andrewducker | Next time someone tells you that Labour and the Conservatives are identical

The main questions I would ask about this graph are:

1. What went so wrong in 1996?

2. What started to go right in 2003?

The Tories' record looks particularly awful because of a huge rise from 1996 to 1998. This period also makes Labour's record look much better. Without it, we have pretty much a steady state from 1994 to 2003. It would be very interesting to know the reason for this huge anomaly.

But there is a definite downward trend in the period from 2003 to the present. It would be interesting to know what changed in 2002-3 to make this happen.

There were a lot of people who were on waiting lists to get onto waiting lists, and when proper reporting was put in place Doctors were no longer allowed to hide those people. I remember a discussion with my father complaining that doctors were no longer allowed to just move people about and reprioritise patients so that people with low need were effectively put off forever.

And it takes time to put people into place - getting new personnel through the system and putting new systems in place takes a lot of time and effort - and for the first while you're running to stand still - and then the backlog clears, and suddenly you're running downhill. It's like paying off a big loan - at first you're just paying off a little more than the interest, but as the debt lowers the same amount of cash pays off much more of it each month.

To play devils davocate: the number of people in the longest-wait categories went down fairly steadily throughout the Conservative era. It looks like the trend over 87-97 was people moving from long waiting lists to short ones.

For the reasons you have already described, plus a wide and enthusiastic variety of others, these statistics are basically meaningless. There are now more ways of massaging the numbers than ever, including interesting things like queueing systems to even be allowed to be put on a waiting list. Rather than a waiting list waiting lists.

And that is somewhat meaningless because it's an invented number with no real value.

I'd guess the primary reason the numbers have come down is that Labour have concentrated the central administrative policy on getting the numbers down. So the administrators find ways to do that. And the table looks better. Whether patient care has improved in the slightest as a result is virtually impossible to discern, because actual medicine doesn't really care what your graph says. More diseases are found or invented damned near daily, more cures and treatments for those diseases are found just as frequently, and everybody dies.

oh, and the lovely policy of discharging patients at the earliest possible opportunity is probably helping a fair bit as well. As a Social Care Worker it certainly kept me busy.

2003-present? Labour began to concentrate almost exclusively on lists and league tables. So Hospitals concentrated on paying more attention to those lists and league tables. The numbers came down because ways were found to reduce them. Whether that improved quality of service is almost completely irrelevant to this set of statistics

Labour also increased spending on the NHS dramatically. Unless you think this money was entirely wasted, I don't think it would be unreasonable to assume that this might be one of the reasons.

I'm assuming your question is 'do I think pouring money in has made a difference to waiting time statistics', disregarding any other improvements.

Well, yes. As intimated by my observation that Labour has concentrated almost exclusively on lists and targets. If your core focus is on making statistical tables look better, then that's what'll happen. Or you're doing something very very wrong.

It takes 5 years to qualify as a doctor, plus a year or two to know what you're doing. Labour created something like 5 new medical schools, and expanded student places at others. So about 5 years after they were first elected, lots of new doctors started work, and another year later they were actually effective. (The OECD says that we went from 1.9 doctors per 1000 people in 2000 to 2.5 doctors per 1000 people in 2007. Nurses went from 9.2 to 10.0 per 1000 people over the same period. pdf link.) I think this may have at least something to do with the 2002-3 decrease.

It seems likely to me that waiting lists will have a vicious circle - with a long waiting list, the average treatment is carried out on a sicker person (because they've waited longer for treatment), and is therefore more complicated and takes more resources, so the number of treatments that can be carried out falls, so waiting lists lengthen. If this is true then the cause of the big increase in 1996 may well be several years earlier.

It takes 5 years to qualify as a doctor, plus a year or two to know what you're doing. Labour created something like 5 new medical schools, and expanded student places at others. So about 5 years after they were first elected, lots of new doctors started work, and another year later they were actually effective. (The OECD says that we went from 1.9 doctors per 1000 people in 2000 to 2.5 doctors per 1000 people in 2007. Nurses went from 9.2 to 10.0 per 1000 people over the same period. pdf link.) I think this may have at least something to do with the 2002-3 decrease.

Yeah, that sounds pretty plausible, especially given those OECD numbers.

It seems likely to me that waiting lists will have a vicious circle - with a long waiting list, the average treatment is carried out on a sicker person (because they've waited longer for treatment), and is therefore more complicated and takes more resources, so the number of treatments that can be carried out falls, so waiting lists lengthen. If this is true then the cause of the big increase in 1996 may well be several years earlier.

Fair enough, but then we have to wonder what caused the equally sharp drop in 1998. A change in clinical priorities such that the number of treatments increased, a change in recording/classification practices such that people were removed from these figures without necessarily being treated, or something else?

"Whether patient care has improved in the slightest as a result is virtually impossible to discern"

True from these data but it's not impossible to discern whether patient care has improved. If you look at tables of mortality and morbidity (te latter slightly more dodgy) you see a very cheery graph. It'd be well worth pulling these figures (ONS publish them) and seeing how they compare to the above. Obviously, one can't be sure about what did or didn't cause any change in the mortality rate (or rather, in the rate in which the mortality rate improves, especially compared to other OECD countries) - but it'd be very interesting.

You can massage all figures, but all-cause mortality is one of the harder ones to fudge.

So they do.

They also publish a separate set of life tables.

Life expectancy at birth and at age 65 consistently increased over the last few decades, but the increases are larger in 1997/99 - 2006/08 than in 1988/90 - 1997/99, for both men and woman and for both ages. The "extra" improvement is between 25% and 95% over the 1988/90 - 1997/99 baseline.

That's exactly what happened in the education system.

Oh, thanks for the direct links, saved a lot of messing around.

Total tangent (always happens to me when I get my head stuck in to these sorts of figures) but I'm interested to note (from an accompanying PDF) that the life expectancy gap between males and females has shrunk from 5.4 years in 1991/93 to 4.2 years in 2006/08 - because male life expectancy improved even more than female.

Hooray for improved life expectancy. It's a good thing to have come to expect.

I have to take issue with your reasoning - apart from all the questions about massaging of statistics and comparing apples with oranges, the fact is that much of the money that was used to get where we are was borrowed and will need to be payed back with interest.

What's the money got to do with whether waiting lists have gone down?

It takes money to train and employ the army of surgeons, nurses, support staff and buy equipment, buildings, etc. If we have to pay back the money then we'll have to make massive cuts which means laying off staff, closing wards, not replacing aging/failing equipment, etc. Hence waiting lists go right back up and beyond where they were.

The chinese and others lent us their savings and they want them back.

It's what happened in most public sector establishments. Most damage, by far, has been caused to the Police who now have to spend so much time doing paperwork carving out their Achievements that they have very little time left to do actual Policing. The terrible reputation our Police service now endures is almost entirely because of this policy.

If this happens, yes. But we shall have to wait and see where we are 5 years from now.

The OECD is international, independent of the UK government, and makes an attempt to produce comparable figures across countries. (However these are not necessarily comparable to government's own reckonings as published by ONS and in the annual budget...) On these figures, the UK national debt went from 52% of GDP in 1997 to 40.4% of GDP in 2001 - down by 12% of gdp in four years! -, 46.9% in 2007, and 71% this year. Germany stands at 77.4% this year, France at 84.5%, the USA at 83.9%. In short, past spending was entirely affordable at the time, and so far from investors wanting their money back gilt auctions remain oversubscribed and interest rates are remarkably low.

The problem with the annual public sector deficit is that it is forecast to remain high in the short-to-medium term unless there are cuts in spending or increases in taxes or both, and this might cause a future blow-up of national debt. But this wouldn't be due to the cost of servicing the current national debt, but to spending on real goods and services in the future.

How else, other than by collecting statistics, does a government tell if anything is changing?

Next time someone tells you that Labour and the Conservatives are identical

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