Fact-checking a few claims about the NHS

What with the campaigning for the general election having gotten into full swing last week, many claims have been made regarding which Party would be better for which aspect of security, the economy, education etc. One particular video regarding the NHS started doing the rounds on Facebook a few days ago. This video makes a number of claims regarding the supposed impact that the recent Coalition and Conservative governments have had on the NHS, with the video then going on to suggest that a Conservative government would be bad for the NHS. For a bit of excitement, here is said video:

 

 

The claims made in that video are many. Some are valid, whereas others are not. Let’s take each of them in turn.

Claim 1: We are experiencing the largest sustained drop in NHS funding as a percentage of GDP since the NHS was founded.

Reality: This claim is false. As per the information shown in the graph below (from the Institute for Fiscal Studies) NHS spending as a proportion of GDP has been stable over the past couple of years, and the decrease between 2009 and 2012 was no larger or longer than decreases in the mid-to-late 1970s or mid-1990s.

bn201_fig1

Moreover, the more relevant metric of NHS spending per capita continues to increase – in other words, more is spent per person on the NHS than ever before, although the rate of that increase has slowed in recent years.

bn201_fig2

Claim 2: If the internal market was abolished we [i.e. the NHS] could save billions.

Reality: This claim is also false. The internal market actually creates savings and is not “wasteful” as is claimed in the video. On the contrary, it promotes competition and stimulates the NHS to provide better services – importantly, the benefits of competition in healthcare are well established. Furthermore, it is actually the refusal of many within the NHS to accept the proven benefits of competition that is causing some harm to the NHS – indeed one of NHS Improvement’s main aims is to promote and encourage “buy-in” of competition among those in the NHS. Hence, abolishing the internal market would actually cost billions rather than save them.

Claim 3: Health tourism costs the NHS £200 million per year, which is insignificant in terms of the overall cost of the NHS.

Reality: This is generally true – although the costs to the NHS associated with people who are not ordinarily resident in the UK are of the order of £2 billion per year, that includes many people who did not come to the UK specifically and solely to use the NHS (i.e. it includes people who are not “health tourists”. Instead, estimates put the upper bound of the costs associated with those who travel to the UK for the sole purpose of using the NHS at around £300 million per year. When compared to the total annual NHS budget of about £90 billion, the costs associated with health tourism are indeed a trivial amount.

Claim 4: Immigrants are not ruining the NHS, they’re running the NHS.

Reality: True. Immigrants from within the EU currently represent about 10% of doctors and 4% of nurses. If non-EU immigrants are included, therefore, the figures are likely to be slightly (although probably not a huge amount) higher. Given that there are already quite severe labour shortages within the NHS, it is clear that without the immigrants currently working within the NHS, the functioning of the NHS would be severely hampered. Moreover, immigrants are net contributors in terms of taxes vs benefits, so also contribute to the NHS in that way. Hence, the claim that immigrants are not ruining the NHS is clearly valid.

Claim 5: 1 in 10 nursing posts are vacant and the nursing bursary has been scrapped

Reality: True. The nursing bursary was indeed scrapped at the start of the year – this means that there is a much-reduced incentive for people to train to become nurses as they will now have to pay £9,000 in tuition fees per year in order to do so. This is likely to lead to problems recruiting sufficient nurses in future. Notwithstanding that, there are also problems recruiting nurses now – the Royal College of Nursing suggests that 1 in 9 nursing posts are now vacant. This figure is actually marginally worse than that claimed (11% vacancy rate vs the 10% claimed).

Claim 6: Tens of thousands of sick patients waited on A&E trolleys this past winter

Reality: Likely to be true. Using data from Quality Watch (and a bit of approximation / extrapolation), roughly 6 million people attended A&E last winter. Of these, around 15% were not seen within the government target of four hours – i.e. about 900,000 people waited more than four hours in A&E. Now, it seems unlikely that all of these people waited on trolleys specifically, but even if only 10% of these people (i.e. 1.5% of all admittances to A&E) did then the “tens of thousands” figure would be accurate. Hence, this claim seems plausible.

Conclusion: As with most of these election video type things, the video contains some claims that are true, some that are likely to be true, and some that are demonstrably false. Does this mean that the Conservatives are the worst Party for the NHS? Who knows?! That’s for you to decide and take into account (if you want to) when you vote. But at least when doing so, you’ll now have a more complete set of facts when you do.

 

Evidentiary standards are slipping

Over the past month, there have been a number of instances in which a politician or journalist has made a bold claim, and then ignored or been unable to provide any evidence to support those claims.

For example, Fraser Nelson claimed that being in the EU had been a net detriment to the UK’s trade, and that the evidence he had seen supports that view. However, when provided with evidence that contradicted his claim, and when challenged to provide the evidence to which he referred, Nelson did not provide any sort of response. Likewise, Michael Gove claimed that there was evidence to indicate that leaving the EU would provide the UK with a “net dividend”. However, when pressed to provide the evidence that he claimed existed, Gove did not do so; nor did he respond to the provision of evidence that contradicted his view.

This is not just a problem for right-leaning opinion makers either; it affects left-leaning ones just as much. For example, despite copious evidence (from the Low Pay Commission) that increasing the minimum wage too high would be detrimental to the employment rate of low-income earners, Jeremy Corbyn claimed that increasing the minimum wage to £10 per hour would raise their living standards.  Again, Corbyn provided no evidence to support his claim.

This seems to be part of a wider, and long-running, malaise, in which policymakers can make a bold claim without any evidence to support it, yet said claim is taken at face value and isn’t challenged by the media nearly as often as it should be. Even worse (and a point made by Jonathan Portes in his recent discussion with Michael Gove), when challenged to provide evidence to support their views many in the media and political sphere tend to rely on a single statistic or anecdote even if copious evidence exists that contradicts their claim.

That’s assuming that the personalities concerned respond at all. Much of the time, they remain meekly silent, failing to respond, yet letting their original claim stand as though it hadn’t been challenged at all.

This isn’t just a point of pedantry – quite clearly, claims made by those covering and participating in campaign trails have real implications. For example, Vote Leave’s claim that Turkey would join the EU (despite all evidence to the contrary) likely played on some voters’ desires to reduce immigration (according to Ashcroft immigration was a major concern for roughly one third of voters), despite the fact that immigration has continually been proven to benefit the UK and everyone in it.  Similar points can be levied against various claims that the current level of trade between the EU and the UK could easily be replaced by trade with Commonwealth countries (despite the fact that the well-proven gravity model of trade directly contradicts this). And it seems likely that the upcoming election will be rife with claims and counter-claims that are (un)supported with evidence to varying degrees.

In essence, it is at least plausible that false claims made by opinion formers were taken to be true by some members of the voting public who based their decisions accordingly, and might have voted differently had they been informed of the actual evidence.

Now, what can be done to ensure that voters (and the general public as a whole) have actual evidence available rather than simply the claims of journalists and politicians?

Well, for a start, the press regulators (IPSO and Impress), the Electoral Commission, and the likes of the Office for National Statistics need to take on a much more proactive role. They should not wait for complaints to be submitted to them by the general public, but should take it upon themselves to investigate and penalise those in the public eye that make misleading or unsupported claims, with those punishments being far more severe than those currently used (for example, newspapers cannot continue to be allowed to get away with publishing retractions in the bottom corner of some page in the middle of their publication).

Second, political programmes like Newsnight, Question Time, and the Daily Politics should do far more to challenge politicians and journalists to support any claims they might make with sufficient evidence (i.e. more than just a single anecdote or statistic).  In other words, any journalist or politician appearing on such shows must be able to demonstrate that their claims are valid. The presenters on such shows should spend far more effort researching the actual evidence as well as questioning their guests on the basis of any claims that they might make.

Third, the Parliamentary Standards Committee needs to realise that their role in holding MPs accountable extends to claims made by MPs that are not supported by any evidence. Such claims are in violation of the MPs’ Code of Conduct and should be treated as such, with the necessary punishments for these violations being far more than the usual slap on the wrist.

Finally, and a much more long-term remedy, the general public should be provided with far greater training in the use and abuse of statistics. This should start from an early age and not only train people in how to calculate various (simple) statistics, but also provide information concerning how to spot when a commenter is using misleading figures or is relying solely on anecdotes to try to substantiate their points.

Once these suggestions have been implemented, the ability of journalists and politicians to deliberately obfuscate and mislead would be markedly reduced. That can only be a good thing.