PUBLIC services in Britain face relentless scrutiny, especially since austerity was implemented in 2010. The Institute for Government, a think tank, uses data analysis to examine how they have coped in recent years. The state of the National Health Service, and specifically the country’s hospitals, is of keen interest to voters. Most public services have faced severe cuts under the current Conservative government, but health has been spared the knife. Has it made the most of this dispensation?

The headline figures look healthy enough. Spending on health in England is up 15% in real terms since 2010. The number of doctors has risen at the same rate and other clinical staff by nearly 10%. Efficiencies in productivity have been achieved as well; outputs, such as completed treatments, have risen faster than spending. Patients’ satisfaction grew marginally and safety of care has been maintained. But demand is accelerating faster and a closer examination reveals some worrying trends.

A majority of NHS spending goes on staff costs and while the workforce has become more clinical—and less managerial—staff shortages are becoming more common. Efficiencies have been made, but they are below their target levels and many are not sustainable year on year. Patients seem as happy with their treatment as before, but the workers are not. Voluntary resignations have grown by over 50% from 2011-12 to 2017-18; workload is increasingly the cause. Replacing staff is proving trickier too. In the two years to September 2017 vacancy rates rose by 16% for medical and dental staff, and for nursing and midwifery specifically by 23%. As the NHS depends heavily on European workers, Brexit will make matters worse.

Hospital accident and emergency (A&E) departments, often the primary contact for patients, are a good barometer of how pressure across NHS services is being managed. The knock at this “front door” is getting louder and more frequent. Since 2011 annual demand has increased by 1.5m visitors, an additional 10%. Not only has the volume increased, but the complexity of conditions has too. In 2007 a tenth of patients had five or more ailments. A decade later, a third do. It is no surprise that admissions via hospital A&E departments have jumped 30% since 2011 and that the national target of 95% of patients attending A&E and being seen within four hours has not been met since August 2013.

The NHS has performed well in difficult times, but it is likely to suffer more from problems outside of its control. Extra money combined with some efficiencies has helped. But like the public it serves, the NHS is an increasingly sick patient with many ailments for which a quick injection of cash is not the answer.