Max Warner
@maxwarner.bsky.social
Economist at the IFS working on health and social care, public spending and public sector productivity https://ifs.org.uk/people/max-warner
NHS England has now produced two sets of productivity growth rates for each NHS acute trust. These are year-on-year growth rates, only 3 months apart (so have a 9 month overlap). But what's striking is that they are essentially uncorrelated!?
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December 15, 2025 at 5:48 PM
NHS England has now produced two sets of productivity growth rates for each NHS acute trust. These are year-on-year growth rates, only 3 months apart (so have a 9 month overlap). But what's striking is that they are essentially uncorrelated!?
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I think another nuance here is that we often talk about defence spending in terms of % of GDP. That makes sense for some types of questions. But (real) GDP is also much higher, so in real-terms we already spend lots more on defence - and that's probably closer to what matters for capabilities
December 12, 2025 at 3:20 PM
I think another nuance here is that we often talk about defence spending in terms of % of GDP. That makes sense for some types of questions. But (real) GDP is also much higher, so in real-terms we already spend lots more on defence - and that's probably closer to what matters for capabilities
We made that exact chart for our recent IFS Green Budget chapter on defence spending
(ifs.org.uk/publications...)
(ifs.org.uk/publications...)
December 12, 2025 at 3:17 PM
We made that exact chart for our recent IFS Green Budget chapter on defence spending
(ifs.org.uk/publications...)
(ifs.org.uk/publications...)
Hospitals currently have a lot more people admitted with flu than at the same time in recent years. It remains to be seen how the peak will compare to previous years. (Half the IFS healthcare team are also currently laid low with it...)
www.bbc.co.uk/news/live/c6...
www.bbc.co.uk/news/live/c6...
December 11, 2025 at 11:06 AM
Hospitals currently have a lot more people admitted with flu than at the same time in recent years. It remains to be seen how the peak will compare to previous years. (Half the IFS healthcare team are also currently laid low with it...)
www.bbc.co.uk/news/live/c6...
www.bbc.co.uk/news/live/c6...
It’s not clear why patients are receiving more hospital activity before they leave the waiting list than the year before. This divergence hasn’t been so large in recent years before 2024–25, and we see it happening for almost all medical specialties.
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December 9, 2025 at 8:41 AM
It’s not clear why patients are receiving more hospital activity before they leave the waiting list than the year before. This divergence hasn’t been so large in recent years before 2024–25, and we see it happening for almost all medical specialties.
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It also isn’t the case that lots of patients are joining the waiting list, counteracting increases in activity. Demand growth remains muted. Instead increases in elective activity have failed to translate into similarly large increases in patients leaving the waiting list.
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December 9, 2025 at 8:41 AM
It also isn’t the case that lots of patients are joining the waiting list, counteracting increases in activity. Demand growth remains muted. Instead increases in elective activity have failed to translate into similarly large increases in patients leaving the waiting list.
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So what explains this difference? We can quickly rule a few factors out. Productivity hasn’t come from squeezing hospital resources, nor has it all gone to increasing emergency activity. Hospitals delivered a lot more elective activity in 2024–25 than in 2023–24.
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December 9, 2025 at 8:41 AM
So what explains this difference? We can quickly rule a few factors out. Productivity hasn’t come from squeezing hospital resources, nor has it all gone to increasing emergency activity. Hospitals delivered a lot more elective activity in 2024–25 than in 2023–24.
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This divergence between productivity growth and waiting list performance is visible at the trust level too. Lots of hospitals have seen productivity growth in 2024–25, for example, without a corresponding improvement in waiting times.
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December 9, 2025 at 8:41 AM
This divergence between productivity growth and waiting list performance is visible at the trust level too. Lots of hospitals have seen productivity growth in 2024–25, for example, without a corresponding improvement in waiting times.
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Elective waiting times in the NHS have improved since Labour came to office, but relatively slowly. Improvements in 18 week performance will have to pick up speed considerably if the government are to hit their headline NHS target by the end of the parliament.
October 24, 2025 at 1:34 PM
Elective waiting times in the NHS have improved since Labour came to office, but relatively slowly. Improvements in 18 week performance will have to pick up speed considerably if the government are to hit their headline NHS target by the end of the parliament.
There are reports that the government is considering changing student loans or pensions for resident doctors. We've written a new @theifs.bsky.social comment on the potential merits of such changes. Here's a summary:
July 19, 2025 at 8:12 AM
There are reports that the government is considering changing student loans or pensions for resident doctors. We've written a new @theifs.bsky.social comment on the potential merits of such changes. Here's a summary:
After defence commitments and the Barnett formula, giving DHSC 2.5% per year in real-terms would leave no real-terms increases for other areas. 3.4% per year for DHSC (closer to the long-run average) would imply 1% cuts per year in real-terms for everything else. 9/12
June 2, 2025 at 9:57 AM
After defence commitments and the Barnett formula, giving DHSC 2.5% per year in real-terms would leave no real-terms increases for other areas. 3.4% per year for DHSC (closer to the long-run average) would imply 1% cuts per year in real-terms for everything else. 9/12
If we look at past Spending Reviews, health has long done well – between SR 1998 and SR 2015, on average, the day-to-day health budget was planned to grow at 3.5% per year, while the overall day-to-day budget was planned to grow at 1.5% per year. 4/12
June 2, 2025 at 9:57 AM
If we look at past Spending Reviews, health has long done well – between SR 1998 and SR 2015, on average, the day-to-day health budget was planned to grow at 3.5% per year, while the overall day-to-day budget was planned to grow at 1.5% per year. 4/12
Lots of discussion today about regional investment. You can use our @theifs.bsky.social public spending tool to explore how much the government currently spends in each region of the UK, what it spends it on, and how that has changed over time: ifs.org.uk/calculators/...
May 30, 2025 at 1:41 PM
Lots of discussion today about regional investment. You can use our @theifs.bsky.social public spending tool to explore how much the government currently spends in each region of the UK, what it spends it on, and how that has changed over time: ifs.org.uk/calculators/...
Finally, the tool allows you to break down many aspects of government spending. For example, here is how the government split capital spending across different areas in 2022–23. Health is much less capital intensive than many other areas of spending.
April 10, 2025 at 8:17 AM
Finally, the tool allows you to break down many aspects of government spending. For example, here is how the government split capital spending across different areas in 2022–23. Health is much less capital intensive than many other areas of spending.
But that isn’t the case for health capital spending, which has stayed a roughly constant share of capital spending over time
April 10, 2025 at 8:17 AM
But that isn’t the case for health capital spending, which has stayed a roughly constant share of capital spending over time
Third, the tool allows you to see how spending on different categories (in different countries/regions) has changed over time. Here, for example, you can see that health has become a larger part of what the government spends its money on (unlike defence – at least up to now!)
April 10, 2025 at 8:17 AM
Third, the tool allows you to see how spending on different categories (in different countries/regions) has changed over time. Here, for example, you can see that health has become a larger part of what the government spends its money on (unlike defence – at least up to now!)
Second, the tool allows you to make detailed spending comparisons between two areas of the UK. For example, Scotland spent more per person on health than England in 2022–23. But the gaps were much larger for education and benefits, pensions and social services.
April 10, 2025 at 8:17 AM
Second, the tool allows you to make detailed spending comparisons between two areas of the UK. For example, Scotland spent more per person on health than England in 2022–23. But the gaps were much larger for education and benefits, pensions and social services.
First, the tool allows you to map many types of government spending across the nations and regions of the UK. Here, for example, is how per person capital spending on healthcare – a key factor for NHS productivity – differed across the UK in 2023–24.
April 10, 2025 at 8:17 AM
First, the tool allows you to map many types of government spending across the nations and regions of the UK. Here, for example, is how per person capital spending on healthcare – a key factor for NHS productivity – differed across the UK in 2023–24.
Taking plausible scenarios for activity growth, changes to demand and changes to which patients are treated first, the table below shows what 18 week performance could be like by mid 2029 (or when the target is hit).
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March 20, 2025 at 9:06 AM
Taking plausible scenarios for activity growth, changes to demand and changes to which patients are treated first, the table below shows what 18 week performance could be like by mid 2029 (or when the target is hit).
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We estimate it would take 4.9% annual activity growth to hit the target without other changes. For comparison, treatment volumes grew by 3.8% in 2024, and by an average of 2.4% each year from 2016 to 2019. So 4.9% would be very hard to achieve.
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March 20, 2025 at 9:06 AM
We estimate it would take 4.9% annual activity growth to hit the target without other changes. For comparison, treatment volumes grew by 3.8% in 2024, and by an average of 2.4% each year from 2016 to 2019. So 4.9% would be very hard to achieve.
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9/17
There is no simple relationship between the size of the waiting list and waiting times, as the chart below shows. For example, 18-week performance was 59% in Sept-07, 71% in Apr-20 and 90% in Jul-17. But in these three months, the waiting list was 4 million.
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March 20, 2025 at 9:06 AM
There is no simple relationship between the size of the waiting list and waiting times, as the chart below shows. For example, 18-week performance was 59% in Sept-07, 71% in Apr-20 and 90% in Jul-17. But in these three months, the waiting list was 4 million.
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It’s therefore very striking that the ONS estimates outputs to have only increased by 2.2%, whereas NHSE think all acute outputs have grown by much more, with a total 6.3% growth rate.
February 10, 2025 at 12:38 PM
It’s therefore very striking that the ONS estimates outputs to have only increased by 2.2%, whereas NHSE think all acute outputs have grown by much more, with a total 6.3% growth rate.
Let’s start by comparing the differences in the two measures as best as we can. Productivity growth is the difference between the growth in inputs (e.g. staffing) and outputs (e.g. patients treated). The table below is the closest we can compare
February 10, 2025 at 12:38 PM
Let’s start by comparing the differences in the two measures as best as we can. Productivity growth is the difference between the growth in inputs (e.g. staffing) and outputs (e.g. patients treated). The table below is the closest we can compare
The NHS planning guidance today sets out some new elective targets. It's not just all about 18 weeks anymore - there's now a long waiter target (again). But unlike the 2022 plan to eliminate 52+ week waits by March 25, the target is to now to get them to 1% of the list size by March 26.
January 30, 2025 at 4:35 PM
The NHS planning guidance today sets out some new elective targets. It's not just all about 18 weeks anymore - there's now a long waiter target (again). But unlike the 2022 plan to eliminate 52+ week waits by March 25, the target is to now to get them to 1% of the list size by March 26.
More broadly hospital bed occupancy remains very high. Higher than this point last year, though slightly lower than the year before when flu occupancy was close to this year.
January 16, 2025 at 10:38 AM
More broadly hospital bed occupancy remains very high. Higher than this point last year, though slightly lower than the year before when flu occupancy was close to this year.