NHS video, factchecked

Full Fact is working with First Draft News to verify and factcheck viral stories for the 2017 election. We identified a video making numerous claims about the NHS that had gone viral with 9.8 million views on Facebook.

We've now factchecked what was claimed in the video.

Funding

• NHS funding in the UK is at record levels, even adjusted for inflation.
• But it’s correct that the increases have been getting smaller, and experts argue that at this rate spending won’t keep up with the size of the economy (as measured by GDP).
• This claim may take its cue from a similarly worded finding by the King’s Fund health think tank, which said that the ten years up to 2020/21 would see the “largest ever sustained reduction in UK NHS spending as a percentage of GDP”.
• Similarly, government health spending in the UK (which counts more than just funding for the NHS) is down as a percentage of GDP since 2010, according to calculations by the Health Foundation and the Institute for Fiscal Studies.

Efficiency

• Around £5 billion could be saved in English non-specialist acute hospitals—a sum worth 9% of their budget—according to the 2016 Carter Review.
• For example, Lord Carter found that if all trusts got their facilities running costs to the average it would save £1 billion a year. Reducing procurement costs could save at least £700 million.
• Modelling for NHS Improvement “suggests that trusts become 1% more efficient each year on average”. It recently set a “challenging but achievable” target of 2% a year over the next two years.
• The UK was ranked first out of 11 developed countries for efficiency in a widely cited 2014 report by the Commonwealth Fund, a US think tank.

• There have been various NHS efficiency initiatives over the years. These include things like early diagnosis of respiratory diseases to save lives and money down the line, or reducing the number of infections people pick up in hospital—this saved the NHS £75 million in 2008/09.
• There are various ways to measure the impact of these initiatives on performance.
• One piece of research does mention that efficiency has been increasing since 2008/09.
• Based on this, the Nuffield Trust think tank told us that “NHS spending in hospitals, community services and mental health trusts (but not GP practices, for which there is far less information) would have been £7.3 billion higher in 2015/16 without annual efficiencies”.

• The debate over whether competition within the NHS—the ‘internal market’—is a good or a bad thing is fundamental, and not something we can dash off a quick answer to.
• Splitting the NHS into competing purchasers and providers of health services necessarily leads to “transaction costs”—such as purchasers and providers and commissioners negotiating with one another. The question is whether those costs are outweighed by financial savings and/or improvements in patient care.
• You can find reports to the effect that the benefits of the internal market are “very small when set against the costs” or that “the effect of [NHS] competition is to save lives without raising costs”.
• A summary of the available evidence by the chief executive of the King’s Fund said that the impact of competition in the 1990s and 2000s was “limited”. His organisation recommends that “competition and choice do have a role to play, but should be used as just one means to improve care rather than being a guiding principle”.

Immigration and health tourism

• The government has estimated that treating deliberate health tourists and those “taking advantage” costs around £100 to £300 million a year. That was in 2012/13.
• Those were incredibly rough figures even at the time.
• The Department of Health was projected to spend £13.8 million per hour on average in 2016/17, which does mean around £200 million every 15 hours. Over the same period NHS England spent roughly £180 million every 15 hours.

• In 2016, 26% of doctors working in NHS hospitals and community health services in England reported they were from other countries—that’s about one in four.
• 16% of nurses and health visitors said they were from other countries—that’s about one in six.
• Overall, around 12%—or roughly one in ten—of all NHS England staff were foreigners.
• These figures only include those staff members who said what their ‘nationality’ was—some may have interpreted this as country of birth or ethnicity—and don’t include GPs or GP staff.

Nursing

• In its manifesto the Conservative Party included a commitment to recruiting 10,000 more mental health professionals. It has separately said this will be by 2020. We’ve asked the Conservatives if this commitment includes all mental health staff or nurses specifically.
• The number of full time equivalent (FTE) mental health nurses in England fell by nearly 5,000 (12%) between January 2010 and January 2017.

• This is correct according to the Royal College of Nursing, but it refers to all registered nurses, rather than those specifically working in mental health. Around 11% of nursing posts in England were vacant as of December 2016; it was 6% in 2013.
• There were around 11,000 adverts for full time equivalent nursing and midwifery jobs published in England in September 2016, according to the NHS. But it points out that the figures are experimental and that one advert doesn’t equal one job—a single advert can be used to fill a number of vacancies. In the same month the previous year there were around 10,000 adverts.
• The NHS previously published figures on the proportion of vacancies, but this was discontinued in 2010.
• In September 2014, 29% of nurses, midwives and health visitors were aged 50 or over, according to figures from the NHS. That’s increased from 21% ten years before.

• From August this year new nursing, midwifery and allied health professional students from England will no longer be given an NHS bursary, but will instead have access to the same student loans system as other students.
• Early data shows that the number of applicants to nursing courses in England in January 2017 has dropped by 23% (or around 10,000) compared to January 2016.
• Applications from students in Northern Ireland, Scotland and Wales, who aren’t affected by the changes, fell by much smaller amounts.

Accident and emergency

• That’s an understatement if anything. There were 196,000 “trolley waits” in English accident and emergency departments in the 2016/17 winter months.
• This doesn’t mean all these people are physically on a trolley, though. It’s a measure of how many times a patient waited for more than four hours for a bed after the decision had been taken to admit them to hospital.
• The number of people in this situation over winter has always been in the tens of thousands since 2010, but “trolley waits” have been rising—in the winter of 2010/11 there were around 35,000.
• Winter waits of over 12 hours after admission have risen from a couple of dozen to almost 2,000 over the same period.
• This is against the background of rising demand for A&E services. There were 2.5 million more visits in 2016 than there were in 2010.