Forced myself to listen to his TRIP interview and couldn’t get this post out of my head

I haven't seen convincing evidence that the increase in long ED waits is due to changes to condition acuity / comorbidity.

This is a problem we'd effectively solved in 2005; and has deteriorated substantially in the last 5 years. So I don't think demand-side args have enough explanatory force

there are various internal and external bottlenecks - see sections 4 and 5 of this Re:State report for a good summary: re-state.co.uk/wp-content/u...

(while we do see shifts in demography and comorbidities - I don't think sufficiently different from 2005, when we proved we could solve this problem)

Media reporting (and parts of the RCN report) seem to conflate "increased demand for urgent care" with "increased pressures on hospitals".

In doing so - they're obscuring the drivers of the problem and leading readers towards ineffective solutions (i.e. more staff, more funding).

But it draws the wrong conclusions on workforce: worsening A&E performance has happened despite 30%+ increases in the number of nurses working in hospitals since 2019.

RCN implies these increases are insufficient due to "increased demand".

But, as we've seen, this is just incorrect!

The full RCN report is mixed. It's reasonable to highlight high bed occupancy rates as a driver of A&E problems.

If there's nowhere to admit patients to, they're either stuck waiting for hours, receive (unsafe) corridor care, or are forced to leave before receiving treatment.

The data *in the report cited* is enough to disprove the hypothesis that poor performance is driven by increased demand. (See +3% attendances vs +8,033% in 12 hr waits)

The real cause of long waits in A&E is poor patient flow, driven by operational dysfunction in other parts of hospitals.

The poor outcomes in A&E are obvious to anyone who looks at the numbers or has simply been to an ED in the last few years.

But as @policyskeptic.bsky.social has repeatedly argued, incorrect diagnoses of the *drivers* of poor outcomes are obstacles to solutions which will improve performance.

h/t to @archiehall.bsky.social substack for flagging the Economist's monthly tracker -

notes.archie-hall.com/p/fifteen-th...

www.economist.com/interactive/...

Last month, there were *54,314* waits longer than 12 hours.

In October 2018, this figure was 214.

While the slice of the govt pie spent on welfare remains roughly the same - the size of the pie is not growing.

We need to reframe this issue as purely 'distributional' and focus on reforms to get people healthier and incentivise work - both a socially progressive and growth-oriented approach

- if we matched leading OECD employment rates, we'd have 2m more people in work

- this economic inactivity due to ill-health now costs £212bn a year - equiv. to 7% of GDP or 70% of *all tax revenue*

None of this is captured by measuring welfare spend as a % of GDP

The govt's Mayfield Review pulled out some striking stats -

- over 20% of UK working-age adults are out of work and not looking (higher than similar countries like Netherlands)

- since 2019, 800k more people have left work due to ill health, with a further 600k projected by 2030

New Labour cut waiting lists to record lows, in part by leveraging priv sector - but they could do this by investing £££ that the current govt doesn't have

Also bravo Baroness Sue Campbell who transformed our Olympic team and then transformed our women's football team. Extraordinary record.

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