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Max Warner @maxwarner.bsky.social · 10/09/2026

Migration policy changes can have big economic effects. This chart shows illustrative estimates of the effects of these 3 policies on GDP. These could have been larger than any of the high-profile ‘supply-side’ policies since 2023, inc planning reform and childcare subsidies. [5/9]

Chart showing the possible supply-side impacts of migration and non-migration policies

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Max Warner @maxwarner.bsky.social · 10/09/2026

There have also been big changes in composition, with most immigration now from outside the EU. International students and dependents made up almost half of non-EU immigrants in 2025, while workers and their dependents made up another quarter, and asylum seekers ~15% [3/9]

Chart showing changes in non-EU+ immigration routes since 2019

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Max Warner @maxwarner.bsky.social · 10/09/2026

There have been large changes in estimates of both immigration and emigration in recent years, with a large rise and subsequent fall in net migration, the difference between the two. Latest Home Office visa data suggests immigration estimates could continue to fall [2/9]

Chart showing changes in immigration and emigration since 2012

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Max Warner @maxwarner.bsky.social · 28/08/2026

Hospitals also slowed down their activity and staffing growth to stick within budgets. This is consistent with the NHS having stronger financial ‘grip’ on trusts, but also shows the trade-off: all else equal, not topping up budgets will slow down performance improvements. [9/12]

Chart showing a slowdown in hospital activity growth in 25-26 compared with 24-25

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Max Warner @maxwarner.bsky.social · 28/08/2026

Zooming out further, 25-26 was the first year in over a decade that the NHS neither made a claim on the Treasury Reserve (a contingency for unexpected spending pressures) or raided capital budgets to meet frontline pressures [3/12]

Chart showing no reserve claims or raids on capital budgets for frontline pressures in 25-26, unlike in previous years

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Max Warner @maxwarner.bsky.social · 28/08/2026

DHSC’s initial budget for 2025-26 was set at the 2024 Spending Review. Excluding transfers and classification changes, it was only topped up by £400 million since then. That compares to top-ups of £16 billion in 24-25 and £8 billion in 23-24. [2/12]

Chart showing 25-26 had much smaller top-ups than 23-24 and 24-25

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Max Warner @maxwarner.bsky.social · 22/07/2026

We have a comment in the Times today on how yesterday's VAT cut will be paid for. The money has to come from somewhere within departmental budgets, but we don't know what will be squeezed. That's different to the bus fares policy, where more specific cuts have been set out

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Max Warner @maxwarner.bsky.social · 10/06/2026

@helenmiller.bsky.social, Matthew Savill and I also discussed a lot of these key issues on the IFS podcast last year, available here: ifs.org.uk/articles/end...

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Max Warner @maxwarner.bsky.social · 10/06/2026

Lots of discussion in recent weeks about how to fund the (much-delayed!) Defence Investment Plan. While this is important, it is only the first step in the longer-term and much larger defence spending increase this government has committed to. A short thread:

Chart showing planned increases in defence spending as a share of GDP

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Max Warner @maxwarner.bsky.social · 02/06/2026

Total NHS trust staffing is therefore growing more slowly that it has in years. The 10 Year Health Plan was clear that the govt thinks the 2023 workforce plan implied too much future staffing growth: it will be interesting to see what the new workforce plan says. (6/7)

Chart showing total English NHS trust staffing since 2009

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Max Warner @maxwarner.bsky.social · 02/06/2026

This trend is in line with the last few years: there are now 20% more doctors in NHS trusts than in 2022, but just 4% more support staff and 9% more estates, admin and management staff. Is this a deliberate policy choice? Or cash-strapped trusts cutting back on recruitment? (5/7)

Chart showing NHS staffing growth in English NHS trusts since 2022

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Max Warner @maxwarner.bsky.social · 02/06/2026

Some areas of hospital activity are growing: 2.6% more outpatient appointments, 2.8% more treatments from the elective waiting list, 3.2% more diagnostic tests. In general, though, these growth rates though are a lot slower than the year before. (2/7)

Changes in activity in English NHS hospitals, comparing growth rates between 23/24 and 24/25 to growth rates between 24/25 and 25/26

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Max Warner @maxwarner.bsky.social · 02/06/2026

We now have data for NHS staffing and hospital activity in England for all of 2025–26. There’s a lot of interesting things going on, so here’s a short thread on some of the key patterns. As the chart below shows, most staff groups and most types of activity are up year-on-year

Chart showing changes in staffing and activity in English NHS trusts between 2024-25 and 2025-26

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Max Warner @maxwarner.bsky.social · 26/05/2026

It's still unclear what the shift to community will do in the NHS. But in a middle-income context, @bancalaria.bsky.social et al find that El Salvador's multidisciplinary community health teams increased preventative appts, shifted the mix of care and reduced preventable hospitalisations.

Chart showing an increase in preventative consultations

Chart showing a fall in preventable hospitalisations for communicable diseases

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Max Warner @maxwarner.bsky.social · 15/05/2026

Despite the focus on programs to reduce the number of patients joining the waiting list overall (like advice and guidance services), it doesn’t seem that there was any significant recent change in new joiners. [10/13]

Chart showing number joining the waiting list

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Max Warner @maxwarner.bsky.social · 15/05/2026

And we see changes here. As the chart shows, In the last few months, the NHS has shifted more focus on treating patients who have waited longer than 18 weeks. That means more of the remaining patients have been waiting less than 18 weeks (the target). [6/13]

Chart showing share of patients leaving the waiting list within 18 weeks

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Max Warner @maxwarner.bsky.social · 15/05/2026

But as @hsj.co.uk have discussed, there was also a large increase in “un-reported removals” from the waiting list. The # of extra completed pathways in March was ~175k more than March 25. Unreported removals were ~106k higher. Both are significant [3/13] www.hsj.co.uk/quality-and-...

Chart showing number of unreported removals from the waiting list

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Max Warner @maxwarner.bsky.social · 15/05/2026

The NHS treated substantially more patients from the waiting list in February and March than in previous years, as part of the recent push to improve performance. This will have contributed to the improvement. [2/13]

Chart showing number of completed pathways from the waiting list

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Max Warner @maxwarner.bsky.social · 15/05/2026

It wasn’t the biggest story yesterday, but the NHS in England hit its intermediate target that 65% of patients should be waiting 18 weeks or less for elective care by Mar26. That’s after big recent improvements from 61.5% in Jan to 65.3% in March. So how was this achieved?🧵

Chart showing performance against the govt's 18 week target

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Max Warner @maxwarner.bsky.social · 27/04/2026

Here is our summary of the parties' plans for the Scottish NHS. A lot of consensus on e.g. more primary care and prevention. Some parties have set out plans for total health spending, but they imply quite slow growth - reflecting the tough fiscal reality faced by the next govt

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Max Warner @maxwarner.bsky.social · 14/04/2026

As per Tim Shipman's story in the Spectator a while ago, this might have caught the government itself off guard spectator.com/article/the-...

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Max Warner @maxwarner.bsky.social · 14/04/2026

One thing I find really striking on defence spending: the Strategic Defence Review was meant to be deliverable with *slower* defence spending than currently planned. The govt accepted all its recommendations. But it's long looked very ambitious to deliver within spending plans

Text from SDR saying that it was conducted within a context of spending 2.5% of GDP on defence

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Max Warner @maxwarner.bsky.social · 08/04/2026

Do listen to our latest podcast on the challenges facing the next Scottish government. One is that public services, inc. the NHS, are still struggling to recover from the pandemic. Hospital activity, for example, is still below pre-pandemic levels, unlike in England or Wales

Chart showing changes in hospital activity relative to 2019 Q3

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Max Warner @maxwarner.bsky.social · 13/03/2026

We have just updated our @theifs.bsky.social public spending tool. It allows you to explore how and where the government spends its money in the UK, now up to 2024-25. You can check it out here: ifs.org.uk/calculators/...

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Max Warner @maxwarner.bsky.social · 12/03/2026

A year ago we published @theifs.bsky.social analysis of whether and how the govt could hit their 18 week waiting time target. Performance has improved over the last year, and lies between our scenarios. Things could change, but it still doesn't look like we are on track for 92% by 2029

Chart showing simulated and actual performance against the 18 week NHS RTT target in England

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Max Warner @maxwarner.bsky.social · 10/03/2026

But although hospital activity has increased, it has grown more slowly than staffing levels, which are 24% higher than in 2019. This suggests a fall in hospital labour productivity, as seen in England – although Wales lacks the detailed productivity estimates produced by NHSE. [7/10]

Chart showing changes to staffing and hospital activity, April to September 2025 vs April to September 2019

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Max Warner @maxwarner.bsky.social · 10/03/2026

Welsh hospitals have increased outpatient appointments well above 2019 levels, but have only just got hospital admissions above pre-pandemic levels. Broadly, hospital activity recovery has been better than in Scotland but worse than in England. [6/10]

Chart showing changes to hospital activity in Wales, England and Scotland

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Max Warner @maxwarner.bsky.social · 10/03/2026

A&E waiting times are also worse than pre-pandemic, and worse than in England and Scotland. Even more concerningly, and unlike elective waiting times, they are still getting worse – largely driven by deteriorating waiting times in North Welsh A&Es in 2025. [5/10]

Chart showing share of patients waiting less than four hours in major A&E departments in England, Wales and Scotland

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Max Warner @maxwarner.bsky.social · 10/03/2026

Very long waits have also become much more common in Wales. 19% of patients were waiting longer than a year for treatment in December 2025, compared with 2% in December 2019. That’s despite Welsh government targets to eliminate most of these waits by spring 2025. [4/10]

Chart showing share of patients waiting over a year from referral to elective treatment in Wales

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Max Warner @maxwarner.bsky.social · 10/03/2026

But Welsh NHS services are in a relatively bad state. Waiting times for pre-planned hospital activity in Wales are far longer than pre-pandemic, and longer than comparable waiting times in England. This chart, for example, shows median waiting times across all specialties [3/10]

Chart showing median waiting time for elective treatment in Wales and England

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Max Warner @maxwarner.bsky.social · 10/03/2026

Wales has long spent more per person on health than England, though the gap has fluctuated over time. In 2024–25, Wales spent 9% more per head than England, and 6% more per head than Scotland. [2/10]

Chart showing spending per person on health in Wales relative to England

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Max Warner @maxwarner.bsky.social · 09/03/2026

Read our full report, funded by @therobertsontrust.bsky.social and @nuffieldfoundation.org, here: ifs.org.uk/publications... This includes great analysis by my colleagues of public spending, school performance and justice performance. [10/10]

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Max Warner @maxwarner.bsky.social · 09/03/2026

England and Wales have seen hospital activity recover faster, in part because they have increased staffing by more. But both countries also seem to have seen a fall in hospital labour productivity, like in Scotland. [8/10]

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Max Warner @maxwarner.bsky.social · 09/03/2026

Strikingly, hospital activity in Scotland remains below pre-pandemic levels. That’s not the case in either England or Wales, and the Scottish govt has repeatedly set targets to increase hospital activity. (Note this isn't all the NHS does though) [6/10]

Chart showing changes to hospital activity

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Max Warner @maxwarner.bsky.social · 09/03/2026

A&E waits in Scotland are much worse than pre-pandemic, but remain shorter than in either England or Wales. [5/10]

Chart showing share of patients waiting less than four hours to be admitted, transferred or discharged in major A&E departments

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Max Warner @maxwarner.bsky.social · 09/03/2026

Turning to the NHS, waiting times have worsened dramatically since the start of the pandemic. A much larger share of patients wait longer than a year for elective activity, for example, despite Scottish government plans to eliminate most of these waits by 2023 and 2024. [4/10]

Chart showing share of patients waiting over a year from referral for elective treatment in Scotland

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Max Warner @maxwarner.bsky.social · 09/03/2026

Scotland has long had worse life expectancy than England or Wales – the gap in life expectancy at birth between England and Scotland was ~2 years in 2023. In areas with similar average incomes, life expectancies are similar in England and Wales, but lower in Scotland. [3/10]

Chart showing the relationship between life expectancy and median income in parliamentary constituencies in England, Scotland and Wales, 2023

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Max Warner @maxwarner.bsky.social · 09/03/2026

Scotland has long spent more per person on health than England. But that gap has narrowed a lot over time, as health spending has grown faster in England. In 2024–25, Scotland spent just 2% more per head, compared with 11% more in 2010–11. Wales now spends the most in GB. [2/10]

Chart showing the difference between real-terms health spending per person in Scotland and England

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Max Warner @maxwarner.bsky.social · 15/12/2025

NHS England has now produced two sets of productivity growth rates for each NHS acute trust. These are year-on-year growth rates, only 3 months apart (so have a 9 month overlap). But what's striking is that they are essentially uncorrelated!? [1/2]

Chart showing there is no correlation between productivity growth in English hospitals between Q1 2024 to Q1 2025 and Q2 2024 to Q2 2025

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Max Warner @maxwarner.bsky.social · 12/12/2025

I think another nuance here is that we often talk about defence spending in terms of % of GDP. That makes sense for some types of questions. But (real) GDP is also much higher, so in real-terms we already spend lots more on defence - and that's probably closer to what matters for capabilities

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Max Warner @maxwarner.bsky.social · 12/12/2025

We made that exact chart for our recent IFS Green Budget chapter on defence spending (ifs.org.uk/publications...)

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Max Warner @maxwarner.bsky.social · 11/12/2025

Hospitals currently have a lot more people admitted with flu than at the same time in recent years. It remains to be seen how the peak will compare to previous years. (Half the IFS healthcare team are also currently laid low with it...) www.bbc.co.uk/news/live/c6...

Chart showing that the NHS currently has more beds occupied with patients with flu than at the same points in recent years. But the current level is below the peaks of past years

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Max Warner @maxwarner.bsky.social · 09/12/2025

It’s not clear why patients are receiving more hospital activity before they leave the waiting list than the year before. This divergence hasn’t been so large in recent years before 2024–25, and we see it happening for almost all medical specialties. 7/11

Chart showing that 2024-25 is the first year in recent years where elective activity has grown much faster than completed waiting list pathways

Chart showing almost all clinical specialties have seen elective activity grow much faster than completed waiting list pathways

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Max Warner @maxwarner.bsky.social · 09/12/2025

It also isn’t the case that lots of patients are joining the waiting list, counteracting increases in activity. Demand growth remains muted. Instead increases in elective activity have failed to translate into similarly large increases in patients leaving the waiting list. 5/11

Chart showing that growth in new referrals has been low, while elective activity growth has been high. But the number of patients leaving the waiting list has been lower than this growth in activity

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Max Warner @maxwarner.bsky.social · 09/12/2025

So what explains this difference? We can quickly rule a few factors out. Productivity hasn’t come from squeezing hospital resources, nor has it all gone to increasing emergency activity. Hospitals delivered a lot more elective activity in 2024–25 than in 2023–24. 4/11

Chart showing that over the last year NHS funding and resources have increased. Hospital activity has also increased, driven by elective not emergency activity

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Max Warner @maxwarner.bsky.social · 09/12/2025

This divergence between productivity growth and waiting list performance is visible at the trust level too. Lots of hospitals have seen productivity growth in 2024–25, for example, without a corresponding improvement in waiting times. 3/11

Chart showing there is little correlation between productivity growth and change in 18 weeks waiting time performance at the trust level in 2024-25 compared with 2023-24

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Max Warner @maxwarner.bsky.social · 24/10/2025

Elective waiting times in the NHS have improved since Labour came to office, but relatively slowly. Improvements in 18 week performance will have to pick up speed considerably if the government are to hit their headline NHS target by the end of the parliament.

Chart showing 18 week performance and trend since the election

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Max Warner @maxwarner.bsky.social · 19/07/2025

There are reports that the government is considering changing student loans or pensions for resident doctors. We've written a new @theifs.bsky.social comment on the potential merits of such changes. Here's a summary:

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Max Warner @maxwarner.bsky.social · 02/06/2025

After defence commitments and the Barnett formula, giving DHSC 2.5% per year in real-terms would leave no real-terms increases for other areas. 3.4% per year for DHSC (closer to the long-run average) would imply 1% cuts per year in real-terms for everything else. 9/12

Chart showing the trade-off between DHSC spending growth and spending growth for all other areas

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Max Warner @maxwarner.bsky.social · 02/06/2025

If we look at past Spending Reviews, health has long done well – between SR 1998 and SR 2015, on average, the day-to-day health budget was planned to grow at 3.5% per year, while the overall day-to-day budget was planned to grow at 1.5% per year. 4/12

Chart showing that the NHS has traditionally received faster planned spending growth than planned total spending growth at Spending Reviews

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