Election 2015: Health

Polls consistently put health care as one of the most important issues helping the public decide who to vote for in the General Election.

Here's our rundown of the claims you're most likely to hear on the topic, and our take on them.

GPs

Common claims:

"A quarter of us are unable to get an appointment with a GP within a week."

That's not what the figures show. We don't know how many people are unable to get an appointment within a week. A quarter of people didn't get an appointment within a week when they last tried, but we don't know how many of these were unable to do so and how many were happy to wait longer.

The figures on GP waiting times show that 11% of patients couldn't get an appointment at all the last time they contacted their GP surgery, while another 14% saw or spoke to someone a week or more later.

So it's fair to say patients don't get an appointment within a week on a quarter of occasions. However, that doesn't mean they can't get one. Some people would have been happy to book that far ahead, for instance if their need for an appointment wasn't urgent.

The same reasoning applies to any claims about patient being unable to get an appointment within two days.

"Fewer GPs are offering extended hours under the Coalition."

We don't have enough information to know whether this is true. It compares 2009 figures on the number of practices offering extended hours to figures on how many got paid for such services in 2013/14.

But the figures are no longer produced in the same way as in 2009, meaning they might count surgeries differently. For example, the 2013/14 data isn't just about GP It also includes some walk-in centres and other centres that provide GP services. That's according to the Health and Social Care Information Centre (HSCIC), which publishes the 2013/14 data. It isn't clear whether the 2009 data includes these services.

And the HSCIC also told us the more recent figures may not include all extended hours services.

"The government's GP access fund is helping reduce pressure on GP surgeries and reduce A&E attendances."

It's too early to say. Evidence on the fund's performance isn't yet available.The 'early evidence' referred to by the Conservatives is based on figures provided by NHS England to Pulse in February 2015. A full analysis of the figures wasn't available, with NHS England telling Pulse there was "insufficient data to measure the success of the scheme". They also said that they "needed more time to gather the evidence to be able to 'demonstrate success'," although they added that early feedback on reducing A&E services was "encouraging".

"Since the election the number of GPs is up by 1,300"

We only have figures on GP numbers in September of each year, meaning we don't know exactly how many there were at the time of the last election in May 2010.

That has a fairly big impact on the figures. If you count from September 2009, GP numbers are up by 500. Count from September 2010 and you get to the 1,300 figure.

It's more accurate to say the number of GPs is up by 1,300 since 2010, not since the election that year.

And anyway, it's not clear how much credit the Coalition can take for an increase in the number of GPs in the past few years. GPs typically take three years to train, so many of the new GPs entering the workforce will have started their training under the last government.

"Young doctors don't want to become GPs."

Early indications suggest the number of applicants to GP training posts has fallen. The number of GP training posts that were filled fell by 4% from 2013 to 2014, from 2,740 to 2,630. These figures were as of June 2014 — some of the posts may have been filled later on because a second application round was introduced to try and address the problem.

Health Education England told us that falling applications were partly to blame, although some applicants were turned down due to not qualifying.

Three regions seemed to have particular trouble; in the East Midlands 62.5% of posts were filled, in the North East 69.3% were filled, and in Yorkshire and Humberside the figure was 77.8%.

Accident & Emergency

Common claims:

"Record numbers are waiting in A&E for over 4 hours."

True, although worth noting that the number being seen within 4 hours is also at a record high, where "being seen" is being admitted to hospital, being transferred elsewhere, or being discharged. That's because there are record numbers of attendances at A&E — over 22 million in England in 2014.

In 94% of A&E attendances, the patient was seen within four hours in 2014, missing the 95% target. More targets were missed in 2014 than in previous years.

Four-hour waits are most common in major A&E departments, which are the largest 24 hour centres.

"Walk-in centres have been closed under this government."

It's very difficult to estimate how many have closed, and it's not clear how helpful it is to do so.

A walk-in centre is an NHS site which provides routine and urgent care for minor cases where there's no need to book an appointment beforehand. The government doesn't collect any estimates of its own on how many have been opening or closed so we're left with estimates from other bodies.

Of an estimated 238 walk-in centres open in 2010, 51 had 'closed' by 2013 — that's 21% of them. That's according to regulator Monitor. But in a third of cases the closures were due to the services provided by centres being moved elsewhere, and it's hard to say whether services suffered (or improved) as a result.

Mental health

There is very little information on NHS mental health services, especially specialist services (generally for rarer or more serious conditions). What evidence there is suggests services can vary across geographical areas and are not always sufficient to meet demand.

We only have information on the treatment of children with mental disorders when they've ended up in hospital.

Common claim: 

"One in four of us will suffer from a mental health issue at some point in our lives"

The evidence on this one is very patchy — but it looks like it might be an underestimate, if anything.

"One in four" is widely quoted in a variety of guises, and has been around since the 1980s. One version says one in four of us will suffer a mental health problem in the course of a year, another that one in four of us will suffer in our lifetimes. Those figures are incompatible — if it's one in four a year it'll be more than that in a lifetime.

The big problem is that many people with mental health problems, and probably most of them, are not in treatment. So these people don't show up in official health statistics.

A 2007 survey found 23% of people in England had a mental illness, measured across a variety of time frames. Because each condition included in the 23% figure has a different time frame it's not meaningful to use the data to say 23% are ill in every year, or in any other time period. But the findings do suggest that the number suffering over a lifetime will be more than one in four.

Privatisation

Common claims:

"The Coalition has privatised the NHS."

NHS spending on services from private providers has gone up in England, but it's been rising since before the Coalition took office. The proportion of the budget spent commissioning private companies to provide healthcare has been rising since 2006/07, according to figures given to us by the Department of Health.

Private providers' share of the NHS budget went up from 4.4% in the year before the Coalition took office (2009/10) to 6.1% in 2013/14.

You could look at these numbers in a couple of ways. On the one hand, at 6% private providers are still taking a minority of NHS funds by the last count. On the other, this represents growth of 40% between the year before the Coalition took office (2009/10) and 2013/14.

"TTIP is going to mean the permanent privatisation of the NHS."

It's too early to say. We can't know whether TTIP would prevent the government from changing its policy on private provision in the NHS, as the exact wording of the deal is still being worked out.

The draft agreement with Canada, which the EU has said is a model for TTIP, is intended to preserve countries' right to keep health services in the public sector, or nationalise them in the future. But the relevant clauses haven't been the subject of much legal challenge, so it's hard to be sure what they do and don't allow.

Unite has argued the wording used wouldn't have the intended effect, while the NHS Confederation thinks it would.

Money — where will it come from?

NHS funding rose by almost £5.5 billion during the last Parliament. In 2010/11 it was about £108 billion in today's prices. In 2014/15 it was about £113 billion.

But the NHS faces increased demand for services. Population growth outpaced NHS spending between 2010/11 and 2012/13, so spending per person fell by 0.4% once inflation is factored in.

Costs are also rising. The number of over-65s is estimated to be up by 10.7% over this parliament, and spending on retired households is nearly double that on non-retired households.

And funding for adult social care has fallen (data on this goes up to 2013/14).

Looking ahead, the NHS will have a funding gap of £8 billion at the very least by 2020/21, according to the health service's own plan for the next five years.

Common claims:

"The government has put £13 billion into the NHS."

This is correct in cash terms. It's up by nearly £5.5 billion after inflation.

"Funding for the NHS has gone up every year."

That's right. NHS spending in England rose in each year from 2010/11 to 2014/15.

Over the whole period it went up by £5.5 billion from £108 billion to £113 billion. These are all in 2014/15 prices.

But population growth outpaced NHS spending between 2010/11 and 2012/13, so spending per person fell by 0.4% during this period once inflation is factored in.

 "Billions have been cut from adult social care budgets, so 300,000 fewer older people have been getting services."

That's right. Between 2009/10 and 2013/14 spending on social care for over-65s went down by £1.3 billion once inflation is accounted for, according to analysis from the Nuffield Trust and Health Foundation.

The number of over-65s receiving the services fell from 1 million to 850,000 in the same period.

"We're pledging £8 billion to close the NHS funding gap."

Maybe £8 billion will close the gap by 2020/21, but that's quite optimistic.

If the NHS in England makes no efficiency savings and funding rises only with inflation, the estimated funding gap will be at£30 billion by 2020/21. If it makes savings of 2-3% that gap falls to £8 billion.

Some have questioned how likely it is for this more optimistic savings target to be achieved.

If the NHS doesn't make £22 billion in savings then the next government will need to pledge more than £8 billion in order to close the funding gap, or the quality or quantity of services will be at risk.

Who's trusted most on the NHS

Common claim:

"Public satisfaction with the NHS is rising."

True: public satisfaction with the way the NHS is run is up to 65% in 2014 from 60% in 2013, according to the British Social Attitudes (BSA) survey. But it's not yet back at 2010 levels (70%).

As a measure, "satisfaction" can capture more than simply views about the quality of the service. Many of the people spoken to hadn't had recent experience of the NHS. It's possible their satisfaction is based on an outside perception of the health service, perhaps influenced by politicians or the media.

Immigration and the NHS

Common claim:

"£2bn is lost to the NHS every year through health tourism"

It really depends on your definition of 'health tourist'.

'Deliberate' use of the NHS—use by those who come here specifically to receive free treatment or who come for other reasons but take advantage of the system when they're here—is hard to quantify. It's thought to cost very roughly between £110 million and £280 million a year.

'Normal' use of the NHS—by foreign visitors who've ended up being treated while in England—is estimated to cost about £1.8 billion a year.

The majority of these costs aren't currently charged for. Only about £500 million is thought to be recoverable or chargeable at the moment.

"60% of those diagnosed with HIV in this country are not British nationals."

This is inaccurate. Of 6,000 people diagnosed with HIV in 2013, 2,292 (38%) were born in the UK; 2,688 (45%) were born in the rest of the world; and the birthplaces of 1,020 (17%) were not reported.

Of those whose birthplace was recorded, 54% were born outside the UK.

And birthplace isn't the same as nationality.

The proportion of people newly diagnosed with HIV who were born outside the UK has been steadily falling since 2004.

"The NHS is dependent on foreign staff."

Foreign nationals make up a significant proportion of staff, notably a quarter of hospital doctors (as of August 2014). A further 7% had no nationality recorded. This only includes staff who were employed directly by the NHS — so agency staff or those working for private providers aren't counted.

The number who were born abroad could be higher — plenty of British nationals were born overseas.

Of overall NHS hospital staff, 10% were foreign nationals, while a further 10% were of unknown nationality.