Is the NHS really in crisis? Madano's Insights team takes a look.

You’ve probably seen the headlines, read the reports and think that you know the answer, but is the NHS really in crisis?

This was the question posed to us a few weeks ago, when four people from Madano’s Insights team – Paulina, Jarlath, Dani and I – were tasked with the job of finding out. It was all part of the 2023 BOBI awards, hosted by BHBIA (British Healthcare Business Intelligence Association) where we were competing to win ‘Analyst team of the year’.

At 9am, we were provided with the task and some data. We then had 24 hours to come up with some ground-breaking conclusions. Fuelled by Wagamamas and brownies, we pressed send with 7 minutes to spare. Finally, we could breathe a sigh of relief. It was intense and exhausting, but we’ll have the bond of a shared experience to take to all our other projects and have discovered just how much you can achieve in a short space of time.

Now back to the point: Is the NHS really in crisis?

Firstly, we looked at how the NHS measures what a crisis is, otherwise what would we be comparing our results to? The NHS has a mandated 18-week referral rate for non-urgent treatment – anything above that is a so-called crisis. And if you go by these figures, the NHS is knee deep in crisis. In January 2013, 143,000 people were waiting for non-urgent treatment. But by January 2023, 10 years later, this number is more than 3 million.

But then we started digging a little deeper, and things got mysterious...

You would assume that the above results would suggest that there isn’t enough staff for the number of patients. But the number of GPs per head have stayed relatively stable over the last 10 years at about 59 doctors per 100,000 patients. Furthermore, the number of staff joining compared to the number of staff leaving has been relatively stable over the last few years. In fact, in 2001/22 – there were 222,000 joiners compared to 175,000 leavers.

… So where are these discrepancies coming from?

One interesting factor could be that the number of people leaving the NHS depends on the age and, in turn, the seniority of staff. Those most likely to leave were 50-59 year olds, those that are experienced in their roles, while it was 30-39 year olds whose numbers were increasing.

Unexpectedly, under 30 year olds in 2022 were also leaving at a high rate (from 14% in 2015 to 25% in 2022) so the NHS has to deal with the double whammy of keeping both experienced, specialist staff and more general trainees before they ever decide which NHS route they want to take.

We also investigated sickness among staff as - whilst included in the working headcount - we believed that there might be staff that were absent. Peaks of absences occur over the winter period, and for the peak in the last year we have data for – 2021/22 – the absence rate was 7%. This can be compared to the same period in 2015/16 where the absence rate was just 4%.

We found that vacancies are on the rise - those headlines are true - with some nerve-wracking stats for anyone who might get unwillingly sick or choose to have a baby soon. In 2021/21 there were 47,000 open positions for nurses and midwives. This figure, in 2022/23, is 120,000 - more than double.

And the NHS crisis is set to deepen…

Staff dissatisfaction is on the rise, with 32% saying they often think about leaving the NHS in 2022 compared with 27% in 2020.

And there was so much more we could have examined…

• By how much is the population aging and how much does this affect the need for treatment?
• Has this crisis occurred in part because of Brexit?
• What are current student numbers and how will this affect the NHS in the next five years?
• Will the recent changes to the pension scheme lure back those much-needed experienced doctors? And if so, by how much?

A few weeks later, and how do I feel?

Admittedly, when we started the day we had some grand plans, thinking we could achieve the world, whereas in reality, there’s only so much you can do in 24 hours. But the ability to get the creative juices flowing, take us out our comfort zone and work on some alternative material was a great way to spend a day.

There were some learnings – if we were to it all again, we’d likely come up with a PowerPoint deck theme in advance, so we’d have something to work off straight away. We’d also not be so blasé about the data. We thought they’d give us something straightforward, whereas in fact it was messy and confusing, and we hadn’t planned to spend the first few hours just getting to grips with it.

But for a day’s work, I think it’s something we can all be proud of.