Waiting lists can’t be compared through the whole history of the NHS

In his leader’s speech to the Labour party conference on 10 October, Sir Keir Starmer mentioned “the shortest NHS waiting lists in history” as one of the party’s achievements during its last period in government.

Mr Starmer may have misspoken, because in the text of his speech published by Labour, it appears that he was meant to say “the shortest NHS waiting times in history”.

If so, this was very similar to the claim that the shadow health secretary, Wes Streeting, made in his speech the following day. He said: “Thirteen years of Labour government delivered the shortest waiting times and the highest patient satisfaction in history.”

Whether Labour was talking about waiting lists or times, both have been measured in many different ways since the NHS was founded in 1948, so it’s not clear how different periods of history can be compared in order to make this claim. 

Full Fact asked experts at the Nuffield Trust, who told us that they were also not aware of any data that would allow a direct comparison of waiting lists and times throughout the history of the NHS.

We’ve asked Labour what evidence Mr Starmer and Mr Streeting’s claims were based on, but did not receive a response. 

Politicians should be clear what they mean when making claims about their record, and provide evidence when necessary. This will help people make well informed decisions, which are important for a healthy democracy.

In this article we have only looked at waiting lists and times in England, which is the part of the NHS that the UK government controls.

Waiting lists through history

From 1948 until 1987, the NHS data we have only covers people waiting for inpatient treatment. The lowest waiting lists in this period generally occurred between 1955/56 and 1960/61, which was under a Conservative government. The lowest of all was 404,176 in 1956/57.

Analysis published last year by the Nuffield Trust shows that when day cases and outpatients began to be included in the data later on, the total waiting list figures naturally grew.

They may also have been affected by the increasing size of the English population, and changes in medical practice.

In its current form, the most commonly used NHS waiting list, known as Referral to Treatment Waiting Times, goes back to 2007. The lowest figure recorded since then was 2.32 million cases in January 2010, when Labour was in government.

These lists do not capture everyone waiting for any kind of NHS service in England at the time. We have written about the current NHS waiting lists in more detail in another article.

What about waiting times?

We can find no data on NHS waiting times in England before 1987—and even after that, the data does not include outpatients until 2004. Experts at the Health Foundation told us that they were not aware of any data before 1987 either.

As a result, we don’t have reliable and consistent data that allows us to compare waiting times throughout the history of the NHS.

The current data series goes back to 2007, and includes median waits in weeks for patients who were admitted, patients who were not admitted, and patients who were still waiting when the data was collected.

The shortest median waits recorded in this series are:

• Admitted: 3.8 weeks, April 2020
• Non-admitted: 3.5 weeks, February 2011
• Still waiting: 5.1 weeks, February 2013

All three were during a period of Conservative-led government—although all three have risen overall since Conservative-led government began in 2010.

We do have historic data on waiting times between 1987 and 2009, but this measured only part of the period between referral and treatment, so it can’t be compared to the current figures.

The lowest point in the historic data comes in November 2008, under a Labour government. In his conference speech in 2009, the Labour Prime Minister Gordon Brown said the party had delivered “the shortest waiting times in history”. This was true at the time going back to 1987, but we can’t say whether it was true throughout NHS history. (Mr Brown put it slightly differently in a government document that year, saying “The NHS is delivering the shortest waits since records began.”)

This data series ended shortly afterwards, however, so we can’t say whether waits were any shorter when measured in this way after 2010, when the Conservatives entered government. Crucially, this means we can’t compare the record of the last Labour government as a whole with the Coalition and Conservative governments since. 

When did patient satisfaction peak?

It is debatable whether Mr Streeting was right to say that a Labour government delivered “the highest patient satisfaction in history”. 

NHS England publishes data on a range of different measures of patient satisfaction. The Department of Health also used to collect data on satisfaction with the NHS among users and non-users, but we can only find this covering the period between 2003 and 2012.

Overall, we’ve not been able to find one consistent measure of patient satisfaction covering the most recent periods of Labour and Conservative-led government, let alone before that. We spoke to the Picker Institute, who conduct research on people’s experience of care. They confirmed that they are also not aware of comparable data covering both periods.

If Mr Streeting was referring to the results of the British Social Attitudes survey, which has tracked public satisfaction with the NHS since 1983, not only among patients, then the highest level of satisfaction recorded was 70% in 2010, the year Labour left office.

However, in its report describing this survey, the National Centre for Social Research, says: “Our 2010 fieldwork took place shortly after the general election, meaning it is too soon to expect to see any clear impact of the new government and its policies on public attitudes.”

In other words, the peak of public satisfaction with the NHS in the last few decades was recorded under a Conservative-led coalition government, but it is unlikely that it had significantly influenced the quality of the health service by then.

With thanks to the Nuffield Trust, the Health Foundation and the Picker Institute for their help with our research for this article.  

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Image courtesy of Chris McAndrew