This is a really big factor. The public discourse around the NHS would lead you to think that NHS spending had been squeezed over the last 14 years - but it hasn't. Cameron made a big political choice in 2010 that the NHS would be exempt from the budget cuts that affected the rest of the public sector; and the NHS budget has actually consistently grown faster than inflation under a decade and a half of Tory health secretaries.
So why does the NHS feel under so much more pressure today than under New Labour?
Broadly, two reasons. The first, outside the government's control, is that the population has aged since 2010, and old people are more likely to need GP appointments and hospital beds. And the second, at least somewhat more in the government's control, is that public health has continued its deteriorating trend of the last several decades - the share of people overweight or obese in particular, who also find themselves disproportionately taking up health services.
We can't do anything about people getting older but we can act on the public health problem. We should be treating combating obesity with the same urgency we treated Covid.
Yes, my point was that above-inflation budget increases (so real-terms budget increases) ought to have led to improving services, other things being equal. But other things aren't equal - partly because people are getting older, but also partly because people are living unhealthier lives.
So just to stand still, the NHS would have needed even larger above-inflation spending hikes than it got; or, heaven forbid, government policy would have had to start treating mass obesity as the public health emergency that it is, rather than fretting about the Tory press calling this a 'nanny state'...
No, the NHS under the Tories received real terms budget increases every year but one (in the second year of the Coalition, when NHS spending rose by very slightly less than inflation).
The problem is that, with large sections of the general public living more and more unhealthy lives, the demands on the NHS have been growing even faster than the real-terms budget. Obesity is correlated with a range of serious health problems - diabetes, cardiovascular disease, various cancers - that devour NHS resources, so the real-terms NHS budget would need to grow at a much faster rate than inflation to cope with the continuing deterioration of public health.
Ultimately, this isn't a problem we should have been trying to spend our way out of anyway. The solution to an obesity epidemic shouldn't have been to try and load the consequences onto the NHS; it should have been to take strong preventative measures to head it off well before the point when a quarter of the adult population of England were technically obese (and as many again were overweight).
When Covid hit, we went into lockdown to avoid overwhelming the NHS - where was the obesity equivalent of the Covid lockdowns?
It's quite easy to give medical or caring exemptions to the relatively small number who need them. That's what low-traffic neighbourhoods in the UK typically do, for example.
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