Yes, so I think, talking about demand, clearly there is a growing elderly population, there are higher morbidities, and that is going to be increasing demand for healthcare over time. But the points being raised here about what's happening to inputs and, if you like, outputs—activities in the NHS—I think is really quite important. So, I've not done any of the number crunching for Wales, but colleagues at the IFS have looked at both England and Scotland, and the figures are actually quite stark. So, in England, for example, NHS staff numbers are up about 15 per cent since prior to the pandemic, since 2019, but the amount of activity in hospitals, so out-patients and in-patients, both emergency and non-emergency, hasn't really increased at all. And that means that you've got, effectively, at a high level, it looks like something like a 13 or 14 per cent drop in productivity. Now, there are some things, looking beneath that, as it does seem, for example, that patients who have incidental COVID, so those who have something else wrong with them but also have COVID, they end up being in hospital for longer, it takes longer to treat them, and that sort of reduces the throughput through hospitals. It also seems that the complexity of cases has gone up a little bit, but it does seem that there is still, at least somewhat, an underlying productivity issue in the NHS, and understanding what has driven that is, I think, quite important.
And, of course, in Wales—and I mentioned this in my last evidence—already it was the case that hospital stays were quite substantially longer than in England, perhaps sometimes for good reasons, but also, again, that does reduce the throughput of people through the hospital system. So, I think it is important to not just think about NHS funding, but NHS productivity and NHS operations as well. As it becomes a bigger and bigger share of the Welsh Government's budget, it becomes more important that it's delivering effectively, which also matters, of course, to people's health as well.
The other thing I'd add on demand, again, talking to English councils, is what they've suggested is that it's not really that the demand, like the number of people requiring, say, children's social care or adult social care, has gone up massively, but it's two factors: it's the complexity of cases and also the cost of providers, especially in these specialist placements for children's services. I'm not sure if that's an issue in Wales to the same extent, but in England there have been huge, huge increases in the costs of placements for very troubled children, as, for example, the market has become more concentrated, with private equity buying up a lot of the providers and pushing up costs.