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-...

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

Important work from my colleagues. If you care about wealth inequality, you need to be able to measure wealth well. That's hard. With an improved methodology, it looks like wealth gaps by age were smaller than official statistics would suggest

You can read more of our analysis of the NHS in Scotland in my thread here: bsky.app/profile/maxw...

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

I'm looking forward to taking part in this event on NHS productivity on the 30th April - do sign up to come along

How much was spent on public services in your area in 2022-23? | Institute for Fiscal Studies Explore how much funding your area receives for key public services, and whether this funding is in line with patterns of needs

Not straightforwardly, I'm afraid - region is the level the government publish these figures at. A couple of years ago we produced our own set of estimates at the LA level for some services: ifs.org.uk/calculators/.... ifs.org.uk/publications...

Screenshot of the tool

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/...

Can the government achieve its 18-week elective waiting time target? | Institute for Fiscal Studies Simulation modelling of NHS elective waiting times in England shows that the government’s 18-week target is unlikely to be met in this parliament.

You can read the original report here: ifs.org.uk/publications...

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

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

Public service spending and performance in Wales | Institute for Fiscal Studies Welsh health and education systems are underperforming – with cuts to spending on some public services likely post-election.

You can read our full report, funded by @nuffieldfoundation.org, here: ifs.org.uk/publications...

This includes great analysis by my colleagues of public spending and school performance.
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The Welsh NHS is clearly struggling. Despite some recent improvements, pre-planned waiting times are much higher than in 2019, and than in England. A&E waits are the longest in GB. Hospital activity has recovered well vs Scotland, in part as staffing has grown by more.
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It’s also noticeable that the big surge in Welsh outpatient appointments hasn’t obviously improved elective waiting times relative to England and Wales. Perhaps similar to the gap we have seen in England between hospital activity and completed waiting list pathways?
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Chart showing changes to staffing and hospital activity, April to September 2025 vs April to September 2019

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

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

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

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

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

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.
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NEW: How is the Welsh NHS performing, and how does it compare to England and Scotland?

We have a new @theifs.bsky.social report out today looking at public service spending and performance in Wales, in advance of the Senedd elections.

🧵on the key Welsh NHS takeaways [1/10]

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.
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The NHS in Scotland is clearly struggling post pandemic. This is also true in England and Wales. But there are differences - A&E waits look better in Scotland (though still worse than pre-pandemic), but English and Welsh hospitals have recovered activity more quickly.
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Chart showing changes to staffing and hospital activity, April to September 2025 vs April to September 2019

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.
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Hospital activity in Scotland is lower than in 2019, despite a 14% increase in staffing and higher funding. This suggests a fall in hospital labour productivity. Productivity is complex, though, and Scotland lacks detailed NHS productivity estimates, unlike England.
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Chart showing changes to hospital activity

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

A&E waits in Scotland are much worse than pre-pandemic, but remain shorter than in either England or Wales.
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Chart showing share of patients waiting over a year from referral for elective treatment in Scotland

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

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

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.
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How is the Scottish NHS performing, and how does it compare to England and Wales?

On Saturday we published a new @theifs.bsky.social report looking at public service spending and performance in Scotland, in advance of the devolved elections.

🧵on the key Scottish NHS takeaways [1/10]