UK healthcare system issues and comparison with other countries

Published 2023-02-22 11:36:53
Nurses demonstrate in London - Photo by Ehimetalor Akhere Unuabona on Unsplash

The steady decline of the NHS, the health service in the UK, over the last few years has sparked concern and outrage from patients and medical professionals alike. It is now viewed as a full-blown health crisis.

Long delays for medical attention have have had serious consequences for patients, and have even resulted in fatalities. Many critics explain that the NHS is not receiving sufficient funding but the government disagree. So what exactly is going on?

Main issues with the NHS

Whilst the issues with the NHS are numerous and complex, here are some of the more obvious and glaring problems:

More spending but still less than needed

In theory, all UK residents are eligible for medical care without any cost. This cost is covered by the taxes they pay and the National Insurance that is deducted monthly from the salary. However, this doesn't include eye care, dental services (which are however offered at capped prices as part of the NHS healthcare offerings) or prescriptions ( the price of medicines is also capped). When the annual NHS budget is calculated per person, it works out to approximately £3,615 per individual for healthcare

Even before the pandemic, healthcare demands were steadily climbing. This was across all services and sectors of the NHS but in parallel, healthcare spending slowed down remarkably.

Despite a healthy healthcare budget, capital project costs have been slashed. This has  consequences for healthcare infrastructure, like IT and building works. Years of insufficient capital spending have resulted in deteriorating assets which are unfit for use. The maintenance backlog increases each year. Obsolete and inadequate IT leads to unnecessary delays and is time-consuming for staff.

For the period 2022-2023, the NHS has been allocated £152.6bn. This is less than the amount allocated for the periods 2021-2022 and 2020-2021. This can discrepancy can be explained by the pandemic that gripped the nation and crippled the NHS.

The Conservatives’ five-year NHS funding plan is proposed to increase by 3.4% a year above inflation. This translates to £149bn of funding available for the period. The Labour party recommended, during the 2019 General Election, that it be increased by 3.9% thus increasing the budget to £155bn by 2023-24. The Lib Dems proposed a budget of £154bn.

Persistent understaffing

Brexit, lower immigration numbers of healthcare workers and early retirement are only some of the factors that have led to a workforce disaster.

According to the NHS 9.7% of positions are vacant. This is especially dire for nursing staff where poor pay discourages young people from entering the profession and retaining existing nursing staff. This statistic translates to about 40,000 nursing posts and 10,000 doctor vacancies.

This staffing crisis is occurring concurrently with the surge in hospital and GP visits post-pandemic. This trend is expected to continue as Covid and flu season put further pressure on the NHS.

Although the UK government introduced the NHS visa towards the end of Brexit to offset the workforce vacuum, there will be a lag period between when visas are approved and when positions are filled.

Using private health organisations

Statistics show that in 2017, 515,000 non-urgent surgical procedures were performed by private doctors for the NHS.

Private companies are being used increasingly– at present, about 7% of the healthcare budget goes to private companies. These costs include contracts with private hospitals for surgical procedures, usually provided by the NHS, like hip and knee surgery, physiotherapy and community health.

Using contracts with private companies was introduced in 2003 under the Labour party as a solution to shorten waiting lists. The NHS funds are also used to purchase equipment and medicines from private companies. The Labour policy resulted into sharp profits for the private sector taking over the most profitable services, while the remaining part provided by the State saw its financing compressed.

Larger ageing population

The NHS also has to provide for an increasingly ageing population. People are living longer now than when the NHS was established due to giant leaps made in medical improvements. Nowadays, the average life expectancy is 13 years longer than previously. Chronic illnesses like diabetes, cancer and heart disease are no longer death sentences. An extensive arsenal of antibiotics makes infectious diseases rarely fatal.

Providing healthcare for older people is more costly. As a patient ages, healthcare costs associated with that patient rise exponentially. A 65-year-old patient costs 2.5 times more than a 30-year-old but a 90-year-old costs seven times that. The healthcare cost is further magnified by higher medical expenses and other general factors like the sharp increase in obesity and its associated health risks.

Healthcare costs in other countries

Universal healthcare in other countries also faces challenges but some deal with these challenges differently. 

France has a universal healthcare system which is funded by the government. It is similar to the value for the UK per capita at £3,699, and relatively below most its neighbouring countries.

In 2000 the World Health Organisation recognised France as providing the “best overall healthcare” globally. However, under-investment and budget restrictions (often labelled as "optimisation" by politicians) decided by consecutive French governments resulted into a sharp declined that was blatant for the French population when they needed to deal with the Covid pandemic. This top ranking now belongs to Japan followed by other Asian countries Singapore and South Korea. Norway ranked fourth in the best overall healthcare globally.

The US spends an equivalent of £9,061 per capita which is much higher compared to the NHS despite the bad reputation of healthcare in the US. Nevertheless, a whopping 28 million people are not protected by national healthcare.

The Swiss are reputed to have an excellent healthcare system in place. They had an average budget of £8,039 per person in 2019. Their universal healthcare scheme is funded by contributions made to the public health insurance. These contributions pay for almost 90% of costs. Recently health insurance premiums were increased to offset the financial strain the pandemic placed on the system.

Norway spends the most out of all the Nordic countries– about £6,644 per capita whilst Finland spends approximately £3,692 per person. Denmark and Sweden’s average healthcare spend is £5,000 per person with Iceland spending slightly more at  £5,200 per person.

The German government budgets £4,500per capita and all legal residents and citizens can receive free “medically necessary” healthcare. However, Germans must additionally have state or private health insurance to cover other medical costs like prescription medication, outpatient costs, etc. The costs of this additional medical cover can range from £132 to £882 per person per year.

In the Republic of Ireland, £4,503 is allocated to healthcare per person. Healthcare is provided through a combination of private and public institutions. A revised national health service was initiated in 2005 to provide a second choice to the large private healthcare market.

Medicare is the national health insurance funded by the Australian government. Australians are allotted an average of £4,501 annually. Although healthcare is free, people must still pay for certain things like ambulance services, and dental and optical care. So people often purchase private health insurance to pay for those expenses not covered by Medicare. Low-income groups get refunds on this extra cost.

Canada also has Medicare where citizens and residents have access to free healthcare. Canada budgets approximately £4,188 per person on healthcare. Once again, some services like dental and prescriptions are excluded from Medicare.

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Author: KashGo
Expat Mum in the Desert and content writer for

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