Behind Brexit 2: how well has Britain coped with its population boom since 2004?
In the 12 years following the accession to the EU of the central and eastern European countries, the UK’s population grew by 5.7 million, nearly 10 per cent. As the first blog in this series showed, the UK has not seen such a sustained period of population growth since the years before the First World War. 5.7 million is the same as the increase over the 44 years up to 2004, beginning in 1960.
Working-age people born outside the UK accounted for 3.4 million of the 5.7 million increase. But the old-age dependency ratio still rose because the number of over 65s shot up by a quarter (2.3 million) even as the number of working-age people born in the UK went down. From an economic point of view, immigration is a sensible response to an ageing population.
What it looks like from other perspectives depends on how far public services and other essential provisions have kept up with the growing population. Britain has become more crowded in this period, but has it also become more over-crowded? This blog takes a simple approach to this question, looking at a handful of nationwide statistics (three for England, two for Great Britain) from the early 2000s, showing the percentage change in some aspect of the volume of four essential services: trains, homes, schools and hospitals, and comparing them against the 10 per cent population growth.
Three things stand out in this graph. First, all the numbers are big: things have not stood still. Second, three of the four increases comfortably exceed the 10 per cent by which the population grew while the fourth – the number of dwellings – only just falls short. Third, the big increase in GP numbers alongside the big fall in hospital beds points to deep change in how the NHS works.
The conclusion is that there is no simple story about inadequate levels of public services. But what happens if we look beneath the surface?
The 19 per cent increase in the number of passenger train miles run on Britain’s railways between 2004/05 and 2015/16 looks impressive – until it is set alongside the 53 per cent increase in the passenger miles travelled on those trains. Together, these mean that the average number of passengers per train mile rose by more than a quarter.
A rise in the average number of passengers is not in itself a sign that the railways are not coping. But over the same period, the percentage of passengers in excess of capacity (for trains in London and the South East) went up from 2.9 per cent to 4.5 per cent. Although that does not sound much, almost a quarter of trains entering or leaving London in the peak three hours were carrying passengers in excess of capacity while over half had passengers standing. Both were up on where they had been in 2011.
Although the big increase in train travel was largely offset by a small fall in travel by car, journey times to and from work by car were up across Great Britain by six per cent. Slower journeys mean more vehicles on the road at any particular point in time. So, both rail and road have become more crowded.
Is the growth rate of the population the right yardstick by which to judge the eight per cent growth in the dwelling stock between 2004 and 2015. Kate Barker’s official Review of Housing Supply published in 2004 offered a range of answers as to how fast the number of homes needed to grow. Starting from the 183,000 homes built in the UK in 2002, her two central options were an extra 39,000 a year, or an extra 93,000 a year (both figures for England), on top of a backlog of another 450,000 households estimated to have been unable to access housing up till then.
Based on these figures, adding an allowance for Wales and Scotland and assuming that the backlog is resolved over 10 years suggests a required rate of increase in the housing stock of between 275,000 and 335,000 a year. Against even the lesser of these numbers, the eight per cent growth rate achieved between 2004 and 2015, adding on average 195,000 a year, fell far short.
The problem is not just too few dwellings. Barker’s estimates were broken down between “affordable” (where the majority of extra homes were said to be needed) and owner-occupied. In reality, after 2004 the number of owner-occupied dwellings and those for social rent both fell (see graph). All the growth – and more – occurred in the private rented sector. This could hardly have been more different from what Barker thought was necessary.
Although the number of nursery and primary school teachers in England grew by 13 per cent between 2005 and 2016, that still fell slightly short of the growth in the number of 5 to 7 year-olds. Class sizes are where the school system appears to take the strain.
Over the ten years from 2006, the percentage of children in the first years of primary school in England in classes of more than 30 went up (see graph). By contrast, there was a fall over the period in the proportion of 7 to 11 year-olds in classes of more than 30, down from 24.3 per cent to 17.5 per cent. On the face of it, this suggests a shift in priorities within primary schools.
As one of the big life events of childhood, entrance to primary school is important for children and their parents. If finding a place is difficult, or the class is large, the sense that the families are in some way in competition with one-another can take hold.
Hospital beds and A&E
The 18 per cent fall in the number of hospital beds alongside the 19 per cent rise in the number of GPs suggest a story not of NHS decline but of change. Within a falling overall total, the number of beds set aside for people with learning disabilities or mental health problems fell much faster than the average while the number of day-only beds rose. Within a rising overall number employed (up 14 per cent between 2004 and 2014), the balance of NHS staff changed too, with 44 per cent more consultants and 25 per cent more scientific, technical and therapeutic staff, but only nine per cent more nurses and two per cent more ambulance staff.
Medical advances and a shift towards providing care outside of hospital have allowed hospital bed numbers to come down for a long time. Indeed, over the 12 years up to 2004, the percentage fall was almost exactly the same as in the 12 years from 2004 (even though the population was growing more slowly then).
But the intensity of hospital bed use has gone up, with occupancy rates for overnight acute beds up from 87 per cent in 2010/11 to over 90 per cent in 2016/17. This, the King’s Fund notes, “is a significant factor in the deterioration in performance against the four-hour standard for admitting or discharging patients from A&E seen in recent quarters.”
That deterioration has been substantial (see graph) but quite recent, 2012/13 being the first year when it rose above four per cent. Since 2014/15 it has shot up, breaching 10 per cent across the year and 12 per cent in the worst three months.
An A&E department is heavily dependent on the hospital that sits behind it and supports it in many ways. That’s why A&E wait times can be treated as a wider measure of overall NHS performance. An increase in attendances may indeed not be “the primary factor impacting on waiting times”, but that is not how it looks sitting for a long time in a crowded waiting room.
Covering a large area and open to anyone without an appointment, A&E is somewhere we meet our district, town or city almost unfiltered. For waiting times to have so deteriorated over the past five years (to the point where the government has in effect abandoned the target), can only strengthen the sense that the country has become over-crowded. Large class sizes at primary school may convey the same message.
Having embarked on a path of rapid population growth after 2004, trains, homes, schools and hospitals show that the institutions that run Britain failed to make the necessary provision to accommodate that growth. That failure is part of the background to Brexit and it must be addressed.
 Data sources are given below where each statistic is discussed.
 All these numbers are measured on a full-time equivalent basis.
 This article cites the National Audit Office conclusion that 85 per cent occupancy is the threshold above which hospitals face various problems.