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Healthcare in the United Kingdom

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Healthcare in the United Kingdom is a devolved matter, with England, Northern Ireland, Scotland and Wales each having their own systems of publicly funded healthcare, funded by and accountable to separate governments and parliaments, together with smaller private sector and voluntary provision. As a result of each country having different policies and priorities, a variety of differences have developed between these systems since devolution.[1][2]

Life expectancy development in UK by gender
Comparison of life expectancy at birth in England and Wales

Despite there being separate health services for each country, the performance of the National Health Service (NHS) across the UK can be measured for the purpose of making international comparisons. In a 2017 report by the Commonwealth Fund ranking developed-country healthcare systems, the United Kingdom was ranked the best healthcare system in the world overall and was ranked the best in the following categories: Care Process (i.e. effective, safe, coordinated, patient-oriented) and Equity.[3] The UK system was ranked the best in the world overall in the previous three reports by the Commonwealth Fund in 2007, 2010 and 2014.[4][5][6]

The UK's palliative care has also been ranked as the best in the world by the Economist Intelligence Unit.[7] On the other hand, in 2005–09 cancer survival rates lagged ten years behind the rest of Europe,[8] although survival rates later increased.[9][10] In 2015, the UK was 14th (out of 35) in the annual Euro health consumer index.[11] The index has been criticised by academics, however.[12]

The 2018 OECD data, which incorporates in health a chunk of what in the UK is classified as social care, has the UK spending £3,121 per head.[13] Healthcare spending as a share of the gross domestic product (GDP) has increased since 1997, where it was 6.8 per cent. By 2019, healthcare expenditure in the UK amounted to 10.2 per cent of GDP.[14][15] In 2017 the UK spent £2,989 per person on healthcare, around the median for members of the Organisation for Economic Co-operation and Development.[16]

Common features

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Each NHS system uses General Practitioners (GPs) to provide primary healthcare and to make referrals to further services as necessary. Hospitals then provide more specialist services, including care for patients with psychiatric illnesses, as well as direct access to emergency departments. Community pharmacies are privately owned but have contracts with the relevant health service to supply prescription drugs.

The public healthcare system also provides free (at the point of service) ambulance services for emergencies, when patients need the specialist transport only available from ambulance crews or when patients are not fit to travel home by public transport. These services are generally supplemented when necessary by the voluntary ambulance services (British Red Cross, St Andrews Ambulance Association and St John Ambulance). In addition, patient transport services by air are provided by the Scottish Ambulance Service in Scotland and elsewhere by county or regional air ambulance trusts (sometimes operated jointly with local police helicopter services[17]) throughout England and Wales.[18]

In specific emergencies, emergency air transport is also provided by naval, military and air force aircraft of whatever type might be appropriate or available on each occasion,[19] and dentists can only charge NHS patients at the set rates for each country. Patients opting to be treated privately do not receive any NHS funding for the treatment. About half of the income of dentists in England comes from work sub-contracted from the NHS,[20] however not all dentists choose to do NHS work.

When purchasing drugs, the NHS has significant market power that, based on its own assessment of the fair value of the drugs, influences the global price, typically keeping prices lower. Several other countries either copy the UK's model or directly rely on Britain's assessments for their own decisions on state-financed drug reimbursements.[21]

Private medicine

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Main article: Private medicine in the UK

Patients can choose to go private, meaning they can choose to pay for private hospital medicine, either out of pocket or through private insurance plans.[22] Individual private healthcare and health insurance remains a niche, unregulated market in the UK. Most regions do not have sufficiently developed private healthcare infrastructure to provide full patient care. The full range of private medical services is available only in limited locations. Even when services exist for those who can pay or are insured, the cover of private medical insurance in the UK is often limited to planned procedures. As a result, many insured patients will still go to an NHS General Practitioner, obtain NHS prescriptions, and use an NHS emergency department.[22] On the other hand, many private healthcare providers, especially in England, will contract with NHS facilities in their locale to provide treatment for patients, particularly in mental health and planned surgery, and conversely, some private treatments are offered for NHS patients.

Primary care, paid for by the NHS, is almost entirely provided by private contractors – general practitioners, community pharmacists, dentists and opticians – who may provide commercial services in addition to NHS services.[23]

Healthcare in England

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Main article: Healthcare in England
 
The Queen Alexandra Hospital is one of the NHS hospitals serving the city of Portsmouth and the surrounding area. The hospital's affiliated universities are the University of Portsmouth and the University of Southampton School of Medicine.[24]

Most healthcare in England is provided by the NHS England, England's publicly funded healthcare system, which accounts for most of the Department of Health and Social Care's budget (£122.5 billion[25] in 2017–18).

Healthcare in Northern Ireland

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Main article: Health and Social Care in Northern Ireland

The biggest part of healthcare in Northern Ireland is provided by Health and Social Care in Northern Ireland. Though this organization does not use the term 'National Health Service', it is still sometimes referred to as the 'NHS'.[26]

Healthcare in Scotland

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Main article: Healthcare in Scotland

The majority of healthcare in Scotland is provided by NHS Scotland; Scotland's current national system of publicly funded healthcare was created in 1948 at the same time as those in Northern Ireland and in England and Wales, incorporating and expanding upon services already provided by local and national authorities as well as private and charitable institutions. It remains a separate body from the other public health systems in the United Kingdom, although this is often not realised by patients when "cross-border" or emergency care is involved due to the level of co-operation and co-ordination; occasionally becoming apparent in cases where patients are repatriated by the Scottish Ambulance Service to a hospital in their country of residence once essential treatment has been given but they are not yet fit to travel by non-ambulance transport.

Public health matters are handled by Public Health Scotland which is sponsored by the Scottish Government and local authorities (through COSLA).

Healthcare in Wales

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Main article: Healthcare in Wales

The majority of healthcare in Wales is provided by NHS Wales. This body was originally formed as part of the same NHS structure for England and Wales created by the National Health Service Act 1946 but powers over the NHS in Wales came under the Secretary of State for Wales in 1969[27] and, in turn, responsibility for NHS Wales was passed to the Welsh Government under devolution in 1999. Public health matters are handled by Public Health Wales.

Comparisons between the healthcare systems in the United Kingdom

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Differences

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Telephone advisory services

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Each NHS system has developed ways of offering access to non-emergency medical advice. People in England[28] and Scotland can access these services by dialling the free-to-call 111 number. Scotland's service is run by NHS24.[29] The telephone number for NHS Direct Wales/Galw Iechyd Cymru[30] was 0845 4647, but the 111 service was rolled out across all areas in 2022.[31]

Best practice and cost effectiveness

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In England and Wales, the National Institute for Health and Clinical Excellence (NICE) sets guidelines for medical practitioners as to how various conditions should be treated and whether or not a particular treatment should be funded. These guidelines are established by panels of medical experts who specialise in the area being reviewed.

In Scotland, the Scottish Medicines Consortium advises NHS Boards there about all newly licensed medicines and formulations of existing medicines as well as the use of antimicrobiotics but does not assess vaccines, branded generics, non-prescription-only medicines (POMs), blood products and substitutes or diagnostic drugs. Some new drugs are available for prescription more quickly than in the rest of the United Kingdom. At times this has led to complaints.[32]

Cost control

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The National Audit Office reports annually on the summarised consolidated accounts of the NHS, and Audit Scotland performs the same function for NHS Scotland.[33]

Since January 2007, the NHS have been able to claim back the cost of treatment, and for ambulance services, for those who have been paid personal injury compensation.[34]

Parking charges

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Parking charges at hospitals have been abolished in Scotland,[35][36] and have also been abolished in Wales.[37] From April 2020, those with greatest need—disabled people, frequent outpatient attenders, parents of sick children staying overnight and staff working night shifts—have had access to free parking in England.[38][39] Parking charges at hospitals in Northern Ireland will be abolished in 2024, when an Act passed by the Northern Ireland Assembly in 2022 prohibiting them takes effect.[40][41]

Prescribed drugs

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In a sample of 13 developed countries, the UK was 9th in its population-weighted usage of medication in 14 classes in both 2009 and 2013. The drugs studied were selected on the basis that the conditions treated had high incidence, prevalence and/or mortality, caused significant long-term morbidity and incurred high levels of expenditure and significant developments in prevention or treatment had been made in the last 10 years. The study noted considerable difficulties in cross border comparison of medication use.[42]

The right to NHS prescriptions is based on residence, not nationality. Northern Ireland, Scotland and Wales no longer charge for prescriptions. In England, a fixed prescription charge is payable for up to a three-month supply of each item (£9.35 as of April 2022), regardless of actual cost.[43] There are many exemptions from the charge, including patients under 16 years old (18 if still in full-time education), over 60, with certain medical conditions, on low incomes or in receipt of certain benefits.[43]

Permanent residents in England who are liable to pay prescription charges can purchase a Prescription Prepayment Certificate (PPC) covering all prescriptions in a specified period; a three-month PPC costs about three times the price of a single prescription, and a 12-month PPC a little less than twelve times the individual price. No charges are made anywhere in the UK for prescriptions administered at a hospital, by a doctor or at an NHS walk-in centre.[43]

Role of private sector in public healthcare

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From the birth of the NHS in 1948, private medicine has continued to exist, paid for partly by private insurance. Provision of private healthcare acquired by means of private health insurance, funded as part of an employer funded healthcare scheme or paid directly by the customer, though provision can be restricted for those with conditions such as AIDS/HIV.[44] In recent years, despite some evidence that a large proportion of the public oppose such involvement,[45] the private sector has been used to increase NHS capacity. In addition, there is some relatively minor sector crossover between public and private provision with it possible for some NHS patients to be treated in private healthcare facilities[46] and some NHS facilities let out to the private sector for privately funded treatments or for pre- and post-operative care.[47] However, since private hospitals tend to manage only routine operations and lack a level 3 critical care unit (or intensive therapy unit), unexpected emergencies may lead to the patient being transferred to an NHS hospital.[48]

When the Blair government expanded the role of the private sector slightly within the NHS in England,[49][50] the Scottish government reduced the role of the private sector within public healthcare in Scotland[51] and planned legislation to prevent the possibility of private companies running GP practices in future.[52] Later, however in an attempt to comply with the Scottish Treatment Time Guarantee, a 12-week _target for inpatient or day-case patients waiting for treatment, NHS Lothian spent £11.3 million on private hospital treatment for NHS patients in 2013–14.[53]

Funding and performance of healthcare since devolution

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In January 2010 the Nuffield Trust published a comparative study of NHS performance in England and the devolved administrations since devolution, concluding that while Scotland, Wales and Northern Ireland have had higher levels of funding per capita than England, with the latter having fewer doctors, nurses and managers per head of population, the English NHS is making better use of the resources by delivering relatively higher levels of activity, crude productivity of its staff, and lower waiting times.[54] However, the Nuffield Trust quickly issued a clarifying statement in which they admitted that the figures they used to make comparisons between Scotland and the rest of the United Kingdom were inaccurate due to the figure for medical staff in Scotland being overestimated by 27 per cent.[55]

Using revised figures for medical staffing, Scotland's ranking relative to the other devolved nations on crude productivity for medical staff changes, but there is no change relative to England.[56] The Nuffield Trust study was comprehensively criticised by the BMA which concluded "whilst the paper raises issues which are genuinely worth debating in the context of devolution, these issues do not tell the full story, nor are they unambiguously to the disadvantage of the devolved countries. The emphasis on policies which have been prioritised in England such as maximum waiting times will tend to reflect badly on countries which have prioritised spending increases in other areas including non-health ones."[57]

In April 2014 the Nuffield Trust produced a further comparative report "The four health systems of the UK: How do they compare?" which concluded that despite the widely publicised policy differences there was little sign that any one country was moving ahead of the others consistently across the available indicators of performance. It also complained that there was an increasingly limited set of comparable data on the four health systems of the UK which made comparison difficult.

In February 2016 the Organisation for Economic Co-operation and Development published a review which concluded that performance of the NHS in Wales was little different from that in the rest of the UK. They described performance across the UK as "fairly mediocre" saying that great policies were not being translated into great practices. They suggested that GPs should be more involved in health boards and that resources should be shifted out of hospitals.[58]

See also

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References

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  1. ^ "'Huge contrasts' in devolved NHS". BBC News. 28 August 2008. Retrieved 27 July 2014.
  2. ^ "NHS now four different systems". BBC News. 2 January 2008. Retrieved 27 July 2014.
  3. ^ "Mirror, Mirror 2017: International Comparison Reflects Flaws and Opportunities for Better U.S. Health Care". www.commonwealthfund.org. Retrieved 1 August 2019.
  4. ^ "Mirror, Mirror on the Wall: An International Update on the Comparative Performance of American Health Care | Commonwealth Fund". www.commonwealthfund.org. May 2007. Retrieved 1 August 2019.
  5. ^ "Mirror, Mirror on the Wall: How the Performance of the U.S. Health Care System Compares Internationally, 2010 Update". Commonwealth Fund. Archived from the original on 11 April 2020. Retrieved 16 June 2014.
  6. ^ Davis, Karen; Stremikis, Kristof; Squires, David; Schoen, Cathy (2014). "Mirror, Mirror on the Wall, 2014 Update: How the U.S. Health Care System Compares Internationally". Commonwealth Fund. Commonwealth Fund. doi:10.26099/9q4x-na97.
  7. ^ "Quality of Death Index 2015: Ranking palliative care across the world". The Economist Intelligence Unit. 6 October 2015. Archived from the original on 9 October 2015. Retrieved 8 October 2015; "UK end-of-life care 'best in world'". BBC. 6 October 2015. Retrieved 8 October 2015.
  8. ^ Allemani, Claudia; et al. (2015). "Global surveillance of cancer survival 1995–2009: analysis of individual data for 25 676 887 patients from 279 population-based registries in 67 countries (CONCORD-2))". The Lancet. 385 (9972): 977–1010. doi:10.1016/S0140-6736(14)62038-9. hdl:10447/129931. PMC 4588097. PMID 25467588; "UK cancer survival rates trail 10 years behind other European countries". The Guardian. 24 March 2015. Retrieved 19 October 2015.
  9. ^ "UK cancer death rates after diagnosis drop 10% in ten years". The Guardian. 4 February 2016. Retrieved 4 February 2016; "Cancer death rates fall by almost 10 per cent in 10 years". Cancer Research UK. 4 February 2016. Retrieved 4 February 2016.
  10. ^ "Bowel cancer death rate falling faster in the UK than in most other EU countries". Cancer Research UK. 7 October 2015. Archived from the original on 11 April 2020. Retrieved 31 October 2015; "Cancer survival in England is improving – but still lagging behind similar countries". Cancer Research UK. 5 August 2015. Retrieved 31 October 2015; "How to improve cancer survival" (PDF). The King's Fund. June 2011. Archived from the original (PDF) on 22 December 2015. Retrieved 19 October 2015; "Cancer mortality trends: 1992–2020" (PDF). Macmillan. May 2013. Retrieved 19 October 2015; "Improving Outcomes: A Strategy for Cancer" (PDF). Department of Health, Public Health England. December 2014. Retrieved 31 October 2015.; "Cancer Survival in England: Adults Diagnosed 2008 to 2012, followed up to 2013". Office for National Statistics. Retrieved 19 October 2015
  11. ^ "Outcomes in EHCI 2015" (PDF). Health Consumer Powerhouse. 26 January 2016. Archived from the original (PDF) on 6 June 2017. Retrieved 27 January 2016.
  12. ^ Cylus, Jonathan; Nolte, Ellen; Figueras, Josep; McKee, Martin (9 February 2016). "What, if anything, does the EuroHealth Consumer Index actually tell us?". BMJ. Retrieved 10 February 2016.
  13. ^ "Swindells: They aren't 'your' patients". Health Service Journal. 24 September 2019. Retrieved 19 November 2019.
  14. ^ "Healthcare expenditure, UK Health Accounts provisional estimates - Office for National Statistics". www.ons.gov.uk. Retrieved 11 October 2021.
  15. ^ OECD, "Health Expenditure". Accessed 10 February 2016.
  16. ^ "How does UK healthcare spending compare with other countries?". Office of National Statistics. 29 August 2019. Retrieved 5 October 2019.
  17. ^ "Wiltshire Air Ambulance". Wiltshire Air Ambulance. Archived from the original on 12 May 2010. Retrieved 28 April 2011.
  18. ^ "Air Ambulance Association". Air Ambulance Association. Retrieved 28 April 2011.
  19. ^ "RAF flight 'saved couple's baby'". BBC News. 21 November 2006. Retrieved 28 April 2011.
  20. ^ Triggle, Nick (3 June 2007). "Call for dentists' NHS-work quota". BBC News. London. Retrieved 5 January 2010.
  21. ^ "International Health Care System Profiles: England". www.commonwealthfund.org. Commonwealth Fund. 5 June 2020. Retrieved 29 October 2023.
  22. ^ a b Guy, Mary (8 May 2019). "Between 'going private' and 'NHS privatisation': patient choice, competition reforms and the relationship between the NHS and private healthcare in England". Legal Studies. 39 (3): 479–498. doi:10.1017/lst.2018.55. ISSN 0261-3875. Retrieved 29 October 2023.
  23. ^ "History of the NHS in pictures". Socialist Health Association. December 2012. Retrieved 6 September 2021.
  24. ^ Fiona Callingham, Fiona (18 May 2021). "Plans for new four-storey car park at QA Hospital in Portsmouth to be changed". The News (Portsmouth). Retrieved 3 August 2021.
  25. ^ Spring Budget 2017. London: HM Treasury. 8 March 2017. Retrieved 11 August 2017. The £122.5bn budget consists of £116.4bn Departmental Expenditure Limit (operating budget) and £6.1bn capital budget.
  26. ^ Hospital warns of 'Third World' NHS BBC News, 30 August 2000
  27. ^ "NHS Wales – About us: History and context: 1960s". NHS Wales. 23 October 2006. Retrieved 16 June 2014.
  28. ^ "Emergency and urgent care services: NHS 111". NHS England. 1 April 2013. Retrieved 26 July 2014.
  29. ^ "About Us". NHS 24. Archived from the original on 26 June 2014. Retrieved 26 July 2014.
  30. ^ "About us: What is NHS Direct Wales". NHS Direct Wales. Retrieved 26 July 2014.
  31. ^ "111 service now available across Wales". GOV.WALES. 4 April 2022. Retrieved 12 April 2022.
  32. ^ Call for quicker drug decisions BBC News, 10 January 2008
  33. ^ "NAO report (HC 129-I 2007–08): Report on the NHS Summarised Accounts 2006–07: Achieving Financial Balance". Nao.org.uk. 11 December 2007. Archived from the original (PDF) on 24 May 2022. Retrieved 28 April 2011.
  34. ^ "NHS Injury Cost Recovery scheme". NHS. Retrieved 10 March 2008.
  35. ^ "NHS car parking charges abolished". BBC News. 2 September 2008.
  36. ^ "All hospital car parking charges in Scotland to be scrapped". BBC News. 24 August 2021.
  37. ^ "Free hospital parking under way". BBC News. 1 April 2008.
  38. ^ "Free hospital parking for thousands of patients, staff and carers". gov.uk. Department of Health and Social Care. 27 December 2019.
  39. ^ "NHS car parking guidance 2022 for NHS trusts and NHS foundation trusts". GOV.UK, Health and social care. 29 March 2022.
  40. ^ "Hospital car parking charges are scrapped". belfastmedia.com. 24 March 2022. Retrieved 14 May 2022.
  41. ^ "Hospital Parking Charges Act (Northern Ireland) 2022, s.1". legislation.gov.uk. Retrieved 14 May 2022.
  42. ^ O'Neill, Phill; Sussex, Jon (18 November 2014). "International Comparison of Medicines Usage: Quantitative Analysis" (PDF). Association of the British Pharmaceutical Industry. Archived from the original (PDF) on 11 November 2015.
  43. ^ a b c "NHS prescription charges". NHS Services. 31 March 2021. Reviewed every 3 years.
  44. ^ BUPA exclusions Archived 31 January 2009 at the Wayback Machine bupa.co.uk, accessed 23 February 2009
  45. ^ "Survey of the general public's views on NHS system reform in England" (PDF). BMA. 1 June 2007. Archived from the original (PDF) on 27 February 2008.
  46. ^ Private hospital serving NHS patients http://www.spirehealthcare.com/Washington/NHS-Services-at-Spire-Washington-Hospital/
  47. ^ NHS units offering services to paying private patients http://www.privatehealth.co.uk/private-hospitals/nhs/
  48. ^ Johnson, Jo (26 August 2012). "What if Surgery Goes Wrong?". privatehealthadvice.co.uk. Private Health Advice. Retrieved 29 October 2023.
  49. ^ Private firm to carry out surgery BBC News, 5 August 2007
  50. ^ "£64bn NHS privatisation plan revealed". guardian.co.uk. The Guardian. 30 June 2006. Retrieved 29 October 2023.
  51. ^ Plans to end private cash for NHS BBC News, 21 June 2007
  52. ^ Sturgeon to end privatisation of GP practices Archived 12 October 2008 at the Wayback Machine Sunday Herald, 8 June 2008
  53. ^ "NHS Lothian's £1m a month private hospital bill". Edinburgh News. 21 September 2015. Retrieved 3 October 2015.
  54. ^ Sheelah Connolly; Gwyn Bevan; Nicholas Mays (20 January 2010). "Funding and Performance of Healthcare Systems in the Four Countries of the UK Before and After Devolution". Nuffield Trust. Retrieved 26 January 2010.
  55. ^ Nuffield Trust statement scotland.gov.uk, 20 January 2010
  56. ^ "Nuffield Trust statement on NHS Scotland figures included in study of UK health performance". Nuffield Trust. Retrieved 27 January 2010.
  57. ^ "Briefing Note, March 2010" (PDF). British Medical Association. Archived from the original (PDF) on 4 June 2012. Retrieved 20 March 2010.
  58. ^ "NHS Wales 'no better or worse' than rest of UK, says OECD". BBC News. 12 February 2016. Retrieved 12 February 2016.

Further reading

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  • Allbutt, Clifford (1908). Hospitals, Medical Science, and Public Health . Manchester: Sherratt and Hughes. (historical perspective)
  • Alcock, P. (2003) Social Policy in Britain. Houndmills: McMillan
  • Allsop, J. (1995) Health Policy and the NHS towards 2000. London: Longman
  • Ham, C. (2004) Health Policy in Britain. London: McMillan
  • Klein, R. (2006) The New Politics of the NHS: from creation to reinvention. Oxford: Radcliff Publishing
  • Thane, P. (1982) The Foundations of the Welfare State. Harlow: Longman.
  • Webster, C. (2002) The National Health Service: a political history. Oxford: Oxford University Press.
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