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Good morning. Rishi Sunak has a big speech today, but one of the many things I am pointlessly ornery about is writing about speeches before they happen, so I will cover that tomorrow. Instead, some thoughts on which of the problems in the NHS are about cash, and which of them are about the health service’s structure.

Inside Politics is edited by Georgina Quach. Follow Stephen on Twitter @stephenkb and please send gossip, thoughts and feedback to

All the things I could do if I had a little money (and a time machine)

Why is the NHS in crisis, despite the fact that the UK now spends about as much money on it as peer countries? Well, a big part of the reason is that important word “now”. The NHS now gets about as much money as its peers, but in the past decade, UK health spending has fallen short of levels in similar countries.

Bar chart of UK current spending on health under various scenarios: median of 2010–2019, £bn per year showing UK health spending has not matched per head levels in similar countries

This isn’t particularly complex or surprising. If you don’t clean your house for 10 years, and then you start to pay a cleaner to spend two hours a week tidying it like your neighbours do, it will be some time indeed before your house is anywhere near as clean as your neighbours’ homes.

As Clive Cookson and Jasmine Cameron-Chileshe explain in their excellent primer on the state of the health service, an awful lot of the NHS crisis is as simple as an absence of money. If you don’t train enough doctors, nurses and paramedics for a decade, there is a hard limit on what you can achieve quickly just by increasing the amount of money you spend.

From a party-political perspective, what would worry me were I a Conservative strategist is that the post-2019 increases in funding will start to actually have an effect on NHS performance, ooh, about a year after the next election, exactly in time for Labour to take the credit and to deepen voter anxieties about my party and the health service. And short of inventing time travel, there is not an awful lot you can do about that.

There is a cheaper and quicker thing you can fix outside the NHS: the UK’s social care system. While filling the growing number of vacancies in the social care system also costs money and time, it takes a lot less time and indeed money to hire, train and place a social care worker than it does to train a doctor, a paramedic or a nurse. A better staffed care sector will allow hospitals to discharge patients more quickly into the community.

Fixing social care is not going to solve all of the NHS’s problems, far from it. But from a narrow electoral perspective, if I were the health secretary Steve Barclay, or the prime minister Rishi Sunak, I would see social care as my best hope of doing something that leads to an improvement in outcomes before my next date with the British electorate in the winter of 2024.

It’s not just money

While many of the problems facing the NHS are about a lack of money, not all of them are.

The NHS has a much lower number of spare beds compared with peer countries, which may at first seem to be a result of lower spending. But this isn’t the case!

Bar chart of Hospital beds per 1,000 residents (2021 or latest available data) showing The UK has too few hospital beds compared with other industrialised countries

Look at this King’s Fund chart of hospital bed numbers.

Right in the middle of this chart is New Labour’s big, big increase in health spending, but you cannot see it on the chart. Whether the NHS has a lot of money flowing into it, or receives about the average for peer countries, or, as it has for the past decade, less money than peer countries, it has lower bed capacity by design.

(Again, the cause here is obvious: with very few exceptions, broadly speaking, UK patients don’t choose their hospital bed, their hospital bed chooses them. This isn’t the case in most peer countries to the same degree.)

The same is true for capital spending. Here’s the key chart, courtesy of John Burn-Murdoch’s Data Points column:

Chart showing that the UK has underinvested in healthcare capital, leaving it with fewer beds than peer countries and less equipment to speed up patient flow

Again — you cannot see the big increase in NHS spending here, other than on the NHS’s building estate. The only bit of capital expenditure in the NHS that really went up under New Labour was in new hospitals or complete redevelopments, such as the renovation of Guy’s Hospital or University College Hospital.

This applies to whenever a politician talks about the need to “reform” the NHS. A good gauge for deciding how seriously you should take them is if their reforms are related to either of these two things: investment in healthcare capital and increasing bed capacity. Almost everything else troubling the NHS is either a problem of underfunding or of the Covid-19 pandemic, and neither can really be wished away just by throwing the word “reform” around like confetti.

Shameless self-promotion

The FT’s auction in support of our financial literacy charity Flic continues: you can either give to Flic directly, or bid for lunch with me at the lovely restaurant Turnips, or with a host of other FT journalists.

Now try this

My partner took me to Wigmore Hall yesterday for Christmas, which was a double bonus because it meant I missed out on seeing Arsenal drop points at home, but also because I hadn’t heard Dmitri Shostakovich’s Piano Quintet in G minor Op. 57 performed live before. It’s a wonderful piece of music and it reminded me that I keep meaning to re-read Julian Barnes’s The Noise of Time, a fictionalised account of Shostakovich’s life. It was the last Barnes novel I really enjoyed — neither The Only Story nor Elizabeth Finch really worked for me.

The FT’s newsletter Europe Express, which normally requires a premium subscription, is free to read today. Read the latest edition by its new lead writer Henry Foy here, and sign up to receive Europe Express each weekday and Saturday morning here.

Top stories today

  • Sunak sets out 2023 plans | Downing Street admitted yesterday that some Britons will find it “very difficult” to access the NHS this winter, as Rishi Sunak tried to regain control of the political agenda in the face of an escalating health crisis. He has already prioritised raising the country’s economic growth by boosting skills training, including by improving the teaching of mathematics in England.

  • Food prices signal ‘another difficult year’ | Annual growth of UK food prices hit 13.3 per cent in December, the British Retail Consortium said today. That was up from 12.4 per cent in November, and the highest reading since the trade body’s records began in 2005.

  • RMT holds the line | Britain’s two main railways unions have warned strikes will last into the summer unless the government and industry come up with new offers on pay and reform. The RMT has planned walkouts for today, Friday and Saturday, with passengers also facing severe disruption on Thursday when Aslef members are set to strike in their own dispute over pay.

  • Protocol can be ‘flexible’, says Varadkar | Leo Varadkar, Ireland’s new prime minister, has admitted that Northern Ireland’s post-Brexit trading arrangements are “too strict”, fuelling hopes of a deal between the UK and the EU to end the dispute over the issue.

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