Stuart Hoddinott
@stuarthoddinott.bsky.social
Associate Director in the public services team
@InstituteforGov. Interested in the NHS, adult social care, and local government. All views my own. He/him
@InstituteforGov. Interested in the NHS, adult social care, and local government. All views my own. He/him
Key chart for public services
Govt is back to pencilling in undeliverable plans to hit its fiscal rules
After taking out likely funding for protected areas, other departments will have to absorb 3.3% annual real terms cuts. That includes prisons, courts, and local govt, among others
Govt is back to pencilling in undeliverable plans to hit its fiscal rules
After taking out likely funding for protected areas, other departments will have to absorb 3.3% annual real terms cuts. That includes prisons, courts, and local govt, among others
November 26, 2025 at 3:59 PM
Key chart for public services
Govt is back to pencilling in undeliverable plans to hit its fiscal rules
After taking out likely funding for protected areas, other departments will have to absorb 3.3% annual real terms cuts. That includes prisons, courts, and local govt, among others
Govt is back to pencilling in undeliverable plans to hit its fiscal rules
After taking out likely funding for protected areas, other departments will have to absorb 3.3% annual real terms cuts. That includes prisons, courts, and local govt, among others
One of my favourite charts from this year's Performance Tracker
Each dot shows a trust's bed occupancy in a given month
What's notable is how little variation there is across the country and across time
Go into any hospital in any month and you will find almost every bed is occupied
Each dot shows a trust's bed occupancy in a given month
What's notable is how little variation there is across the country and across time
Go into any hospital in any month and you will find almost every bed is occupied
November 24, 2025 at 11:56 AM
One of my favourite charts from this year's Performance Tracker
Each dot shows a trust's bed occupancy in a given month
What's notable is how little variation there is across the country and across time
Go into any hospital in any month and you will find almost every bed is occupied
Each dot shows a trust's bed occupancy in a given month
What's notable is how little variation there is across the country and across time
Go into any hospital in any month and you will find almost every bed is occupied
Paragraph on that topic below
Best comparator I found was ONS data, but that's on a UK level and is based on self-reporting in the LFS whereas NHS data is from the admin system
Still, seems to be higher in the NHS than the economy
Best comparator I found was ONS data, but that's on a UK level and is based on self-reporting in the LFS whereas NHS data is from the admin system
Still, seems to be higher in the NHS than the economy
November 20, 2025 at 10:00 AM
Paragraph on that topic below
Best comparator I found was ONS data, but that's on a UK level and is based on self-reporting in the LFS whereas NHS data is from the admin system
Still, seems to be higher in the NHS than the economy
Best comparator I found was ONS data, but that's on a UK level and is based on self-reporting in the LFS whereas NHS data is from the admin system
Still, seems to be higher in the NHS than the economy
A chart that surprised me: NHS staff absences for mental health reasons are at record highs, above pandemic levels
Absences for that reason have grown far faster than the combination of other reasons since 2016
Staff were absent for 1.4% of all working days for mental health reasons in YE May 2025
Absences for that reason have grown far faster than the combination of other reasons since 2016
Staff were absent for 1.4% of all working days for mental health reasons in YE May 2025
November 20, 2025 at 9:34 AM
A chart that surprised me: NHS staff absences for mental health reasons are at record highs, above pandemic levels
Absences for that reason have grown far faster than the combination of other reasons since 2016
Staff were absent for 1.4% of all working days for mental health reasons in YE May 2025
Absences for that reason have grown far faster than the combination of other reasons since 2016
Staff were absent for 1.4% of all working days for mental health reasons in YE May 2025
I think I can safely describe Reform's NHS policies from last year's manifesto as "light at best"
Most of it is nonsense though. A campaign of "pharmacy first, GP second, A&E last" will do nothing for A&E performance
Ditto cutting managers
And the independent sector is only good for some activity
Most of it is nonsense though. A campaign of "pharmacy first, GP second, A&E last" will do nothing for A&E performance
Ditto cutting managers
And the independent sector is only good for some activity
November 19, 2025 at 3:14 PM
I think I can safely describe Reform's NHS policies from last year's manifesto as "light at best"
Most of it is nonsense though. A campaign of "pharmacy first, GP second, A&E last" will do nothing for A&E performance
Ditto cutting managers
And the independent sector is only good for some activity
Most of it is nonsense though. A campaign of "pharmacy first, GP second, A&E last" will do nothing for A&E performance
Ditto cutting managers
And the independent sector is only good for some activity
But there is considerable variation across trusts
The top performing acute trust is Northumrbia, where elective performance is at almost 80%
But there are also acute trusts where less than 50% of people are treated within 18 weeks
I'll do a longer thread on elective performance later
The top performing acute trust is Northumrbia, where elective performance is at almost 80%
But there are also acute trusts where less than 50% of people are treated within 18 weeks
I'll do a longer thread on elective performance later
November 19, 2025 at 3:02 PM
But there is considerable variation across trusts
The top performing acute trust is Northumrbia, where elective performance is at almost 80%
But there are also acute trusts where less than 50% of people are treated within 18 weeks
I'll do a longer thread on elective performance later
The top performing acute trust is Northumrbia, where elective performance is at almost 80%
But there are also acute trusts where less than 50% of people are treated within 18 weeks
I'll do a longer thread on elective performance later
Digging deeper, there are other performance issues
- 12+ hour A&E waits have not come down at all
- Ambulance response times remain higher than pre-pandemic levels
- Progress on long elective waits has stalled
Though govt might argue that none of these are its priority
- 12+ hour A&E waits have not come down at all
- Ambulance response times remain higher than pre-pandemic levels
- Progress on long elective waits has stalled
Though govt might argue that none of these are its priority
November 19, 2025 at 3:02 PM
Digging deeper, there are other performance issues
- 12+ hour A&E waits have not come down at all
- Ambulance response times remain higher than pre-pandemic levels
- Progress on long elective waits has stalled
Though govt might argue that none of these are its priority
- 12+ hour A&E waits have not come down at all
- Ambulance response times remain higher than pre-pandemic levels
- Progress on long elective waits has stalled
Though govt might argue that none of these are its priority
So what does all this mean for performance in hospitals?
Waiting times in key areas have improved slightly since the election in elective care, diagnostics, cancer care, and 4-hour A&E waits
All positive, but from a really low base and still a long way from national targets
Waiting times in key areas have improved slightly since the election in elective care, diagnostics, cancer care, and 4-hour A&E waits
All positive, but from a really low base and still a long way from national targets
November 19, 2025 at 3:02 PM
So what does all this mean for performance in hospitals?
Waiting times in key areas have improved slightly since the election in elective care, diagnostics, cancer care, and 4-hour A&E waits
All positive, but from a really low base and still a long way from national targets
Waiting times in key areas have improved slightly since the election in elective care, diagnostics, cancer care, and 4-hour A&E waits
All positive, but from a really low base and still a long way from national targets
This one surprised me. There was an uptick in sickness absence in 2024/25 to near-pandemic levels: 5.1% of days lost to sickness
That's much higher than govt's goal of 4.1%. If NHS had achieved that in 2024/25, it would have meant 5.4 million more working days, equivalent to ~24k more FTE staff
That's much higher than govt's goal of 4.1%. If NHS had achieved that in 2024/25, it would have meant 5.4 million more working days, equivalent to ~24k more FTE staff
November 19, 2025 at 3:02 PM
This one surprised me. There was an uptick in sickness absence in 2024/25 to near-pandemic levels: 5.1% of days lost to sickness
That's much higher than govt's goal of 4.1%. If NHS had achieved that in 2024/25, it would have meant 5.4 million more working days, equivalent to ~24k more FTE staff
That's much higher than govt's goal of 4.1%. If NHS had achieved that in 2024/25, it would have meant 5.4 million more working days, equivalent to ~24k more FTE staff
Strikes are back. Resident doctors walking out disrupts hospital activity: more than 1.5m cancelled elective appts so far
Though there's evidence that the impact is falling. When resident doctors first went on strike the NHS cancelled or rescheduled 2.0 elective appts per doctor. Now it's only 0.7
Though there's evidence that the impact is falling. When resident doctors first went on strike the NHS cancelled or rescheduled 2.0 elective appts per doctor. Now it's only 0.7
November 19, 2025 at 3:02 PM
Strikes are back. Resident doctors walking out disrupts hospital activity: more than 1.5m cancelled elective appts so far
Though there's evidence that the impact is falling. When resident doctors first went on strike the NHS cancelled or rescheduled 2.0 elective appts per doctor. Now it's only 0.7
Though there's evidence that the impact is falling. When resident doctors first went on strike the NHS cancelled or rescheduled 2.0 elective appts per doctor. Now it's only 0.7
We know bed occupancy is high nationally, but it's absurd how little variation there is across the country. You can go into almost any hospital in any month, and you'll find that close to every bed is occupied
Very few trusts are below RCEM safe levels, and often they're small specialty trust
Very few trusts are below RCEM safe levels, and often they're small specialty trust
November 19, 2025 at 3:02 PM
We know bed occupancy is high nationally, but it's absurd how little variation there is across the country. You can go into almost any hospital in any month, and you'll find that close to every bed is occupied
Very few trusts are below RCEM safe levels, and often they're small specialty trust
Very few trusts are below RCEM safe levels, and often they're small specialty trust
While productivity is improving, many of the headwinds that we've discussed before still exist
The maintenance backlog in hospitals is now larger than the entire DHSC capital budget (£16.3bn in 2025/26 prices vs £13.6bn)
That means leaks closing wards, diagnostic equipment breaking down, etc
The maintenance backlog in hospitals is now larger than the entire DHSC capital budget (£16.3bn in 2025/26 prices vs £13.6bn)
That means leaks closing wards, diagnostic equipment breaking down, etc
November 19, 2025 at 3:02 PM
While productivity is improving, many of the headwinds that we've discussed before still exist
The maintenance backlog in hospitals is now larger than the entire DHSC capital budget (£16.3bn in 2025/26 prices vs £13.6bn)
That means leaks closing wards, diagnostic equipment breaking down, etc
The maintenance backlog in hospitals is now larger than the entire DHSC capital budget (£16.3bn in 2025/26 prices vs £13.6bn)
That means leaks closing wards, diagnostic equipment breaking down, etc
National data also obscures variation in productivity across the country
Very crude metric, but we can compare changes in activity to changes in staffing since 2019
In elective care, only 3/42 ICBs grew elective activity grew faster than staff
Diagnostics fairs better (15/42 ICBs)
Very crude metric, but we can compare changes in activity to changes in staffing since 2019
In elective care, only 3/42 ICBs grew elective activity grew faster than staff
Diagnostics fairs better (15/42 ICBs)
November 19, 2025 at 3:02 PM
National data also obscures variation in productivity across the country
Very crude metric, but we can compare changes in activity to changes in staffing since 2019
In elective care, only 3/42 ICBs grew elective activity grew faster than staff
Diagnostics fairs better (15/42 ICBs)
Very crude metric, but we can compare changes in activity to changes in staffing since 2019
In elective care, only 3/42 ICBs grew elective activity grew faster than staff
Diagnostics fairs better (15/42 ICBs)
Productivity is below pre-pandemic levels, but slowly improving
Latest ONS data is only to the end of 2022/23, but more up to date reports from NHSE and ONS seem to indicate that the upward trend has continued
If so, it will mean that planned spending on NHS goes further than currently
Latest ONS data is only to the end of 2022/23, but more up to date reports from NHSE and ONS seem to indicate that the upward trend has continued
If so, it will mean that planned spending on NHS goes further than currently
November 19, 2025 at 3:02 PM
Productivity is below pre-pandemic levels, but slowly improving
Latest ONS data is only to the end of 2022/23, but more up to date reports from NHSE and ONS seem to indicate that the upward trend has continued
If so, it will mean that planned spending on NHS goes further than currently
Latest ONS data is only to the end of 2022/23, but more up to date reports from NHSE and ONS seem to indicate that the upward trend has continued
If so, it will mean that planned spending on NHS goes further than currently
And there are some indications trusts' response in the data
- Hiring has slowed. There has been no growth in non-clinical staff working in hospitals since 2023
- Joiner rates are tumbling across staff groups
- Nursing vacancy rates are at historic lows, due to trusts slowing hiring
- Hiring has slowed. There has been no growth in non-clinical staff working in hospitals since 2023
- Joiner rates are tumbling across staff groups
- Nursing vacancy rates are at historic lows, due to trusts slowing hiring
November 19, 2025 at 3:02 PM
And there are some indications trusts' response in the data
- Hiring has slowed. There has been no growth in non-clinical staff working in hospitals since 2023
- Joiner rates are tumbling across staff groups
- Nursing vacancy rates are at historic lows, due to trusts slowing hiring
- Hiring has slowed. There has been no growth in non-clinical staff working in hospitals since 2023
- Joiner rates are tumbling across staff groups
- Nursing vacancy rates are at historic lows, due to trusts slowing hiring
That pattern looks set to continue. There's no final data yet but estimates from NHS England's board meetings show that 18 out of 42 ICBs were in deficit at the end of 2024/25
And 2025/26 is looking even worse, with 32 out of 42 ICBs forecasting a defict
And 2025/26 is looking even worse, with 32 out of 42 ICBs forecasting a defict
November 19, 2025 at 3:02 PM
That pattern looks set to continue. There's no final data yet but estimates from NHS England's board meetings show that 18 out of 42 ICBs were in deficit at the end of 2024/25
And 2025/26 is looking even worse, with 32 out of 42 ICBs forecasting a defict
And 2025/26 is looking even worse, with 32 out of 42 ICBs forecasting a defict
Relatively low funding growth could be an issue
Hospital finances struggled in the late 2010s, with acute trusts running deficits in every year between 2015/16 and 2019/20. It was only Covid funding which returned trusts to surplus
But deficits in acute trusts returned in 2022/23 and 2023/24
Hospital finances struggled in the late 2010s, with acute trusts running deficits in every year between 2015/16 and 2019/20. It was only Covid funding which returned trusts to surplus
But deficits in acute trusts returned in 2022/23 and 2023/24
November 19, 2025 at 3:02 PM
Relatively low funding growth could be an issue
Hospital finances struggled in the late 2010s, with acute trusts running deficits in every year between 2015/16 and 2019/20. It was only Covid funding which returned trusts to surplus
But deficits in acute trusts returned in 2022/23 and 2023/24
Hospital finances struggled in the late 2010s, with acute trusts running deficits in every year between 2015/16 and 2019/20. It was only Covid funding which returned trusts to surplus
But deficits in acute trusts returned in 2022/23 and 2023/24
Spending on UK health rose slowly in the early 2010s, before reaching just under 3% per year under Tory govts
Under current plans, spending will grow by roughly similar amounts under this govt (2.7% per year)
That's below historic average (3.9% 1950/51 to 2009/10) and well below New Labour (5.9%)
Under current plans, spending will grow by roughly similar amounts under this govt (2.7% per year)
That's below historic average (3.9% 1950/51 to 2009/10) and well below New Labour (5.9%)
November 19, 2025 at 3:02 PM
Spending on UK health rose slowly in the early 2010s, before reaching just under 3% per year under Tory govts
Under current plans, spending will grow by roughly similar amounts under this govt (2.7% per year)
That's below historic average (3.9% 1950/51 to 2009/10) and well below New Labour (5.9%)
Under current plans, spending will grow by roughly similar amounts under this govt (2.7% per year)
That's below historic average (3.9% 1950/51 to 2009/10) and well below New Labour (5.9%)
We've published the final installment of our analysis of public services performance
Our view is that govt has made limited progress on most services
The exceptions are children's social care, where reforms look really positive
And adult social care, where govt has likely harmed the sector
Our view is that govt has made limited progress on most services
The exceptions are children's social care, where reforms look really positive
And adult social care, where govt has likely harmed the sector
November 19, 2025 at 9:41 AM
We've published the final installment of our analysis of public services performance
Our view is that govt has made limited progress on most services
The exceptions are children's social care, where reforms look really positive
And adult social care, where govt has likely harmed the sector
Our view is that govt has made limited progress on most services
The exceptions are children's social care, where reforms look really positive
And adult social care, where govt has likely harmed the sector
The Public Accounts Committe published a damning report about NHS progress on elective waits
I couldn't agree more with this section: the NHS and govt is hoping that shiny tech improvements will solve everything, while ignoring the fundamentals
committees.parliament.uk/publications...
I couldn't agree more with this section: the NHS and govt is hoping that shiny tech improvements will solve everything, while ignoring the fundamentals
committees.parliament.uk/publications...
November 19, 2025 at 8:44 AM
The Public Accounts Committe published a damning report about NHS progress on elective waits
I couldn't agree more with this section: the NHS and govt is hoping that shiny tech improvements will solve everything, while ignoring the fundamentals
committees.parliament.uk/publications...
I couldn't agree more with this section: the NHS and govt is hoping that shiny tech improvements will solve everything, while ignoring the fundamentals
committees.parliament.uk/publications...
DHSC has now provided a quote for this article
It claims we "ignore" their £1.1bn of investment in general practice...accept we don't. There's a whole section that says exactly that
Our report is on our website, it'd be great if DHSC read it
www.instituteforgovernment.org.uk/publication/...
It claims we "ignore" their £1.1bn of investment in general practice...accept we don't. There's a whole section that says exactly that
Our report is on our website, it'd be great if DHSC read it
www.instituteforgovernment.org.uk/publication/...
November 17, 2025 at 9:57 AM
DHSC has now provided a quote for this article
It claims we "ignore" their £1.1bn of investment in general practice...accept we don't. There's a whole section that says exactly that
Our report is on our website, it'd be great if DHSC read it
www.instituteforgovernment.org.uk/publication/...
It claims we "ignore" their £1.1bn of investment in general practice...accept we don't. There's a whole section that says exactly that
Our report is on our website, it'd be great if DHSC read it
www.instituteforgovernment.org.uk/publication/...
The decision seemed to have been made over a matter of days in Feb/March this year, mostly in response to unfolding events such as Amanda Pritchard's resignation as CEO of NHSE
That is a terrible way to make a decision which will define the govt's health policy for this parliament
That is a terrible way to make a decision which will define the govt's health policy for this parliament
November 16, 2025 at 2:47 PM
The decision seemed to have been made over a matter of days in Feb/March this year, mostly in response to unfolding events such as Amanda Pritchard's resignation as CEO of NHSE
That is a terrible way to make a decision which will define the govt's health policy for this parliament
That is a terrible way to make a decision which will define the govt's health policy for this parliament
Rather than an NHS mission the govt should have a "health mission" with an outcome target such as improved healthy life expectancy
That would require improvements in general practice, ASC, public health, and wider determinants of health i.e. it'd actively support the community and prevention shifts
That would require improvements in general practice, ASC, public health, and wider determinants of health i.e. it'd actively support the community and prevention shifts
November 16, 2025 at 2:47 PM
Rather than an NHS mission the govt should have a "health mission" with an outcome target such as improved healthy life expectancy
That would require improvements in general practice, ASC, public health, and wider determinants of health i.e. it'd actively support the community and prevention shifts
That would require improvements in general practice, ASC, public health, and wider determinants of health i.e. it'd actively support the community and prevention shifts
The 10-year health plan for England (10YHP) hints at alternatives: neighbourhood contracts? Integrated care organisations?
But nothing concrete. And even if there were, it is hard to replace partners' discretionary effort or the improved satisfaction patients have in practices with more partners
But nothing concrete. And even if there were, it is hard to replace partners' discretionary effort or the improved satisfaction patients have in practices with more partners
November 16, 2025 at 2:47 PM
The 10-year health plan for England (10YHP) hints at alternatives: neighbourhood contracts? Integrated care organisations?
But nothing concrete. And even if there were, it is hard to replace partners' discretionary effort or the improved satisfaction patients have in practices with more partners
But nothing concrete. And even if there were, it is hard to replace partners' discretionary effort or the improved satisfaction patients have in practices with more partners
General practice is a good place to start. Arguably, GPs are more important than any other doctor for the three shifts
So it's good that there are many more salaried GPs. But that's happening while the partnership model crumbles: GP partners continue to leave the service, with no sign of change
So it's good that there are many more salaried GPs. But that's happening while the partnership model crumbles: GP partners continue to leave the service, with no sign of change
November 16, 2025 at 2:47 PM
General practice is a good place to start. Arguably, GPs are more important than any other doctor for the three shifts
So it's good that there are many more salaried GPs. But that's happening while the partnership model crumbles: GP partners continue to leave the service, with no sign of change
So it's good that there are many more salaried GPs. But that's happening while the partnership model crumbles: GP partners continue to leave the service, with no sign of change