100 Ways The Conservative Party Have Failed Our NHS, 2010-17

100 WAYS THE CONSERVATIVE
PARTY HAVE FAILED OUR NHS,

2010-17
By Eoin Clarke
@ToryFibs
100 ways the Conservative Party have failed our NHS, 2010-17
Foreword
In 2017 the NHS was, once more, ranked by the Commonwealth Fund as the best
health system among the developed economies. The cost efficiency and standard of care its
staff deliver year in and out, is second to none. Despite the funding restraint, the NHS
continues to defy the odds. The government have also had some successes too. Recent
improvements in the staff survey, productivity, and a belated recognition that the funding
settlement must improve are noteworthy. There is also now an awareness of the staff crisis
that faces the NHS and the need to train more staff. Importantly, Jeremy Hunt through his
words has given increased focus to the importance of mental health services, and that is
creditworthy.
That said, much of this is too little too late. Hunt’s words on mental health ring hollow.
Moreover, a recognition of the need to train more nurses, runs contrary to the decision to
axe nurses’ bursaries. The Health Secretary’s talk on the importance of transparency flies in
the face of his increasing inclination to bury important data, such as OPEL alerts. In this
document, below, I lay out 100 Tory failings in our NHS, providing an evidenced hyperlink for
you to click on to view the data and check yourself. Also, if you click the footnote that follows
the point it will include an explanation below of facts pertaining to the failing, and it some
instances I point out where the government has begun to make improvements. Not
everything this government has done has been wrong. Not everything Labour did from 1997-
2010 was right, by any means. This document, however, attempts to breakdown the areas
where the government has failed our NHS, since 2010. It was researched in good faith, and
the points presented are truthful to the best of my knowledge. If you have evidence to the
contrary or would like to offer feedback, please feel free to send me a message @ToryFibs.
Warmest regards,
Eoin Clarke, 31st December 2017
Copyright, Eoin Clarke 2017. All rights reserved.
31st December 2017 pg. 1

Mental Health
1. 5,162 overnight mental health beds have closed since 30 June 2016, cutting 1.8million
bed spaces, annually, from the NHS’s mental health services.i (evidence)
2. There are 5,240 fewer Mental Health Nurses employed in the NHS today than there
were in May 2010. The CQC judge that the number of mental health nurses has
declined by 12% since 2010.ii (evidence, evidence p.7)
3. Detentions under the Mental Health Act are up 30% since 2012. The CQC argue that
this is evidence that only the most immediate and intensive needs are admitted to
the mental health ward.iii (evidence p. 78, evidence)
4. The mortality rate for patients with a mental health condition has grown since 2010.iv
(evidence p. 111)
5. Mental Health bed occupancy regularly exceeds the 85% recommended level, and
anecdotal evidence has been gather that on occasion there are no beds available.v
(evidence, evidence, evidence).
6. The number of “out of area” placements for mental health patients has grown by a
half in two years. BMA say this requires a 4-6-hour journey.vi (evidence, evidence p.
78)
7. The percentage, and number, of mental health patients on the care programme
approach (CPA) who were followed up within seven days of discharge from psychiatric
care has fallen to its lowest annual levels since 2010.vii (evidence)
Social Care
8. 1.2 million Elderly persons are not having their social care needs met, an increase of
48% since 2010.viii (evidence, evidence)
9. Since 2010, the NHS has lost 10 million bed spaces as a result of delayed discharges of
patients, at a cost to the NHS of £4bn.ix (evidence)
10. NHS England saw a record 2.2m bed spaces lost to delayed discharges for the last 12
months, an increase of 41% since 2010.x (evidence)
11. The number of admissions from patients aged 80 and above at A&E has grown by
500,000 since 2010, a symptom of a failing social care system.xi (evidence)

12. The number of elderly & disabled in receipt of meals on wheels in England has
dropped dramatically since 2010, by between 63% and 80%.xii (evidence, evidence)
13. The Competition & Markets Authority found that self-funding users of adult social
care are being overcharged about £1 billion a year to plug the shortfall in government
funding for social care. Client contributions to fund social care have climbed £400
million a year, 17%, under the Tories. xiii (evidence, evidence, evidence)
14. Two thirds of unpaid carers have reported a deterioration in their mental and physical
health. (evidence)
15. The number of beds available at nursing and residential homes has fallen by more
than 4,000 in 2 years, at a time when more are needed. (evidence p.22)
16. Social Care homes are increasingly struggling to recruit the staff they need, as vacancy
rates have doubled for care workers since 2012.xiv (evidence p. 24)
17. The National Audit Office cast serious doubt on whether Tory plans to integrate
health & social services had reduced admission, made savings or led to better
outcomes. (evidence p.7)
Cancer services
18. NHS England’s performance at meeting Cancer Waiting Targets has worsened since
2010. The Two Week Wait from GP Urgent Referral to First Consultant Appointment
has fallen from 94.9% 2010/11 to 93.8% in 2017/18 (ytd). Two Week Wait Breast
Symptomatic (where cancer not initially suspected) from GP Urgent Referral to First
Consultant Appointment has fallen from 94.8% in 2010/11 to 91.9% in 2017/18 (ytd).
The One Month (31 days) Wait from a Decision to Treat to a First Treatment for
Cancer has fallen from 98.2% in 2010/11 to 97.5% in 2017/18 (ytd). The Two Month
(62 days) Wait from GP Urgent Referral to a First Treatment for Cancer has fallen
from 86.2% in 2010/11 to 81.9% in 2017/8 (ytd).xv (evidence, evidence)
19. According to Cancer Research UK, the Tories cut spending, by newly diagnosed cancer
patient, 10% in the first three years of their government.xvi (evidence)

Accident & Emergency

20. Since the Tories came to power, the four hour A&E target has been missed more than
10 million times.xvii (evidence)
21. Under Jeremy Hunt, our A&Es are in their worst crisis for 13 years. Last year, more
than one in ten patients waited more than four hours at England’s A&Es. This is the
NHS’s worst annual performance in more than 13 years.xviii (evidence)
22. The number of patients waiting more than 12 hours at A&E from decision to admit to
admission to a ward has climbed by 2,700% since 2011.xix (evidence: summary report
9-10)
23. The number of trolley waits of greater than twelve hours has climbed fivefold since
2010. (evidence, evidence: summary report 9-10)
24. Currently, A&E admissions [type one] have stopped rising but performance has still
deteriorated on the year.xx (evidence)
Closures
25. More than 40% of NHS Walk In Centres have been affected by Tory cuts or closures.
From 2000 until 2010, Labour opened 230 NHS Walk In Centres in England. Since
2010, the Tories have either closed or downgraded 100+ NHS Walk In Centres.xxi
(evidence & evidence)
26. 16,481 NHS beds have closed under the Tories. This means that there are now 6m
fewer bed spaces per year today than there were on 30 June 2010.xxii (evidence)
27. The NHS has closed maternity wards and A&E wards at a time when both services are
struggling.xxiii (evidence, evidence, evidence)

Staff
28. The number of workers quitting the NHS because it was affecting their work life
balance has tripled since April-June 2011, and reached record highs in the most
recent quarter.xxiv (evidence)
29. 37,842 doctors registered with the General Medical Council have applied for
certificates of good standing since the Tories came to power. By any measurement,
this is a marked increase since Labour were in power.xxv (evidence)
30. The size of the NHS’s workforce increased three times faster under Labour, 1999-
2010, than it has done under the Tories.xxvi (evidence)
31. There has been an increase in the percentage of NHS staff working unpaid hours, and
the percentage of NHS staff satisfied with their pay has reached record low levels. xxvii
(evidence)
32. The number of nurses leaving the profession in the UK has soared under the Tories,
with 140,000 leaving the register in the last 5 years. xxviii (evidence, evidence)
33. The number of nurse vacancies has reached dangerously high levels, with some
reports suggesting 27-42,000 unfilled nursing posts.xxix (evidence, evidence, evidence,
evidence)
34. Mean annual earnings for a qualified nurse has fallen more than £3k in real terms
since August 2010.xxx (evidence & evidence)
35. In nominal terms, Jeremy Hunt’s basic MP’s salary has risen at twice the pre-inflation
adjusted speed of an NHS worker since 2010. MPs have seen a rise of 14%, while NHS
staff have endured an annual public sector pay cap of 1% amounting to rises of 7%
before the cost of living is factored in.xxxi (evidence & evidence)
36. The number of health & social care workers on zero hours contracts continues to
grow to record highs.xxxii (evidence)

Privatisation
37. The 2012 Health & Social Care Act brought competition law into our NHS. Since then,
private health firms have been able to threaten the NHS with legal action for not
being awarded contracts. (evidence p. 98, evidence)
38. The amount of NHS cash used to purchase non-NHS healthcare has climbed by 72%
since April 2010. A total of £70bn has been spent purchasing healthcare from non-
NHS providers since 2010, with a record £12.7bn cash heading that way last year.
£50bn of that cash has gone to for-profit health firms.xxxiii (evidence, evidence,
evidence, evidence)
39. Income generated, and therefore resources devoted, by the NHS to treating private
patients has climbed 38% to £583m since April 2011. This, while the same trusts
record their longest waiting lists and worst A&E performances for a decade or
more.xxxiv (evidence, evidence, evidence, evidence)
40. There are extensive links between government politicians and private health firms
which offers the potential for serious conflicts of interest.xxxv (evidence)
41. The introduction of CCGs has failed to put GPs at the heart of commissioning, as the
Tories promised it would.xxxvi (evidence, evidence p.21, evidence, evidence)
42. 10 major health firms gaining contracts in our NHS have structures of their firms
located in offshore tax havens.xxxvii (evidence: see note xxxxvii)
43. Private health firms have walked away from contracts when they’ve struggled to
make a profit, leaving thousands of patients in the lurch. (evidence, evidence)
44. The government deny NHS privatisation is taking place but research shows upwards
of a third of NHS contracts are awarded to the private sector.xxxviii (evidence, evidence,
evidence, evidence, evidence)

Waste
45. The Tories have wasted £22bn on agency staff spend in the NHS, a quadrupling of
annual spend since 2010.xxxix (evidence, evidence, evidence, evidence)
46. The Tories have wasted £3.5bn of taxpayers’ cash on hiring private management
consultants for the NHS, this is a doubling of costs since 2010.xl (evidence, evidence,
evidence, evidence)
47. The government spent £1.1bn on NHS redundancies, and subsequently rehired 5,120
of those made redundant.xli (evidence, evidence, evidence, evidence, evidence)
GP Services
48. Since 2011, the proportion of unfilled GP advertised posts has climbed more than
fivefold. We’re are in the midst of a GP recruitment crisis.xlii (evidence, evidence)
49. By 2020, there will be a c10,000 shortage of GPs across the UK.xliii (evidence p.21)
50. The number of GP Practices in England has fallen by 889 since 2010, a fall of 11%, as a
result of closures or mergers.xliv (evidence, evidence)
51. Since 2010, England’s GP to Patient ratio has fallen by 6%. There are now fewer
doctors per patient that there were under Labour, and it has fallen steadily since the
end of 2009.xlv (evidence)
52. There are 4,425 fewer staff working at GP Practices today, compared to 2010.xlvi
(evidence p.15)
53. The GP Patient Survey shows record levels of dissatisfaction across several key
criteria. Patients finding it hard to get through to a GP, or finding the receptionist
helpful are at record levels.xlvii (evidence)
54. The proportion of the NHS budget going to general practice, excluding the
reimbursement of drugs, has fallen from 9.6% in 2005/06 to 7.9% in 2016/17.xlviii
(evidence)

NHS Finances
55. NHS spending under the Tories, since 2010, has grown 68% slower that the NHS’s
average spending settlement since 1955. No government has invested less additional
cash in real terms in our NHS than post-2010.xlix (evidence)
56. The government is on course to break its manifesto pledge of delivering £8bn real
terms spending increases to the NHS budget.l (evidence)
57. NHS spending, as a share of UK GDP, has fallen since 2010.li (evidence, evidence)
58. Spending on adult social care fell 8% from 2010 to 2017.lii (evidence)
59. Two thirds of NHS Trusts & NHS Foundation Trusts are now in deficit, and the total
deficit for NHS Trusts has tripled in one year.liii (evidence)
60. In February 2017, the PAC noted a black hole of £22bn in the NHS’s finances.liv
(evidence)
61. The amount of cash charged at NHS Car Parks has soared under the Tories to a record
£174m this year.lv (evidence, evidence)
NHS Rationing
62. For many patients, a free at the point of use NHS no longer exists. This is because
rationing in our NHS has increased substantially under Jeremy Hunt.lvi (evidence,
evidence)
63. IVF treatment has been rationed under the Tories, with 80% of CCGs now refusing to
fund the 3 cycles of IVF that NICE recommends.lvii (evidence p.6)
64. Hip & Knee Surgery is now being denied to patients who smoke or are obese in over
1/3 of Clinical Commissioning Groups. In addition, CCGs have begun to restrict free
hearing aids on the NHS for those suffering hearing loss. (evidence, evidence,
evidence)

Ambulance Services
65. The proportion of staff quitting the ambulance service has doubled and ambulance
services now have a vacancy rate of 10%.lviii (evidence)
66. Ambulance services are now losing 500,000 hours a year due to Ambulances backed
up outside A&Es. In 2010, 80% of ambulance transfers met the 15-minute transfer
target, now just 58% meet that benchmark. (evidence, p.21)
67. The percentage of ambulances meeting their target for the most life-threatening
callouts (Red 1) fell from 76% in 2011 to just 68% in 2017.lix (evidence, evidence,
evidence)
68. More than 70,000 NHS Staff in England were physically attacked last year, a rise of
30% since 2009. This was a record high.lx (evidence)
69. The value of clinical negligence payments reached a record high of £1.7bn last year,
double the figure it was in 2009-10. This is increasingly fuelled by cuts to maternity
services causing errors.lxi (evidence, evidence, evidence, evidence)
Maternity Services
70. 276,767 maternity care mistakes were made in England in the two years from April
2015, and in 63,380 incidents there was harm caused to the mother or baby. NHS
Improvement recorded 139,857 incidents in 2016/17, up from 136,910 in 2015/16.lxii
(evidence)
71. At least 58% of Maternity Units have had to temporarily shut their doors to mothers
in labour since 2011, and the number of Maternity Unit closures has increased by
41% in two years.lxiii (evidence, p. 12, evidence)
72. The relative risk of maternal death of mothers in the lowest quintiles almost doubled
from 2010 to 2015 (page 17)

Patient Safety
73. The British Medical Journal published that it is possible to link 120,000 deaths to
government cuts to health and social care. Other data also points to an increase the
mortality rate.lxiv (evidence, evidence)
74. The number of patient safety incidents reported in the NHS across England & Wales
reached record highs in the most recent data, and has almost doubled since 2010.lxv
(evidence)
75. The number of written complaints to the NHS reached a record high last year, and
have increased by more than a quarter since 2010.lxvi (evidence)
76. OPEL alerts, or black alerts as they are sometimes referred to, reached a record high
in 2017. 74 NHS Trusts declared OPEL levels 3 or 4 in January. (evidence, evidence,
evidence)
77. In 2016-17, A&Es in England recorded their highest ever number of ‘diverts’ with 80%
of NHS Trusts reporting higher diverts. (evidence)
78. The mortality rate for respiratory illness has climbed significantly, to 10-year highs.lxvii
(evidence)
79. Over 5 years NHS Shared Business Services compromised the confidentiality of more
than 700,000 pieces of NHS correspondence. (evidence, evidence)
80. Life Expectancy growth has halved under this government.lxviii (evidence, evidence)
81. A 2015 report by the ombudsman found serious failings in end of life palliative
services that was potentially impacting up to 350,000 patients a year. A second report
by the Royal College of Physicians reached the same conclusions.lxix (evidence,
evidence)
82. 1,198 never events have occurred in our NHS since April 2015.lxx (evidence, evidence,
evidence)
83. Two thirds of NHS acute non-specialist trusts require improvements say the CQC,
including 81% who require improvements in safety.lxxi (evidence)
84. NHS England’s bed occupancy has been above the recommended 85% since 2012,
and hit a record 91.4% in March 2017. This is dangerous.lxxii (evidence p. 64)

Training
85. Medical school intake grew by a half under Labour, 1997-2010 but since the Tories
have come to power intake has tailed off. This is stoking up future dangers for the
NHS.lxxiii (evidence)
86. Applications to nursing places at universities have fallen 22% in just one year
following the government’s decision to axe nurses’ bursaries. This comes at a time
when nursing vacancies & shortages are reaching record highs.lxxiv (evidence)
87. There is a 3,500 shortage of midwives on the NHS.lxxv (evidence)
Performance
88. The number of unresolved complaints made against the NHS that needed to be
passed on to the Ombudsman has grown more than 50% in 5 years.lxxvi (evidence, p.7)
89. The number of urgent operations cancelled for a second time by the NHS has reached
record highs, and more than doubled since 2010.lxxvii (evidence)
90. Under Jeremy Hunt, NHS Waiting Lists have grown to their highest levels in a decade.
At least 3.78m patients are on NHS Waiting Lists still awaiting the commencement of
treatment. This is the worst yearly average since the end of 2007.lxxviii (evidence)
91. Under the Tories, public satisfaction with the NHS has declined from a record +52%
(net) in 2010 to +41% in 2016.lxxix (evidence, evidence)
92. The percentage of NHS111 calls answered within 60 seconds fell to its lowest
percentage for any November on record, in the most recent data.lxxx (evidence)
93. The number, and percentage, of patients not treated within 28 days of an operation
being cancelled has more than doubled since 2010.lxxxi (evidence)
94. A 2015 report by the King’s Fund found serious failings in Dermatology Services,
especially in the commissioning of services which are increasingly privatised.
(evidence)
95. In 2017, the Ombudsman published a report concluding that the Eating Disorders
Services provided by the NHS were failing patients (evidence).

Jeremy Hunt
96. Jeremy Hunt was warned one year before the NHS Cyber Attack of May 2017 but did
not formally respond.lxxxii (evidence)
97. UK judges and official statisticians have rebuked Jeremy Hunt and the Tories on
several occasions for acting illegally or dishonestly. (evidence, evidence, evidence,
evidence)
98. Jeremy Hunt has presided over the scrapping of targets, and burying of data to
disguise his failings. OPEL alerts, weekly A&E data, the 18-week targets amongst other
things have been abandoned or buried. (evidence, evidence, evidence)
Children’s Services
99. The number of childhood admissions to hospital where obesity was a primary or
secondary diagnosis has climbed by two fifths since 2010. The figure has more than
doubled for adults.lxxxiii (evidence)
100. The maximum wait for a routine appointment for children has grown from 11
weeks in 2012-13 to 26 weeks in 2015-16.lxxxiv (evidence p.15)

i
The NHS reports its overnight bed availability data on a quarterly basis. On 30 June 2010, the NHS
had 23,515 bed spaces for mental health. As of 30 September 2017, the NHS now has just 18,353.
This is a record low.
ii
When this reduction in mental health nurses is put to Jeremy Hunt he says that there have been
increases in other aspects of mental health staffing to compensate for this reduction. He is correct.
Since May 2010, the number of Healthcare Assistants working in mental health services has
increased by 4,072. This data is contained in the same link cited. Importantly, Healthcare Assistants
are not health professionals. They are assistants to nurses rather than nurses themselves. This
represents a significant downgrading of the skill portfolio of the staff employed in mental health
services. There has been an increase in community psychiatric nurses but as the CQC point out, page
16, this has not been enough to offset the reduction.
iii
One positive in this data is that decreasing number of those detained under the MHA are held in
police custody. Having said that, the CQC remains concerned that a high proportion of mental health
wards are “locked wards”, a practice it condemns. The data runs from 2012-2016.
iv
In 2010, it was 210% higher than a person with no mental illness. By 2012, it was 227% higher.
Information obtained in the CQC’s 2017 state of care report.
v
The NHS doesn’t publish data on times when there are no beds available. Also, the figures we see
for occupancy are at midnight. Often, throughout the day, occupancy rates are higher. Plenty of
anecdotal evidence exists that bed availability is a growing pressure, and we can also substantiate
the permanent closure of 5,000 mental health beds under the Tories. The CQC point out that NHS
England has one of the lowest beds to patient ratios in the EU.
vi
This has cost the NHS about £40m extra, as the costs of placing a mental health patient further
afield is more expensive. When Jeremy Hunt says he is increasing spending on mental health
services, this is an example of the rather short-sighted way he is spending it. Retaining bed spaces,
and maintaining psychiatric nurses would have been a smarter way to spend that money.
vii
The number of follow ups within seven days of discharge from a psychiatric unit was 62,674 for the
last 4 quarters on record (to Q2 2017/18). The same figure for the four quarters of 2010/11 was
66,165.
viii
The government refused to implement the Dilnot recommendations, and abandoned its own plan
for what became known as the ‘Dementia Tax’. The void created by indecision and underfunding has
escalated the crisis in social care. Funding announcements in 2017 have gone a little way to closing
the Social Care funding gap in the years forthcoming but it is insufficient to solve the crisis.
ix
The National Audit Office cited a DoH forecast that cutting the number of delayed discharges had
the potential to save the NHS £391 per day, per patient. Since August 2010, there have been a total
of more than 12 million delayed discharges in England’s hospitals. This equates to an additional cost
of £4.6bn to the NHS.
x
The NAO has already recorded its belief that any evidence of integrated care proving a success has
yet to emerge. This data is the strongest indicator that it is not. Unavailability of care packages at
home meant that it was unsafe to release patients, see p. 38. This is putting extra pressure on
hospital services. It is possible to observe a correlation between social care cuts, and increasing
spend by NHS Trusts.
xi
Research shows that delayed discharges from hospitals have soared to an annual 2m+. This has
cost the NHS a cumulative £4bn since 2010. Most often, the reason cited for the delayed discharge is
that there is no care package for the patient at home. An increase in over-80s attending A&Es, is
another symptom of this care-gap. 1-week prolonged stay in hospital is associated with a 10%
decline in muscle strength, see p. 39.
xii
In 2010, 296,000 were in receipt of meals on wheels. That figure is well below 100,000 today and
falling further still. More than half of councils in England have completely discontinued their meals
on wheels service, which was founded in 1943.

xiii
There have been a variety of approaches to measuring the impact on self-funders the
government’s neglect of social care has had. There is no easy way to do it. Measuring homes sold to
pay for social care is not robust. And the lack of expansion in social care home places means it is
impossible to point to a growing share of places in care homes going to self-funders. Two methods
that anecdotally point to pressures on self-funders. First, the Competitions and Markets Authority
report shows that self-funders are overcharged to plug the funding gap in social care. Second, it is
possible to observe an increase in the amount of client contributions paid to fund social care, which
in part captures the offload onto self-funders. Both sources point to increased pressure on self-
funders, in part because of social care failings. The Age UK estimations of the growth in the numbers
of unpaid carers is not robust. The government’s own family survey shows the proportion of elderly
carers has remained at a static level of 8% of the population for a decade, although it does point to
those carers spending longer hours caring for the elderly.
xiv
Zero Hour Contracts, 204,000, and low pay are rife in this sector. The increase in the national living
wage will create great pressure on the financial viability of the care homes, many of which are going
bust. The sector’s current funding model is not fit for purpose. The staff turnover rate has also
grown to nearly 15% in this sector.
xv
The Two Week Wait From GP Urgent Referral to First Consultant Appointment has fallen from
94.9% 2010/11 to 93.8% in 2017/18 (ytd). Two Week Wait Breast Symptomatic (where cancer not
initially suspected) From GP Urgent Referral to First Consultant Appointment has fallen from 94.8% in
2010/11 to 91.9% in 2017/18 (ytd). The One Month (31 days) Wait from a Decision to Treat to a First
Treatment for Cancer has fallen from 98.2% in 2010/11 to 97.5% in 2017/18 (ytd). The Two Month
(62 days) Wait from GP Urgent Referral to a First Treatment for Cancer has fallen from 86.2% in
2010/11 to 81.9% in 2017/8 (ytd).
xvi
This report was published in July 2015. I am cautious about extending its findings beyond this
period because it is not clear where the recent funding commitments made to the NHS will be
apportioned.
xvii
Current spreadsheet on the NHS website runs from August 2010 to November 2017. It shows the
A&E target to see patients within four hours has been breached 10.4m times. This excludes May,
June and July 2010 and the current month.
xviii
The NHS kindly supplied me with A&E performance data, all types, dating back to 2002. For 2004,
the average performance against the four-hour target exceeded 90% (94%+), but in the most recent
twelve months the average was just 89.1%.
xix
The NHS does not have published data for this measurement in 2010, quite possibly because it
was not prevalent. In 2011, just 123 patients were kept waiting longer than 12 hours. The number of
patients admitted into A&E reached record highs this year both as a percentage of A&Es and in raw
terms. There has been a 500,000-annual rise in the number of re-attendances at A&E, which places
avoidable extra pressure on the NHS than if they had been adequately dealt with the first time.
xx
Current period runs Dec. 2016 to Nov. 2017 (15.332m). Previous period runs Dec. 2015 to Nov.
2016 (15.362m). Admissions fell c30,000. But the performance dipped from an average over the 12
months of 84.4% last to 83.6% for the current year.
xxi
This figure is an amalgamation of two pieces of research. First, Monitor published a report on NHS
Walk In Centre Closures from 2010 to February 2014. The author conducted his own research on
downgrades or closures since that date by reviewing local press for reports of cuts to NHS Walk In
Centres. In this instance, the term downgrade refers to any NHS Walk In Centre where the opening
hours have been reduced.
xxii
The NHS reports its overnight bed availability on a quarterly basis from Q1 2010/11. On 30 June
2010, the NHS had 144,455 beds. As of 30 September 2017, the NHS had just 127,614 beds. This is a
record low.
xxiii
There is no central collection of data on the number of A&E Wards, so that we can monitor their
closures. One Telegraph journalist has monitored closures and reported on them regularly over the
years. It is also possible to observe a decline in the number of sites submitting A&E data to NHS

Digital on a weekly basis. In 2010, 297 sites submitted data but that figure is closure to 240 today. Of
course, some of these could be mergers. The data points to about 1 in 6 urgent care centres, minor
injuries units or A&E wards having been closed or downgraded since 2010.
xxiv
Since June 2011, 80,000 NHS staff have quit because their job was impacting their work life
balance. The numbers quitting on a quarterly basis has tripled since Q1 2011/12. 1,521 quit that
quarter. But in the most recent quarter, Q2 2017/18 a record high of 4,692 have resigned.
xxv
On average, applications for certificates from the GMC are up a third under the Tories.
Applications are viewed as a barometer for morale among doctors as the certificates are required if
they wish to practice overseas. Not everyone who applies for the certificate follows through with it,
however, which is why we are not able to say they are leaving the NHS. Also, there may be many
reasons for application.
xxvi
From 1999 to 2010 (11 years), Labour increased of the NHS’s workforce by 365,000. From 2010,
(7 years) the Tories have increased the number of people working in the NHS by 77,000. This means,
on average, the NHS workforce increased at a pace of 33,000 a year under Labour but only by 11,000
under the Tories. As the UK population expands, the Tories are not recruiting enough people to the
NHS to keep pace. NHS Digital data shows the Tories increasing the Trust & CCG workforce by
c30,000 but the ONS data is a better way of catching the total number of extra jobs created in the
health & social care sector. It should be said, ONS labour force survey data shows that more than
20,000 of these new posts are zero hours contracts. A later part of this paper focuses on the social
care sector where low wages and high costs render the current social care funding model
unsustainable.
xxvii
The staff survey five-year trends show the NHS performing better in many key areas but
satisfaction levels with pay is the stand out area of concern. If the NHS is to plug the staff shortages
that are set to increasingly plague it, then solving pay worries is key.
xxviii
By any measurement the number of nurses leaving the profession is climbing steeply. The NMC
record 140,000 as having left in the last 5 years and show a rise of 40% in that time. Parliament also
recorded significant rises in the number leaving from 2010, 6.8% in 2010-11 to 9.2% in 2014-15. The
NMC’s data indicated there has been another 40% proportionate increase since then, which may
point to a near doubling in the numbers leaving on an annual basis since 2010.
xxix
HSCIC show us that Labour had reduced the nurse vacancy rate from about 10% in 2002 to less
than 1% by the time they left office. Every available indicator shows that the nurse vacancy rate has
grown this then. A discontinued data series disallows us from showing this precisely but we can
aggregate several reports to show this is the case. RCN suggest 40,000 unfilled posts. NHS Digital
show 30,000 monthly vacancies across all sectors for March 2017, with nursing comprising of the
largest total. The Labour Force Survey and ONS employment data show that the health and social
care sector has experienced a doubling of the vacancy rate since 2010. Evidence exists that the nurse
vacancy rate may be as high as 12% which would equate to a tenfold increase since the Tories came
to power. The National Audit Office have warned that this could worsen.
xxx Although mean annual earnings has increased in nominal terms e.g. £1.9k for qualified nurses,
once you factor in cumulative inflation, CPI, for the same period to September 2017, real mean
annual earnings for qualified nurses is on average £3.3k lower in real terms than August 2010. To
confirm this, pop the mean annual earnings of a qualified nurse into the Bank of England’s inflation
calculator for August 2010, and view the amount that would be equivalent to in real terms today.
Then deduct that sum from the actual reported mean annual earnings for that staff group from the
reported mean annual earnings cited by NHS Digital for September 2017. That figure will give you
the real terms fall in mean annual earnings since August 2010.
xxxi
NHS workers have been subject to a public sector pay cap since 2010 of 1%. During this same
period, MP’s were given a one-off pay rise of c10%, and added to the modest increases they
received their cumulative nominal pay rises total 14%. It’s true that some workers increase earnings
by moving through the increments but overall take home pay for nurses (mean salary) is down more
than £3k in real terms.

xxxii
The most recent data, ONS, shows there are 204,000 zero hours’ workers in health & social care.
In December 2015, this figure was 179,000.
xxxiii
In 2009/10, £7.4bn was spent on non-NHS providers with typically more than two thirds of that
figure going to for-profit providers. Last year, that figure climbed to £12.7bn with a similar
proportion, 70%, going to for profit providers. In total, an accumulated £70bn of taxpayers’ cash has
been used to purchase healthcare from non-NHS providers under the Tories with about £50 billion
of that sum going to for-profit providers. In nominal terms, the cash spent on purchasing healthcare
from non-NHS providers has grown 72% since the Tories came to power. This data excludes 2017/18
which a recent report claimed saw a record number of contracts won by private health. See here.
xxxiv
In 2010/11, the NHS earned £421m treating private patients. Last year, it was a record £583m.
The difficulty here is that tight financial settlements for hospitals are causing them to prioritise
treating private patients to accrue income instead of clearing waiting lists that are at 10-year highs.
Deteriorating performance has coincided with an increase in private work.
xxxv
The report refers to government MPs from the 2010-2015 intake. It is possible to link 700
donations totalling £20million to the Conservative Party from persons or companies who have had
some links to the private healthcare industry.
xxxvi
When the CCGs were set up in shadow form, 57% of their members were GPs. This figure has
declined steadily in the years that follow, to about a third. In their place, the void has been filled by
unaccountable corporate lawyers often linked to US health firms. This runs contrary to the stated
aim of the introduction of CCGs.
xxxvii
A report by Unite the Union published in the Guardian in 2015 listed 10 firms with contracts the
run the NHS, but also tax haven status in part of their company structure.
xxxviii
NHS Privatisation occurred under New Labour but not in the way, or volume, it has done under
this government. The 2012 H&SCA allowed for the forced tendering of large parts of primary
healthcare under Any Qualified Provider. It also invested EU competition law into the NHS. Forced
tendering under competition rules has meant private sector is winning an increasing volume of NHS
contracts. This is part reflected in the DoH annual accounts that show an increasing percentage of
NHS cash being paid to non-NHS providers. But it won’t tell the whole pictures. Contracts awarded
run into several years, and it will take years for the full effects of contracts awarded to the private
sector to fully show up on NHS accounts. A report published by the NHS Confederation at the end of
December 2017 shows that private firms were winning up to 70% of the £7bn contracts tendered in
2017. Much of these awards will take years to show up on DoH accounts.
xxxix
From 2010, the Tories commenced a large-scale redundancy programme in the NHS. That,
amongst other things, caused gaps to appear in NHS staffing. Lower morale among NHS workers has
caused more to leave, also. In addition, training output of staff has stagnated. Hospitals have
plugged this gap, created by Tory mismanagement, by hiring temporary agency staff at much more
expensive levels. 2009/10 expenditure was £0.83bn. 2010/11, £1.1bn. The most recent year saw
expenditure on temporary agency staff of £3.7bn, a figure celebrated by the Department of Health
because it was a little lower than the £4.1bn of the previous year.
xl
2009/10 saw expenditure on private management consultants of £197m. The figure for the most
recent year was £389m. On average, the last 6 years spending was £500m per annum. When
commentators talk about the extra spend because of the top-down reorganisation of the NHS, some
of the costs of that are in this spend. The redundancy programme saw many managers made
redundant. In part, this increase in expenditure on private consultants is plugging the gap left by that
lost expertise.
xli
Rehired rates of redundant staff were put at 18% as of 2014. There has been no follow up research
since as to whether that rate had increased but the raw number of NHS redundant staff who were
rehired climbed by almost 1,000 in the year after that figure. The average redundancy pay-out was
£43,000. Thus, we can say that £200m was paid in redundancy to staff that were subsequently
rehired by the NHS.

xlii
From 2011, Pulse Magazine have been surveying the number of unfilled GP posts. The figure has
climbed steading from 2.1% in 2011 to 12.2%, a record high, for this year. The HoC Library also show
that GP vacancy rates were much lower under Labour but a brief gap in the collection of the time
series data, means that it is more robust to use the Pulse data.
xliii
Under Labour, the number of medical degree training places at UK universities increased steadily,
almost doubling. Since 2010, the number of places has flat lined. Even if the new doctors we train
enter the UK workforce, their numbers cannot keep pace with the growth in population which
averages an additional 0.8% per year.
xliv
In 2010, according to NHS Digital, there were 8,324 GP Practices in England. GP Online, say that
figure stands at 7,435 in 2017. This represents a fall of 889. Upwards of 800 GP practices have closed
during this time, and about a fifth of that figure have newly opened. The remaining figure is account
for by GP Practices merging.
xlv
In 2009, England had 7 GP practitioners per 10,000 patients. By the end of 2016, that figure was
just 6.4, and it had fallen steadily in the intervening years. Proportionately, it has fallen by 6% since
the end of 2010.
xlvi
In 2010, there were 136,831 staff working at GP practices in England. The most recent data shows
that figure now stands at 132,406. During the same period, the number of staff working at GP
practices in Wales increased.
xlvii
Patients finding it hard to speak to a GP or finding that their GP has enough time to see them is at
record levels. This is most likely a symptom of the GP shortages, as well as 889 reductions in GP
practices.
xlviii
The NAO have detailed the many errors the government made in pushing ahead with its 7-day
access to GP services plan. Amidst a 4,000 cut in GP Practice Staff, and a reduction of 889 GP
practices, it was ill thought from the outset. With the stagnation in medical training places, and
surging vacancy rate among GP practices, the government have placed increased pressure on GP
services. Recent improvements in the funding settlement for GP services will take time to reverse
the damage to GP funding caused by cuts in the early years of this Tory government.
xlix
The IFS NHS spending briefing paper shows that NHS spending has grown at an average real terms
rate of 4.1% since 1955. Under this government, the growth rate has been just 1.3%. Per capita, the
figures are even worse. 4.0% between 1955-2010, and just 0.6% from 2010.
l
This is strongly contested statement. The Nuffield Trust explain that without new funding pledges,
and based on current inflation forecasts, the government are on course to break their manifesto
promise. They also point out that £3.3bn of the NHS cash is to be generated from the sale of NHS
land.
li
By every measurement, NHS spending is lower as a share of GDP today that it was in 2010. OBR,
Nuffield Trust and the King’s Fund are agreed on this. When additional spending on private health,
non-NHS, is added in, the UK figures look a little better (see ONS for total healthcare spend). Also,
the IFS predict that healthcare spend as a share of GDP will have to climb in future years due to an
ageing population. For now, however, NHS spending as a share of GDP has fallen under the Tories.
lii
Spending per adult has fallen 13.%.
liii
When Labour left power, NHS Trusts were in surplus. For the year, 2015-16 the total deficits of
NHS Trusts reached £2.5bn. Cost pressures, mismanagement and underfunding have caused this.
liv
Part of this £22bn black hole will have been alleviated by the increased funding announced in the
Autumn Budget of 2017, but the bulk of it remains. Using £1.6bn of the Department of Health’s
Capital Funding for day-to-day spending in the NHS was branded as reckless by the PAC. In addition,
the second efficiency plan in 7 years was deemed as unrealistic, with the government expecting the
NHS to make efficiency savings of 4% per year.
lv
In 2014-15, the figure was £114m, in 2015-6 £160m and this year £174m.
lvi
A report by the British Medical Journal has shown that rationing has increased substantially.
Doctors making direct appeals to CCGs for individual funding
lvii
Caesarean sections, on demand, are now being refused by some CCGs. See Nuffield.

lviii
Ambulance services report increased demand; calls are up 20%. Ward closures, and bed cuts
mean there are few places to bring patients. Capacity in the NHS, as well as cuts to social care have
placed a greater burden on ambulance services.
lix
The government are abandoning current targets in favour of new ones, so the data will soon be
incomparable. The old data for 2010 response times is also not on the NHS website, so a comparison
with that time frame is not possible. Therefore, we have a comparison of the most recent data,
October 2017, with 2001. The performance data for category two calls was even worse, at 58% for
October 2017.
lx
NHSBA gathered this data until this year, but NHS Protect ceases to exist, and it is not clear who
will gather this data going forward. In 2008-09, 54,758 NHS staff were physically assaulted. In 2015-
16, this figure surpassed 70,000.
lxi
Claims are not always made in the year the event occurs, and payments that year often do not
relate to claims for that year. In other words, there is a lag. But the data shows that the record
number of claims made relate to 2011-13, and that increasingly it is linked to errors being made in
maternity services. There was evidence in the early part of this government that many claims related
to a fallout of the Mid-Staffordshire inquiry and a greater encouragement to speak out. But the new
claims data is showing post-2010 as recording the record number of claims. In other words, the old
Tory defence of this data is becoming increasing less credible.
lxii NHS Improvement report that 276,767 clinical errors occurred from April 2015, resulting in 288
deaths. Royal College of Nursing say that a shortage of 3,500 midwives is partly to blame. Other data
shows that 58% of maternity units shut their doors to expectant mothers at one time or another.
lxiii
The IFS sent FOIs to all 258 maternity units in England, at unreturned responses were counted as
non-closures in the instances of presenting the closure figure as a minimum. The spike in closure
days matched September, the month where the most births occur. This suggests closures were
linked to inability to meet demand. FOI requests sent by the BBC show that MU closures grew by
41% in just two years, from 225 closures in 2014, to 382 closures in 2016.
lxiv
Making strong conclusions based on mortality data is fraught with danger. Thus, the robustness of
the BMJ report, or indeed the mortality rate is for others to comment on. This point is simply to
reflect findings in popular discourse. ONS have reported a stagnation in life expectancy that is out of
kilter with recent trends and therefore it is valid that this becomes a point of discussion. Patient
outcomes data shows mortality from respiratory illness is at its worst for 10 years.
lxv
There were 2 million patient safety incidents reported in the last year. In 2010, the same figure
was 1.2m. £1.9bn of Clinical Negligence claims were made, a record high. We know that 276,766
maternity incidents occurred since April 2015, and that is this fuelling the rise in clinical negligence
pay-outs. One the one hand, the government have done a good job in promoting a culture of
reporting, and this undoubtedly is one of the key reasons for an upsurge in incident reporting. But it
is not the only driver. More mistakes, fuelled by staff shortages and in some cases inefficient
reconfigurations, are being made.
lxvi
Greater transparency and inclination to complain should be welcomed, and to the governments
credit they have helped create a culture where complaining is to be welcomed. But the year on year
increases in the number of complaints when viewed against other data such as clinical negligence
claims, declining patient satisfaction and poorer performance data means that it can be taken as a
barometer of increasing dissatisfaction with how the NHS is performing.
lxvii
Cardiovascular and cancer mortality rates continue to fall but respiratory illness mortality rates
have been a notable exception.
lxviii
The rate of growth in life expectancy has halved since 2010. It now takes a decade to add one
year to average life expectancy of a women, whereas before the 2010 election this was occurring
every five years.
lxix
The main reasons cited were poor staffing and training. This led to almost half of patients not
being told they were dying, and often having no specialised staff there to deal with them
appropriately at the end.

lxx
Never events are serious largely preventable safety incidents that should never occur. It is not
possible to compare never event incidents post April 2015 with the years before it because the
criteria for what constitutes a never event has changed. Since the updated never event criteria have
been introduced, the NHS has recorded 442, 424 and 332 (ytd) never event blunders.
lxxi
CQC published this report in 2017, and the data is accurate as of 31st December 2016.
lxxii
The is a direct consequence of the closure of 16,000 beds since 2010.
lxxiii
The government have belatedly realised that their failure to develop medical school intake is
fuelling a recruitment crisis in the NHS. Recently, they announced 1,500 new medical school places
commencing 2018, 2019 and 2020. From 1997-2010, Labour grew medical school intake by 2,500. In
recent years, intake has struggled with only 88% of the places available last year, filled. Intake was
just 5,800 in September 2016.
lxxiv
Applications is not the same as measuring places filled. There is every chance places will still be
filled but the government are now drawing upon a smaller pool of applicants.
lxxv
The government have increased the number of midwives since 2010, but growth has not kept
pace with population increases. Errors in maternity services are fuelling record high Clinical
Negligence claims, £1.9bn this year, and data shows mistakes are made at 1 in 5 births. 288 deaths
have occurred because of errors in maternity services in the last two years.
lxxvi
In 2011-12, 14,701 unresolved complaints were passed to the Ombudsman. In 2016=17, that
figure grew to 22,965. The number of complaints upheld have increased nearly fivefold in that time.
lxxvii
164 urgent operations were cancelled by NHS England for the second time in the last 12 months
to November. The earliest 12 months of data, 2010/11, recorded a figure of 57 operations over a 12-
month period.
lxxviii
We have 10 months of data for 2017, so far. On average 3.78m patients await the
commencement of treatment. This figure is an understatement since not all data centres returned
the data. Experts say the true figure is likely to be closer to 4.1m. We have not seen figures that high
since 2007.
lxxix
In 2010, public satisfaction with the NHS reached a record high of 70%. Last year, satisfaction
with our NHS was 7% lower, and dissatisfaction was 4% higher.
lxxx
More than 5 million calls have taken longer than 60 seconds to answer since NHS111
commenced, with 3m+ of those <60 second calls occurring since 2016. Correspondingly, the number
of calls abandoned has also increased sharply with 1.5m calls being abandoned after 30 seconds, and
0.8m of those calls occurring from January 2016 onwards. One thing the government have improved
upon is increasing the percentage of calls that have a clinical input, up to a record 37% in the most
recent month.
lxxxi
In 2010, 3.5% of patients who had operations cancelled were still not seen within 28 days. For the
most recent year, that percentage had more than doubled to 7.3%.
lxxxii
The government cut £5.5m funding for IT support to computers using Windows XP.
lxxxiii
In 2009/10, 211,783 people were admitted to hospital where obesity was a primary or
secondary diagnosis. Last year, that figure reached 524,000. Correspondingly, the figure for those
under 16 was 2,400 in 2009/10, rising to 3,412 in 2015/16
lxxxiv
Memory services, and those suffering eating disorders have been particularly badly affected. See
p. 21.

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