austerity' in public services: lessons from the 2010s | Institute for Government

Jeremy Hunt is right to delay his fiscal statement – but should not rush into a new austerity programme.

www.instituteforgovernment.org.uk

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Stuart Hoddinott

@StuartHoddinott

7 months

On management and support staff. There are far fewer managers per FTE in the NHS now than in 2010. That makes it very difficult to plan and innovate effectively in hospitals Lack of support staff means that frontline staff are often left doing less productive admin work

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Stuart Hoddinott

@StuartHoddinott

7 months

Speaking of frontline staff. Govt decided to first freeze and then hold down public sector pay in the 2010s. The result was large real terms decline in pay that was made worse by recent inflation...

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Stuart Hoddinott

@StuartHoddinott

7 months

First, capital. The UK has always been bad at investing in health capital, but even by our low standards the 2010s were atrocious UK invested only 62.5% of the OECD average between 2011 and 2020 compared to 84.3% between 1970 and 2010

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Stuart Hoddinott

@StuartHoddinott

7 months

What does that actually mean? It means hospitals are falling apart, with a record £11.6bn maintenance backlog that leads to e.g. sewage in hallways, and operating theatres that can't be used

Stuart Hoddinott

@StuartHoddinott

8 months

New NHS estates data out today. The maintenance backlog grew to £11.6bn in cash terms in 2022/23, up from £10.2bn in 2021/22 - a 7.5% real terms increase The high risk backlog grew fastest, up 23.9% in real terms and now accounts for >20% of the total for the first time

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Stuart Hoddinott

@StuartHoddinott

7 months

All this to say: yes, if you add more doctors and nurses to hospitals - as was the Conservative manifesto promise in 2019 - without addressing the underlying issues discussed above, then of course they will be less productive and you will likely end up with worse value for money

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Stuart Hoddinott

@StuartHoddinott

7 months

From a wider system perspective, the underinvestment in primary care has also been catastrophic The number of GPs fell throughout the 2010s. That arguably means health problems are more complex by the time patients reach hospitals

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Stuart Hoddinott

@StuartHoddinott

10 months

NEW REPORT: General practice is delivering more appointments than ever, despite declining GP numbers. But increasing pressure risks worsening already-bad retention issues and jeopardising the sustainability of the service Thread of findings 👇

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Stuart Hoddinott

@StuartHoddinott

7 months

...the pandemic worsened already low morale and from mid-2021 onwards there was a large outflow of staff from the service They were replaced with many new, relatively inexperienced staff who are just far less productive Some of that will improve naturally, but takes time

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Stuart Hoddinott

@StuartHoddinott

7 months

I could go on, but this thread is already long. For more on NHS productivity, please read @Samfr 's and @racheljanetwolf 's excellent report from last year And here's my thread on hospitals from our most recent Performance Tracker

The NHS productivity puzzle | Institute for Government

The NHS crisis will only be solved with capital investment, increasing management capacity and staff retention – not just more doctors and nurses.

www.instituteforgovernment.org.uk

Stuart Hoddinott

@StuartHoddinott

10 months

NEW REPORT: despite higher funding and more staff, hospitals are struggling to return to pre-pandemic performance, with most activity only just reaching levels achieved in February 2020 What's going on? Thread below

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Stuart Hoddinott

@StuartHoddinott

7 months

And then there's under-provision of adult social care Funding cuts mean fewer people can access the support they need - spending in 2019/20 was only at 09/10 levels despite much higher demand Not the worst outcome of those cuts, but that also increases demand for hospitals

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Stuart Hoddinott

@StuartHoddinott

9 months

Hard to overstate how much the social care sector has relied on int'l staff since 2021/22 These plans will severely limit that source of workers without a plan to replace them. Govt has effectively announced that it's giving up on expanding care capacity before the election

Beth Rigby

@BethRigby

9 months

Busy day as Starmer gives keynote speech on economy and Sunak gets going on plans to cut migration as record net migration eats even further into Tories’ poor poll ratings. Home sec to announce package of measures today to cut aimed legal migration, incl scaling back of health

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Stuart Hoddinott

@StuartHoddinott

7 months

Have now updated this chart so it starts in Mar '09 and includes most recent data To the end of Sep '23 consultants' and jr docs' pay fell 22.8% and 25% respectively in real terms Also noteworthy that ongoing inflation is quickly eroding last year's pay bump for other staff

Stuart Hoddinott

@StuartHoddinott

7 months

Speaking of frontline staff. Govt decided to first freeze and then hold down public sector pay in the 2010s. The result was large real terms decline in pay that was made worse by recent inflation...

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Stuart Hoddinott

@StuartHoddinott

7 months

Jeremy is right that productivity improved during the 2010s, and more quickly than in the decade or so before Avg annual productivity improvements: 2001/02-2009/10 = 0.6% 2009/10-2019/20 = 1.2% But that stored up problems for the future, which the NHS is now experiencing

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Stuart Hoddinott

@StuartHoddinott

1 year

GP leaver data is out for March. The worrying trend of younger GPs leaving continues. Under-30s remains above 20%, though this is noisy due to so few of them More concerningly, GPs aged 30-39 overtook those aged 50-64 for the first time

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Stuart Hoddinott

@StuartHoddinott

10 months

Then there's management. Despite press narratives, the NHS is woefully undermanaged, with a large drop in manager:staff ratios since 2010 That means frontline staff do more admin work and senior managers focus on operational tasks, preventing focus on improving the service

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Stuart Hoddinott

@StuartHoddinott

8 months

Here we go again. Below is my thread from when Kate used this chart to claim that the UK spends a lot more on health than other countries Tl;dr - the chart is very misleading and the UK is much closer to the middle of the pack than she'd have you believe

Kate Andrews

@KateAndrs

8 months

You want it, you got it. The % of GDP bit, anyway. Do not expect one of the most centralised systems in the world to filter this record level of cash to the right places, like frontline services or staff pay. (No one wants a US-style, 'privatised system'.)

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Stuart Hoddinott

@StuartHoddinott

6 months

Quick reminder that since the govt made it easier for people to come and work in the care sector (yes, it was their own policy) workers from outside the UK and EEA have basically propped up social care Yet govt boasts about banning those people from bringing loved ones to the UK

James Cleverly🇬🇧

@JamesCleverly

6 months

Today in Parliament we have laid an order to ban overseas care workers from bringing dependants. This is just one part of our plan to deliver the biggest-ever cut in migration 👇

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Stuart Hoddinott

@StuartHoddinott

1 year

This is not a good use of data for a number of reasons I recreated this chart (Austria looks a bit strange, but there's no source so I'm working with what I've got) and will do a quick thread explaining why it's not a great basis for comparing health spending

Kate Andrews

@KateAndrs

1 year

Germany and France do indeed spend more ... just. Both countries -- and the UK -- are now in the top 5 highest spending countries in the OECD.

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Stuart Hoddinott

@StuartHoddinott

1 year

Great to be on @BBCNewsnight talking about Birmingham council and local gov finance Financial problems are spreading beyond councils who have made bad investments and now includes those who have nothing left to cut, after more than a decade of squeezed funding and rising costs

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Stuart Hoddinott

@StuartHoddinott

10 months

The result is the highest maintenance backlog on record, roughly half the number of diagnostic machines per capita compared to the OECD average, and IT systems and hardware that are not fit for purpose All those new staff are not being given the tools to succeed

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Stuart Hoddinott

@StuartHoddinott

5 years

Some of the best I’ve read this year: 📚 @romankrznaric - Carpe Diem Regained 📚 @MazzucatoM - The Value of Everything 📚Kate Mascarenhas - The Psychology of Time Travel #booksof2019

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Stuart Hoddinott

@StuartHoddinott

10 months

That spike of staff movement coinciding with workforce expansion means that staff are less experienced than they were in 2019; e.g. huge expansion in the no of nurses with <5 years experience That makes staff both less effective and uses experienced staff time to train recruits

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Stuart Hoddinott

@StuartHoddinott

10 months

Next there's capital. Between 1970 and 2020, the UK govt only exceeded the OECD average level of investment in 2 years But even by that low standard, the 2010s were particularly bad UK was 84.3% of OECD average between 1970 and 2009 and just 62.5% between 2010 and 2019

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Stuart Hoddinott

@StuartHoddinott

9 months

Also worth noting that the NHS reallocated £500m of its capital budget last week because the govt refused to fund the in-year deficit that's arisen from strike action That's money that would have *genuinely* helped solve IT productivity issues

Forcing the NHS to reallocate capital spending is a false economy | Institute for Government

The Sunak government is still choosing short-term fixes over long-term solutions.

www.instituteforgovernment.org.uk

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Stuart Hoddinott

@StuartHoddinott

10 months

There is real attrition of younger GPs, either leaving the service entirely or working increasingly part time Even though there are relatively few of them, GPs under 30 are leaving the service at shocking rates and GPs under 40 have seen a marked increase post-pandemic

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Stuart Hoddinott

@StuartHoddinott

10 months

Yes Covid has had an impact, but in many cases performance was worsening long before the pandemic The last time the NHS hit its target for cancer referral times, elective wait times and A&E wait times was in Dec 2015, Feb 2016 and Jun 2013 respectively

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Stuart Hoddinott

@StuartHoddinott

10 months

Govt needs to stop chopping and changing policy so much; cutting the management budgets of ICBs 8 months after putting them on a statutory footing is an egregious example But emergency funding during crises is also terrible policy that leads to poor value for money

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Stuart Hoddinott

@StuartHoddinott

10 months

What are those issues? First, there is just less capacity in the system than there has been The number of beds has halved since the late 80s. Some of that is for good reason, but also evidence that it's gone too far, with occupancy often >95% since mid-2010s

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Stuart Hoddinott

@StuartHoddinott

1 year

This is exactly the problem with Sunak's pledges that we highlighted back in Jan: "He will be able to point to any improvement, anywhere in the [NHS], at any point [before] the election, as a promise kept" Reality is waiting list increased in March

Rishi Sunak

@RishiSunak

1 year

I promised I would cut NHS waiting lists and we are delivering. Reducing 18-month waits by over 90% is huge progress. We still have work to do, but backed by record government investment and the ongoing efforts of the NHS, I am confident we will get patients the care they need

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Stuart Hoddinott

@StuartHoddinott

10 months

The result is that the number of GPs under-40 has fallen far faster than any other age group These staff are supposed to be the future of the service and there are 10% fewer of them than seven years ago

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Stuart Hoddinott

@StuartHoddinott

8 months

Great to be on BBC News earlier talking about the junior doctor strikes Pay is a large factor in doctors' dispute with the govt, but they also have concerns about conditions. Hospitals are in a worse state than they were in 2010, after a decade of underinvestment in capital

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Stuart Hoddinott

@StuartHoddinott

1 year

🚨 New NHS data out today. Elective waiting list had its largest month on month increase since August 2022, up 114k to 7.3m What's going on? Short thread below

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Stuart Hoddinott

@StuartHoddinott

9 months

I wonder if the government’s elite team of technical experts can harness AI to get NHS computers to turn on when they’re actually needed?

Emma Runswick 🏳️‍🌈

@ERunswickBMA

9 months

I am having a stupidly busy shift. I have done lots of things without stopping and I need to document them. This is the NHS computer including after a restart. I can't click on anything. I could cry.

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Stuart Hoddinott

@StuartHoddinott

11 months

Birmingham last week was the most recent in a growing trend of local authorities going "bankrupt" (officially known as issuing a section 114 notice) Since the start of 2018, there have been eleven s114s, and only one before that - Hackney in 2000

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Stuart Hoddinott

@StuartHoddinott

10 months

The government has successfully recruited its target of 26,000 direct patient care (DPC) staff; there are now 31k more compared to Mar 2019 But they do not replace lost GPs and often add to GP workloads by needing more management and leaving complex cases for GPs

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Stuart Hoddinott

@StuartHoddinott

10 months

🚨New data out today shows the elective waiting list grew to 7.75m in August, up from 7.68m in July Another record high, and 531k higher than in January when Sunak pledged to bring down waiting lists What's driving the increase? And what's happening to other parts of the list?

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Stuart Hoddinott

@StuartHoddinott

6 months

Spending plans are already a fantasy, cutting them further will just mean top-ups when service performance worsens I wrote the below in November. I'm running out of ways to describe how irresponsible it is for govt to fund tax cuts by cutting spending

Ian Mulheirn

@ianmulheirn

6 months

Sigh

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Stuart Hoddinott

@StuartHoddinott

10 months

There is also a change in the composition of new recruits - the increase in both doctor and nurse numbers has been driven predominantly by recruitment from the rest of the world, while British and EEA staff have been net leavers since the middle of 2021

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Stuart Hoddinott

@StuartHoddinott

8 months

NEW: My piece for @instituteforgov on this week's local government finance settlement Is it as generous as the government made out? Will it stop councils issuing 'bankruptcy' (s114) notices? Answers in the link and short thread 👇

The local government finance settlement is unlikely to end council ‘bankruptcies’ | Institute for...

Both the government and the Labour opposition should be prepared to explain how they plan to address crumbling local authority finances.

www.instituteforgovernment.org.uk

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Stuart Hoddinott

@StuartHoddinott

7 months

For context, inflation has eroded local authority budgets so much that before today the govt would have needed to provide £2.3bn in 2024/25 to return councils' spending power to where it was after the 2021 spending review After this new £500m, the gap is still £1.8bn

Anushka Asthana

@AnushkaAsthana

7 months

EXC: Hearing that the Chancellor and Michael Gove have now agreed on a boost to the local government finance settlement and we could get the figure as early as today. The number I’m hearing is £500m which will be seen as a “modest” increase - but still… THREAD 1/

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Stuart Hoddinott

@StuartHoddinott

7 months

The NHS is also employing a lot more staff than in 2019, roughly 20% more doctors and nurses in September 2023 compared to April 2019 Despite that, activity in the 12 months to Nov 23 is only 1% higher than in 2019

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Stuart Hoddinott

@StuartHoddinott

10 months

Spending has increased in the service, by 13.8% in real terms between 2019/20 and 2021/22. Part of that was due to Covid, but part was always planned as under the NHS Long Term Plan But that increase in spending followed a decade of below trend spending increases

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Stuart Hoddinott

@StuartHoddinott

10 months

Ways of working have also changed. There are far fewer GP partners - the GPs who own and manage practices - and more salaried GPs The partnership model of general practice relies on partners taking on financial risk and providing large amounts of hidden admin work

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Stuart Hoddinott

@StuartHoddinott

1 year

🚨New NHS data shows that the government hit its target of recruiting 26k more direct patient care (DPC) staff into primary care networks a full year earlier than their manifesto commitment Impressive delivery on its promise, but there are some caveats to this good news 🧵👇

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Stuart Hoddinott

@StuartHoddinott

1 year

But health care spending as a % of GDP is affected by that second bit - a country's GDP. If GDP falls disproportionately (like it did in the UK in 2020/21), health spending looks high A better comparison could be health spending per person Again UK is middle of the pack

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Stuart Hoddinott

@StuartHoddinott

10 months

Also worth saying that a lot of this analysis builds on work done by @racheljanetwolf and @Samfr , I referenced their excellent report from the summer repeatedly while writing Performance Tracker

The NHS productivity puzzle | Institute for Government

The NHS crisis will only be solved with capital investment, increasing management capacity and staff retention – not just more doctors and nurses.

www.instituteforgovernment.org.uk

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Stuart Hoddinott

@StuartHoddinott

10 months

There were 1,910 fewer fully-qualified, permanent GPs (the best measure of GP capacity) in Sep 2023 compared to Sep 2015 - a 6.7% decline In the same time, the number of registered patients increased by >10% Demand for the service is far outstripping supply, esp post-Covid

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Stuart Hoddinott

@StuartHoddinott

2 years

In a NEW REPORT out today I answer 3 questions about the NHS crisis: 📊Is the govt right about the cause of the crisis? 🚑How is govt responding and will it be effective? 🔎Is Sunak's pledge on the NHS really as unambiguous as he claims? Quick thread

The NHS crisis: Does the government have a plan? | Institute for Government

The government's NHS crisis response is likely too little and too late for this winter.

www.instituteforgovernment.org.uk

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Stuart Hoddinott

@StuartHoddinott

9 months

NEW COMMENT: The government's decision not to provide more support to the NHS is a false economy, which could come back to haunt Sunak at the next election Short thread on the argument 👇

Forcing the NHS to reallocate capital spending is a false economy | Institute for Government

The Sunak government is still choosing short-term fixes over long-term solutions.

www.instituteforgovernment.org.uk

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Stuart Hoddinott

@StuartHoddinott

1 year

Great to speak to @katelamble about public inquiries on @BBCNewsnight The government's refusal to comply with Lady Hallett's requests risks undermining public trust in the Covid inquiry, which could in turn make it harder to implement recommendations when the inquiry reports

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Stuart Hoddinott

@StuartHoddinott

10 months

Despite these issues, GPs and other practice staff are delivering more appointments per FTE than ever, almost 10% more than before the pandemic The govt might see this as a real win, but it raises questions of workload pressure and burnout, which might worsen retention

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Stuart Hoddinott

@StuartHoddinott

10 months

But there was also a large movement of staff - either to a new post or out of the service entirely - from the middle of 2021 onwards That spike in staff movement has passed, but the service is still dealing with the fallout

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Stuart Hoddinott

@StuartHoddinott

10 months

What is the impact? People are being treated either less or less quickly than in 2019, despite levels of demand in some cases not increasing that much It also increases pressure on other parts of the system: primary and community care, adult social care and others

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Stuart Hoddinott

@StuartHoddinott

7 months

🚨New NHS data shows that the elective waiting list fell by 96k in Nov to 7.61m - the 2nd consecutive monthly fall and the largest (non-Covid) monthly drop since Dec 2010 But that still leaves the total 400k higher than when Sunak pledged to cut lists in Jan 23 🧵👇

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Stuart Hoddinott

@StuartHoddinott

10 months

The govt has done well increasing the number of GP trainees, meeting its target for five years in a row But those trainees are still not translating into full-time GPs That is partly due to the pressures of the job - we heard that it is less attractive due to high workloads

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Stuart Hoddinott

@StuartHoddinott

9 months

NEW COMMENT: The autumn statement shows that the government has abdicated responsibility for public service performance Short thread below

The government has abdicated responsibility for public services | Institute for Government

Jeremy Hunt’s tax cuts have been funded by further tightening public service budgets.

www.instituteforgovernment.org.uk

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Stuart Hoddinott

@StuartHoddinott

10 months

The source of GP trainees has also changed over time. There has been a large increase in the number recruited from outside the UK and EEA Those trainees made up 43% of the total in Sep 2023, up from 12% in Sep 2015

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Stuart Hoddinott

@StuartHoddinott

10 months

The increase in the number of patients per GP has happened everywhere in the country, but it has been worse in the most deprived areas The ratio rose 23.9% in the most deprived decile of areas between March 2016 and March 2023, compared to 8% in the least deprived areas

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Stuart Hoddinott

@StuartHoddinott

10 months

One again the problem is more stark among younger GP partners There are almost half as many GP partners under the age of 40 as in 2016, while the 65+ population has only declined slightly in comparison

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Stuart Hoddinott

@StuartHoddinott

10 months

That means that when there is a shock, then the carefully balanced system (that was barely working before) is thrown out of kilter That is what happened with Covid Bed occupancy has returned to 90%-95% levels since 2020

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Stuart Hoddinott

@StuartHoddinott

10 months

Some performance issues are due to Covid - the elective list has grown faster since 2020 - but in most cases it is due to frailties that pre-date Covid E.g. the elective list almost doubled between 2010 and 2019 Long term decisions made hospitals more vulnerable to shocks

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Stuart Hoddinott

@StuartHoddinott

10 months

The result is far more staff in the service than in 2019/20: 13.3% more doctors and 14.9% more nurses by July 2023 compared to March 2020 In comparison, numbers only grew 24.8% and 17.0% respectively in the nine years between March 2010 and March 2019

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Stuart Hoddinott

@StuartHoddinott

10 months

In the meantime, general practice continues to absorb unprecedented levels of pressure and demand For now, GPs are performing better than can be expected but that does raise questions about sustainability without a change in approach

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Stuart Hoddinott

@StuartHoddinott

10 months

An under-appreciated (and difficult to quantify) problem is underinvestment in capital in general practice. Staff are often working in old buildings and on IT systems that are not fit for purpose There is often nowhere for newly-hired staff to work, making them less productive

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Stuart Hoddinott

@StuartHoddinott

9 months

Astounding that Pritchard argues productivity issues in hospitals are a 'misunderstanding' 14% more spending on hospitals and similar increases in nurses and doctors, and yet most activity has only recently returned to pre-pandemic levels I'd love to see her evidence for this!

Chris Smyth

@Smyth_Chris

9 months

As NHS brings in McKinsey to find out why it's treating no more patients than pre-Covid despite more cash and more staff Amanda Pritchard tells @CommonsHealth that productivity figures based on a "misunderstanding" and insists NHS is doing more

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Stuart Hoddinott

@StuartHoddinott

2 years

@BBCMoreOrLess A couple of charts which explain your point: on the left is a time series of FTE numbers, splitting out fully-qualified and trainee GPs. On the right shows % change in GPs incl. trainees and GPs excl. trainees compared to patient numbers

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Stuart Hoddinott

@StuartHoddinott

10 months

I also wrote the general practice and adult social care chapters for Performance Tracker, threads to come... And @philipnye @matthew_fright @gil_richards1 and @NJ_Davies all have threads on other parts of the report

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Stuart Hoddinott

@StuartHoddinott

9 months

@Brian178086840 @DrSteveTaylor Great! I can’t wait! Will be amazing to see what AI can do on an NHS computer that’s running windows XP 🙄

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Stuart Hoddinott

@StuartHoddinott

10 months

Thread on general practice is now here:

Stuart Hoddinott

@StuartHoddinott

10 months

NEW REPORT: General practice is delivering more appointments than ever, despite declining GP numbers. But increasing pressure risks worsening already-bad retention issues and jeopardising the sustainability of the service Thread of findings 👇

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Stuart Hoddinott

@StuartHoddinott

10 months

Relying on international staff is not necessarily a problem and is preferable to large numbers of vacancies But GMC work shows intl doctors stay registered in the UK for less time than British equivalents and the govt has far less control over the pipeline of future recruits

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Stuart Hoddinott

@StuartHoddinott

10 months

Spending has increased on the service but much of that increase is on higher wage bills to remain competitive with other employers (incl wider NHS) and also on expanded DPC workforce Core GP funding has not increased in line with inflation or with funding for hospitals

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Stuart Hoddinott

@StuartHoddinott

2 years

As a footnote, I did not have "write a report that would feature on the front page of the @DailyMirror alongside @Rodstewart " on my 2023 bingo card, but there we go

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Stuart Hoddinott

@StuartHoddinott

2 years

This is a lazy from the Times. On almost any metric, the NHS is woefully undermanaged: - 2% of NHS staff are managers, compared to 9.5% of the UK workforce - Approx. 1.5% of spending is dedicated to management, compared to OECD avg. of 3.1%, 4.1% in France and 7.9% in the US

The Times and The Sunday Times

@thetimes

2 years

Hundreds of NHS bureaucrats are earning more than £100,000 a year as frontline staff including nurses prepare to strike over their low pay, figures show

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Stuart Hoddinott

@StuartHoddinott

1 year

More importantly, there was something pretty major happening in 2020 and 2021 - a global pandemic - which affects both health spending and GDP A much better year to compare countries is therefore 2019, which we can do... ...and suddenly the UK is firmly in the middle

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Stuart Hoddinott

@StuartHoddinott

10 months

When combined with other crises - a bad flu season, industrial action, and political instability - hospitals are struggling to return to trend performance levels E.g. even though hospitals are now doing more diagnostic tests than 2019, it is beneath where we'd expect them to be

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Stuart Hoddinott

@StuartHoddinott

2 years

Not my usual topic, but was curious about home working patterns in the census Chart below shows people in almost every local authority report wfh more than in 2011, but the largest increases have been in least deprived areas Some LAs with >50% working mostly from home

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Stuart Hoddinott

@StuartHoddinott

10 months

All age groups of GPs have fewer partners as a proportion than in 2016, but the problem is by far the worst in younger GPs This raises the question of who is going to take on partnerships as the older GPs retire?

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Stuart Hoddinott

@StuartHoddinott

10 months

This is more of a personal view, but I think the expansion of the DPC workforce represents a major - and not well-publicised - shift in how primary care is delivered I'm not saying it's necessarily negative but it is different

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Stuart Hoddinott

@StuartHoddinott

2 years

Quick thread on the local government finance settlement (which I'm sure is top of everyone's mind on Dec 22nd), summarising this comment I wrote for @instituteforgov

The government is right to rebalance funding towards disadvantaged councils | Institute for...

Stuart Hoddinott welcomes the new local government finance settlement's announcement that more money will go to disadvantaged councils.

www.instituteforgovernment.org.uk

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Stuart Hoddinott

@StuartHoddinott

10 months

Some of these issues will improve naturally; e.g. staff will become more productive as they stay in post longer But many require longer-term thinking and planning

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Stuart Hoddinott

@StuartHoddinott

8 months

New NHS estates data out today. The maintenance backlog grew to £11.6bn in cash terms in 2022/23, up from £10.2bn in 2021/22 - a 7.5% real terms increase The high risk backlog grew fastest, up 23.9% in real terms and now accounts for >20% of the total for the first time

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Stuart Hoddinott

@StuartHoddinott

10 months

Despite all that extra activity, there is evidence that demand is still outstripping supply Satisfaction with the service continues to decline, particularly on metrics that asses how easy patients find it to access the service

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Stuart Hoddinott

@StuartHoddinott

1 year

🚨New elective waiting list data for June 2023 out today Another month with an increase of more than 100k, bringing the total to 7.57m, another record amount Quick thread below on what's driving that increase

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Stuart Hoddinott

@StuartHoddinott

10 months

NEW REPORT: The govt increased funding for adult social care at the 2022 autumn statement. But our research shows that that money will be stretched thin by rising costs and competing priorities, making it hard to reduce unmet need More findings 👇

Performance Tracker 2023: Adult social care | Institute for Government

The government has provided more funding, but the sector may struggle to address unmet need in the face of rising costs and competing priorities.

www.instituteforgovernment.org.uk

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Stuart Hoddinott

@StuartHoddinott

1 year

The government has been rolling out Community Diagnostic Centres (CDCs) to increase testing capacity away from hospitals, but to date hasn't released any data on CDC activity I submitted an FOI to find out how many tests the NHS is conducting in them Results 👇

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Stuart Hoddinott

@StuartHoddinott

1 year

New report out today from @Samfr and @racheljanetwolf They answer the question of why some hospital activity has not returned to 2019/20 levels despite higher spending and staffing in the NHS A short thread on some of the most interesting insights

Sam Freedman

@Samfr

1 year

New post just out With more doctors strikes starting today; worst ever waiting lists/A&E times; + 1000s of excess deaths - I look at why the NHS crisis isn't getting better and what the key causes are. "How bad does it have to get?" (free to read)

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Stuart Hoddinott

@StuartHoddinott

2 years

For a policy that is supposedly taboo, changing the funding model of the NHS is discussed remarkably often. You might even say it's the closest thing some people have to a national religion This from Politico is a prime example Let's look at what it gets wrong 🧵👇

POLITICOEurope

@POLITICOEurope

2 years

It has an exhausted, understaffed workforce, buildings in desperate need of repair and is constantly pleading for more cash from government. The UK's 75-year-old National Health Service is ailing. Is it time ... to ditch it?

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Stuart Hoddinott

@StuartHoddinott

1 year

When the government does not invest in adult social care - particularly workforce - it resorts to emergency funding pots when the inevitable crisis hits; a far more costly approach than up-front investment We're stuck in a cycle of 'crisis-cash-repeat'

Adult social care: Short-term support and long-term stability | Institute for Government

The government's plan won't turn around adult social care performance.

www.instituteforgovernment.org.uk

Dave West

@Davewwest

1 year

Exclusive: ‘Shameful’ £500m cut to workforce and reform budgets

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Stuart Hoddinott

@StuartHoddinott

10 months

We're recruiting to join the public services team! What you can expect: 1) Making pretty charts like the one 👇 2) Free lunch (at the cost of endlessly discussing food choices) 3) You get to/are forced to* work with @NJ_Davies , @DarwinKim_1 , and me *delete as appropriate

Institute for Government

@instituteforgov

10 months

Work with us! We are looking for a Researcher or Senior Researcher to join our public services team. Applications close on Tuesday 14 November at 14:00.⏱️ Find out more and apply

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Stuart Hoddinott

@StuartHoddinott

9 months

This is the third section 114 this year and the 12th since 2018. There were two section 114 notices in the thirty years before 2018

Jack Shaw

@JackTShaw

9 months

Nottingham City Council has issued a Section 114. It cannot close the £23 million deficit it forecasts by March 2024.

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Stuart Hoddinott

@StuartHoddinott

9 months

Nottingham council issued a section 114 last week, effectively declaring bankruptcy. I was curious how their finances compare to other councils Answer: their spending power fell 23% between 2023/24 and 2009/10, compared to an average of -12% for other social care authorities

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Stuart Hoddinott

@StuartHoddinott

10 months

NEW COMMENT: Short-term policy making has trapped public services in a ‘doom loop’ Services are struggling to return to pre-pandemic performance levels and all are performing worse than they were in 2010 What's driving that performance? 🧵👇

Short-term policy making has trapped public services in a ‘doom loop’ | Institute for Government

Chronic short-termism is harming service performance in key public services.

www.instituteforgovernment.org.uk

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Stuart Hoddinott

@StuartHoddinott

2 years

The second Week in Public Services in as many weeks - you can't say we don't spoil you! This week: Truss's new government; vacancy rates in health and social care; and, financial difficulties in local government

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Stuart Hoddinott

@StuartHoddinott

10 months

And finally thread for adult social care is here:

Stuart Hoddinott

@StuartHoddinott

10 months

NEW REPORT: The govt increased funding for adult social care at the 2022 autumn statement. But our research shows that that money will be stretched thin by rising costs and competing priorities, making it hard to reduce unmet need More findings 👇

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Stuart Hoddinott

@StuartHoddinott

10 months

The GP contract that was agreed in 2019 (and which the govt has refused to update despite a global pandemic and bout of inflation) ends in March 24. The negotiation over the next GP contract will be crucial for determining the future path of general practice

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