The NHS: 'First Get the Facts - You Can Distort Them Later'

17/07/2013 15:00 BST | Updated 16/09/2013 10:12 BST

Well, Fraser Nelson, editor of the Spectator, heeded the second part of Mark Twain's remark in a recent blog about the British NHS. But even in political arguments it's useful to have some idea of the facts prior to distortion.

As Jonathan Portes - Director of the National Institute of Economic and Social Research - pointed out on Twitter, Nelson could have made a perfectly respectable argument for liberalising the NHS through greater competition but ruined it through 'evidence-free hyperbole'. In fact Nelson's blog (and subsequent Twitter exchange with me and Portes) wasn't exactly evidence-free, it was worse: it was selectively evidenced at best and wrongly evidenced at worst.

Nelson's starting point for arguing for (even) greater plurality of public and private providers selling care to an NHS purchaser was what he claimed was the failure of a decade of increased funding: 'If cash was the answer, the NHS would be fixed by now.' Instead, the extra billions provided by the Labour governments from the turn of the century have been frittered away - mainly, according to Nelson, on a bulging bureaucracy of ne'er-do-well managers intent on doing harm to patients. I exaggerate - but slightly.

But what are the facts? Let's start with funding. In 2000 according to the OECD, the UK spent 5.6% of GDP from public money on the NHS and another 1.5% privately by individuals on their own health care (7.1% in total). When Labour came to office in 1997, public satisfaction with the NHS was at its nadir - 34% very or quite dissatisfied. And compared to other OECD countries the UK ranked a lowly 24th out of 33 on spending. Something had to be done.

The deliberate political decision to add over 2 percentage points of GDP to NHS funding over the decade from 2000 brought public spending up to 7.8% (with private spending on 1.6% of GDP) - 9.4% in total, a rise in the spending about equal to the OECD average of 9.3% and equivalent to a near doubling in real spending for the NHS.

So what did the extra money buy? Did the NHS just grow 'fatter and more expensive' as Nelson claimed? The evidence suggests a more obvious outcome; staffing increased (and pay too) and waiting times came down to historic lows. And the public noticed the changes; by 2010 satisfaction increased to a historical peak of 70%. There was more equipment and more hospitals. Far from managers doing evil, a combination of money, targets and political will improved the lot of patients.

Could the NHS have done better? Of course. Is the NHS 'fixed'? Well, it's hard to know quite what that means. But even at a time when the money was flowing it seems the NHS managed to squeeze a bit extra out of every health care pound: productivity increased by around 0.6% per year between 2000-2010. Perhaps nothing to go wild about, but over the five years from 1995 to 2000, it only increased by 0.02% (yes, two hundredths of a percent) per year.

Health outcomes have also improved - but given the life course of many illnesses, the real improvements will take place over decades, not over night. And so with spending too. The boost since 2000 needs to be put in context. In 2011 the UK spent 21% less on health care than Germany, 24% less than France and 27% less than the Netherlands. But more than this, the fact is that such gaps have existed for decades. Germany has been spending more than the UK on health care to the tune of 2.8 percentage points of GDP every year - for forty years. That buys an awful lot of health care.

Money isn't always the answer, but when you're starting with relatively little it can make a big difference. And ultimately the numbers do matter. Ill informed debates are just that, ill informed.