On BBC Sounds, there are podcasts to help you look after your body and your mind from increasing your immunity to feeling more confident or tips on how to focus. Sorry, what were you saying? If it matters to you, it matters to us. Feel good inside and out with What's Up Docs and Complex with Kimblee Wilson. Listen on BBC Sounds. Hello and welcome to the second in a special series of programmes for more or less with me, Tim Harford. Every day this week we're going to take on some of the big statistical questions that say something interesting about the state of our nation. Yesterday the theme was the economy and if you missed it you can catch up on BBC Sounds. Today we're looking at health. It's Tuesday. Normally a life scientific but here on more or less we reckon those scientists get plenty of glory. You know who never gets their moment in the sun? Actuaries. So let's take a swing at a life actuarial. Life expectancy is one of those metrics that tells you something very important about the state of our nation. It is hard to think of a more important stat than the length of time we get on this planet and the factors that shorten or lengthen that brief moment in the sun. Because of course the sun always shines on Britain. For most of us such questions are a matter of existential contemplation but for actuaries those brave finance professionals who analyse risk and uncertainty it is all in a day's work. Stuart MacDonald has devoted his life to the study of these numbers. For most of that life the story has been a positive one. For decades our life expectancy has been going up but in recent years in the wake of the Covid pandemic something strange has happened. Our life expectancy has stalled. Stuart, what's going on? Good morning Tim. Thank you. So life expectancy in the 1990s and the first decade of this century was improving very rapidly. It almost gains in cardiovascular survival driving a lot of that. The way I often think about it, life expectancy was increasing by around 15 minutes an hour so over the course of this show you'd get 7 or 8 minutes back. And unfortunately things slowed down and we were seeing considerably slower mortality improvement but things hadn't completely flat lined. But since 2020 we've seen almost no improvement. Obviously life expectancy if you measure it in terms of the death rates experienced in a particular year fell quite sharply in response to Covid but it has subsequently recovered and as of 2024 the last complete year life expectancy was broadly back where it was in 2019 the last pre-pandemic year. In 2019 in the UK life expectancy was about 79.5 years for men and 83.2 years for women. Those were, roughly speaking, the mean average ages that people died. If you were listening to our last series you know that the median is higher. That reflects a few people dying much younger than the mean and a lot of people dying a few years later. Paradoxical as it might seem the majority of people outlive their life expectancy. You have got a peek at the latest data so we've got some data from 2025. What is that showing us? Yes so 2025 we have so far provisional death registrations data from the Office of National Statistics going up until late November and as at that latest data we're seeing death rates significantly lower than were seen in 2024 so you could say lowest mortality on record for 2025 at that point. When mortality rates are down that means fewer people of each age are dying each year relative to the population and that of course means that as mortality rates are down life expectancy is up. And with mortality at the lowest on record life expectancy should be the highest on record although the flu outbreak might still have an impact on that and we'll have to wait for the official stats later in January to confirm that for the full year. Sounds like quite exciting news. You're perfectly entitled to get excited I think but we have 180 years of progress and mortality rates fall year on year. I suppose it's like saying stock market at highest level ever. It's the sort of thing we've... It happens a lot. Exactly right. However under the hood of this reasonably good news that different age groups there are some worrying signs. For the over 65s the news is good. Mortality has recovered post pandemic and life expectancy is improving. The situation is much worse for the working age group. There was barely any improvement in mortality in the decade leading up to the pandemic and there's been no recovery subsequently for older middle aged groups and actually the situations were still when we look at the younger working age population. So for those aged 20 to 45 death rates were rising even before the pandemic. They've been increasing since around 2012. Of course the total numbers of deaths in these groups are much lower but these trends are not good ones. The causes of death tell a story. For the youngest age groups it's things such as accidents, overdoses and suicides and as you move up the ages it's chronic disease, early onset cancer and then more excess cardiovascular deaths. But why are there more deaths from heart disease? It's hard to move from the cause of death quite objective written down by the doctor to the underlying drivers. The cause of the cause if you will. But we believe that disruption to preventative care during the pandemic and also the ongoing health care challenges with both acute and chronic care in the NHS are contributing. That's the breakdown by age. What about the differences between the nations of the UK? Yes, so there are significant differences between the nations. The lowest mortality generally in England. Wales and Northern Ireland broadly similar. Scotland very different. So the general patterns that I've been describing here in terms of low mortality rate in 2019, a shock in 2020, some recovery, all those general patterns hold when you are talking about Scotland or whether you're talking about England and Wales. But the important context is just how much higher death rates are in Scotland than they are in England and Wales. So both England and Wales and Scotland and the UK as a whole experienced a big shock to mortality rates during 2020. Nevertheless, death rates in England and Wales remained lower than they have ever been in Scotland. You heard that right. Life expectancy in England and Wales at the worst moment of the pandemic was still better than at its best ever level in Scotland. So the effect of living in Scotland essentially is worse than the effect of the pandemic with the mitigations and controls that we introduced in England and Wales. Interesting. This is all fascinating. We are trying to do a life scientific here or rather a life actuarial. So, so, Stuart, how do we do this? Take me back to your formative years. When I was the first moment where you woke up in bed and you thought to myself, my path in life is to become an actuary. Surprisingly late actually, Tim. Most people go straight in after university. I had a few wilderness years. Very good. Let's let's go back to the numbers. Stuart, you've been very clear that one of the problems we are facing with life expectancy in the UK concerns people in their 40s, 50s, 60s and that one of the causes of the problem is the strain the National Health Service is under. So what are the key metrics that you would look at to try to understand the performance of the NHS? One of the easiest things to measure and to drive insights from is ambulance response times. So I would typically look at category two emergencies. So this is heart attacks, strokes and the target time here is 18 minutes and in the years leading up to the pandemic, broadly speaking, we were there or thereabouts, often around 20 minutes, some seasonal variation. The ambulance waiting time for these serious emergencies rose during the pandemic and then peaked at 90 minutes in December 2022. Some recovery subsequently, but we haven't got anywhere near the 18 minute target. We're back in the 40 to 50 minutes zone with some seasonal variation and in October, the average wait was 32 minutes and rising as we move into those winter months. And there's another stat that's not good news for your chances of surviving a medical emergency. So before the COVID-19 pandemic, almost no one was waiting more than 12 hours in A&E after the clinician had decided that they were serious enough to admit them. If you plot that on a graph today, it's basically a flat line at zero. There is no target for this measure. Of course, nobody should be waiting that long. We had a couple of winters with a few thousand people waiting that long and headlines saying NHS winter crisis in response. But since 2021, we have now seen three successive winters where we have had a peak of more than 50,000 people waiting more than 12 hours in A&E in a month. So what's driving these statistical trends? Why can't the NHS get these numbers down? One factor is throughput in the system. So you can't get somebody out of the ambulance and into A&E, out of A&E and into the wards if beds are full? This is just a selection from a veritable variety pack of statistical stories in the NHS. Each of them with their own trends and frankly massive challenges. We haven't even touched on less acute treatment. But one thing is clear. Demand for NHS services is only going up. This is partly driven by the fact that the UK population is ageing as like a pig in a python, the baby boom generation passes through society. The amount of healthcare that people need increases broadly exponentially with age. And that is one contributing factor to ever increasing demand for healthcare. Interestingly, we also see healthcare utilization increasing across the age spectrum and across the socioeconomic spectrum. Basically everybody asking more of the healthcare system for one reason or another? Yes, exactly. And so across the spectrum we've found that people are using more healthcare. Lastly, healthcare costs have been rising more sharply than GDP growth for the last couple of decades. So if we project those trends, we could see healthcare costs as a proportion of GDP just rising inexorably over the next decade by around 50 billion. So from around 8% of GDP to about 9.6% of GDP. You would need to achieve quite a significant increase in NHS productivity coupled with a large narrowing of inequalities in healthcare to hold the healthcare spend consistent. Stuart, it's been wonderful to talk to you. It always is. I'm still looking for a little bit of that life actuarial kind of getting a sense of the beating heart behind the data. So tell us, what do you do to relax? Well Tim, I've always found ASMR very interesting. Ah yes, ASMR. I always wanted to record it and more or less like that I found it very soothing myself. Sorry Tim, I meant aged nationalised mortality rates. Oh, um, Stuart MacDonald. Thank you very much. Thanks to Stuart MacDonald. You're listening to a special series for more or less. The Health Service is more than just hospitals. How's England's network of GP searchers faring? Nathan Gower has been taking a look for us. Hello Nathan. Hi Tim. So this is one of those areas where successive governments have set targets or made promises but the targets have been missed and promises broken. For example, Boris Johnson's government, which was elected in 2019, pledged to add 6,000 GPs by 2024. That's to a base of more than 28,000. By the way, all these numbers are full-time equivalents, so two half-time GPs count as one GP and also we're only talking here about fully qualified GPs. Full-time equivalent, fully qualified, understood. So the numbers were meant to go from 28,000 to more than 34,000. How did that promise go? Not well. The number of GPs actually fell by about 500 over that period. And because the population has grown during that time, the number of GPs per person has actually fallen quite substantially. Meaning what? In 2015, there were 52 fully qualified GPs for every 100,000 patients. Now there are just 45. The government have boosted the number of GPs in training. We used to have 5,000 GP trainees a year, now it's more like 10,000. But that's not yet resulted in the number of fully qualified GPs increasing. It's hard to say exactly why this is happening, but it suggests that incoming trainees have been outweighed by existing GPs leaving the workforce or working fewer hours. There are also plenty of reports of people who have qualified as GPs who are actually struggling to find GP posts. So this is England. What about the other nations? Wales only started collecting the data in 2021, so their number of GPs has stayed pretty much flat. The ratio of GPs per 100,000 patients has also stayed pretty much the same. They're at 48 fully qualified GPs per 100,000 people. Scotland's GP workforce is lower than it was a decade ago, but the latest data has shown a 4% increase year on year, so there might be cautious signs for optimism there. And Northern Ireland, they only publish headcount data, not full-time equivalent, which limits what we can say. In terms of headcount, there's been a 25% increase since 2014, but there's other unofficial data which suggests the full-time equivalent increase may be more like 11%. And how much work are these GPs doing? Has that gone up or down? It's definitely gone up. In England, if you look across 2024, there was an average of 13.5 million appointments a month conducted by GPs. That's up from 13 million a month in 2019, before the pandemic. Of course, GP surgeries also have other staff who do appointments, like nurses and paramedics. Overall, there are about 30 million appointments a month done by all practice staff. That's up from an estimated 26 million in 2019. And finally, how much funding is being directed to GPs and to other primary care services? So the proportion of the health budget in England going to primary care services, which includes GPs, but also services like dentistry and pharmacies, it hovered around 9% in the second half of the 2010s. It fell slightly from 2021 to 2022, but in the last two years, it's climbed back up to 10%. And this is part of the government's long-term strategy of shifting more care from hospitals into the community. Thank you, Nathan. And thanks too to Becky Baird from the Kings Fund. We've heard how things are going in general in the NHS, but wanted to focus on one specific area, cancer. We heard last year that nearly all the NHS trusts in England, 118 out of 121, were missing at least one of their targets on cancer treatment. And given what we've heard about the NHS having all kinds of problems, we'd expect this to also be reflected in the cancer stats. So what's going on? John Shelton is the head of Cancer Intelligence at Cancer Research UK. First, of course, the big picture. Predominantly driven by our growing and aging population, we are still seeing increases in the number of people being diagnosed with cancer every year. In fact, our projections over the next 10 to 15 years show that those numbers will increase even further. So we're currently around 360,000 cases per year, and we're expecting that to increase to around 500,000 per year, probably over the next 15 years. But most of the rise in cancer is because the population is older than it used to be, and older people are more at risk of cancer. But that wasn't the whole story. The risk that a given person of a given age would get cancer was also rising for a long time. That has changed, partly driven by a decrease in smoking, particularly for men, which is good news. If we look at the view that we normally look at for studying cancer across the population is to look at age standardised rates. So we account for the changing age structure of the population over time. And what we see is in those age standardised rates, we've seen longer term there has been an increase in those rates if we look back over quite a few decades. But the last decade has seen a much more of a kind of levelling out, in fact, in some areas a bit more of a reduction. The overall picture is starting to kind of flatten out and slightly reduce for all cancers combined. What can we say about the prospects for somebody who is diagnosed with cancer? I'm sure that will also depend on what the cancer is. But how are people faring after a diagnosis? We actually just recently published a paper looking at trends in cancer survival over the last 50 years. And the good news is that we are making really good progress in a lot of areas in terms of improving cancer survival. We've seen increases across the board. We've just seen better increases for some cancer sites and not for others. For example, 10-year survival rates have risen steadily for leukemia and kidney cancer. But in recent decades they've flattened off for breast and prostate cancer. Cancer Research UK have also compared these survival rates across different countries with similarly advanced healthcare systems. And while survival is going up everywhere, including in the UK... The negative sign for the UK is that we are seeing improvements in other countries and indeed higher rates of survival in other countries compared to the UK. So we are making improvements in cancer survival, but we're still lagging at other countries. The reasons for this are complex, but one factor is the health of the NHS. We diagnose cancers at a later stage in this country and therefore delays in people being diagnosed is a real challenge for us. Coupled with do we get people started treatment in time? So getting people through the healthcare system, getting them to present in the first place and then getting that cancer diagnosed as early as possible, we think that we can make quite a lot of improvements in there that would lead to our survival increasing further and becoming much more closer to those of the international comparators. The NHS has a target here. After an urgent referral, a certain percentage of patients with cancer should have the diagnosis and start treatment within 62 days. That percentage target is different across the UK. 85% in England, 75% in Wales, 95% in both Scotland and Northern Ireland. But you don't need to worry about these differences because every nation is missing its own target by a clear margin. Northern Ireland is missing its target by over 60 percentage points, with only 33% of patients being seen within the target time. Thanks to John Shelton from Cancer Research UK. We've heard so far about the immense stress the NHS is facing, both right now and also over the next few decades given the pressures of an ageing society. It's both a practical and a financial challenge and it looks like it'll demand even more staff and more money than it does already. But what if we could ease some of the pressure simply by improving the productivity of the NHS? I know it may be an unglamorous topic but nothing makes economists happier than being more productive. So what is the state of productivity in our healthcare services and could it help us dispel some of the gloom? To find out, I spoke to Ben Zaranco. He's a sunny-minded economist, friend of the programme and an associate director at the Institute for Fiscal Studies. We should get to the basics. What is healthcare productivity? Healthcare productivity is the amount of healthcare services, things like the number of hospital procedures or the numbers of doctor appointments that we get for the amount of stuff that we put in. Most notably staffing but also the buildings and equipment that those people use. Or you can think about it in different terms in terms of the funding that we put in but it's really about what do we get in return in terms of health services that we want for what we are putting into the health service. Can you just take us back, I don't know, however long, maybe it's 20 years, maybe it's 30 years, give us the history of NHS productivity. Okay, so we've only really been measuring, by we here, I mean the government, I've been measuring healthcare productivity since about 1997. And the story from 1997 up to about 2009, which was a period when economy was growing and funding for the health service was growing even faster. New labour government. Yeah, new labour government, lots of cash sloshing around from Tony Blair and Gordon Brown. We were spending more on the NHS but we were actually putting inputs into the NHS for growing, employing more people, we were building more hospitals but actually outputs were growing even faster. So productivity was growing but only slowly basically. Then from 2010 to 2019 when you had much slower funding growth for the NHS in the austerity years, the NHS actually continued to get more productive but did so even more quickly. When you look at both periods together, from 1997 to 2019 on average NHS productivity, what you get out for the stuff you put in grew at just under 1% a year. But then came the Covid pandemic which unsurprisingly made the health service hugely less productive down by 24% in 2020. Since then productivity did bounce back from that crisis but it hasn't reached pre-pandemic levels. The longest running numbers we have come from the Office for National Statistics and more recently in England, the NHS England body which is assumed to be merged into the overall department have been producing their own estimates for the more recent years, focusing just on the hospital sector in England. The ONS think that in 2024 we were about 8% below where we were pre-pandemic. That's a lot. It is but NHS England also said in 2024 that in hospitals we were also about 8% below where we were pre-pandemic. So they largely agree on that. Does the National Health Service have a target for what productivity should be? As part of the funding settlement agreed with the Treasury in the summer, the NHS in England has a target to increase productivity by 2% per year. And yeah, so if we hit 2% a year for four years from here, great. So by about 2028, 2029, maybe we'll be about back where we were. Now, are we doing that? NHS England would say yes. On their measure, productivity has been growing at about 2.5% per year, about 2.4% in the most recent 12 months, 2.7% before that. So they think they're ahead of target basically. But if you look at the ONS numbers, actually healthcare productivity so far in 2025 has been effectively flat and they think it was almost flat in 2024 as well. So somewhere between three years and never is when we're back to 2019. If you extrapolate the ONS chart, we'd basically say never. If you believe the NHS, then we should be maybe in about three years' time back to where we were. And that matters a lot, right? This is about 8% of the economy. Which number do you believe? I think without sufficient detail, I can't come down firmly one side or the other. But I suspect that NHS England are doing a more sophisticated job of adjusting for the different types of things hospitals are doing now than in the past. And that could potentially be a big deal. They're the ones with a more optimistic story. So there is some reason to believe the more optimistic story. There is. But at the same time, NHS England are the ones with the target to do 2% increases per year. Fair. They're in some sense marking their own homework. It would be better if there was a universally agreed productivity measure around which everyone could gather around and study. At the moment, I think that my first ask would be more transparency. And the second thing would be to have better explanation from the ONS and NHS why they don't quite line up. The NHS has continued to take a larger and larger proportion of government spending and a larger and larger proportion of the economy as a whole. Is there any realistic rate of productivity growth that could stop that happening? So the NHS budget doesn't have to keep growing? The analysts at the Office of Budget Responsibility, which is the government's fiscal watchdog, did some nice analysis of this and they show that health spending will need to grow by something like 7% of GDP over the next 50 years or so. That's in this baseline scenario. If we were able to find a way to get healthcare productivity to grow as fast as productivity in the rest of the economy, which isn't something it's done historically, but it was in the realms of possibility, health spending would still need to go up, but it would go up only about half as much and we'd save more than 3% of GDP by the 2070s. Now that's getting on for £100 billion in today's money. So healthcare productivity is a massive deal. It can meaningfully alleviate the pressures that the NHS puts on the government. But I think even in an optimistic scenario, we're probably going to have to spend more on healthcare and we should start planning on that basis, is my view. Our thanks to Ben Zaranco from the Institute for Fiscal Studies. And that's it for today's Stats of the Nation. We're back tomorrow with sex, drugs and Council Tax Occupancy Exemptions for Empty Homes, which is almost as good as rock and roll in our book. That book has squared paper if you're interested. Until then, goodbye. More or less was presented by me, Tim Harford, the producer was Tom Coles. With Nathan Gower, Charlotte MacDonald, Lizzie McNeill and Katie Soloveld. The programme was recorded by Sarah Hockley and the series was mixed by James Beard, Neil Churchill and Sarah Hockley. The production coordinator was Maria O'Gondley and our editor is Richard Vartan. Hello, I'm Amal Rajan and from BBC Radio 4, this is Radical. We are living through one of those hinge moments in history when all the old certainties crumble and a new world struggles to be born. So the idea behind this podcast is to help you navigate it. What's really changed is the volume of information that has exploded and also by offering a safe space for the radical ideas that our future demands. Go to the transfer and say cut, radically cut the taxes of those with children. Telling our stories is powerful and a radical act. Listen to Radical with Amal Rajan on BBC Sounds.
