Struggling To Perform
The NHS in Britain is one of the biggest public health care providers in the world and is both loved and reviled in equal measures. As the NHS is tax-funded, the performance of the service is largely tied to the performance of the UK economy and NHS funding has tended to broadly track the economic cycle of the UK, growing as the economy expands and shrinking as the economy contracts.
NHS spending in the UK over 2017/2018 was £125 billion and is set to grow to £127 billion over 2019/2020. Spending over 2017/2018 was comprised of £110 billion from the NHS budget with the remaining amount contributed by the Department of Health. The Government recently announced that a further £20 billion will be made available for the NHS by 2023/20124 though it is not yet clear how this money will be spent.
NHS Has Far Fewer Doctors & Nurses Than Other Healthcare Providers
The NHS employs over 1 million full-time staff though in terms of Doctors per person in the population, across 21 countries the UK has fewer than almost all. Data collected by the Organisation for Economic Co-Operation and Development shows that per 1000 population, the UK has just 2.8 doctors with only Canada and Poland having a lower figure at 2.7 and 2.3 respectively. The UK’s figure is also far below the unweighted average of the 21 countries which is 3.6 and far below the leader of the group Austria which has 5.1.
The UK also has far fewer nurses per 1000 of the population than the other countries in the group with just 7.9., well below the average of 10.4 and again, far below the leader of the group Switzerland which has 18.
In terms of assessing why the UK’s ratio of doctors and nurses is so low the most obvious place to look is spending. As a total share of GDP, the UK spends 9.7% of GDP which is actually just above the average of 9.6%. The lowest country in the group is Poland which spends just 6.4% of GDP while the leader of the group, Switzerland, spends 12.4% of GDP.
NHS Struggling To Recruit
Although the NHS spends 65% of its budget on staff and is consequently one of the world’s largest employers, its workforce is under increasing pressure and staffing statistics continue to underperform international averages. The OECD reports that there are around 100k vacancies for clinical staff in the English NHS which has fuelled concerns about the ability of the NHS to recruit and retain appropriate staffing numbers.
The outlook is bleak with Nuffield Trust reporting that 44% of NHS trusts are in a deficit, spending more than they manage to bring in. In 2017/2018 the proportion of acute trusts in the deficit was 65% with the combined deficit weighing in at £960 which was up sharply from the prior year’s £800 million.
Will The NHS Become Privatised?
Given the difficulties in achieving adequate funding, there is growing concern that the future of the NHS will see the public healthcare provider privatized. Indeed, there is already a high level of concern that the NHS is far more involved in private work than is publicised, with the activity mostly disguised from being on official records by complicated operating arrangements. The privatization of the NHS and the potential implications for users is something we will be looking at in a forthcoming article.