Using WHO, US Bureau of Statistics and World Bank data, Britain鈥檚 economic input into healthcare 鈥� its GDP Expenditure on Health (GDPEH) 鈥� and compared it to 20 other Western countries, to show how effective and efficient the NHS really is.
Successive UK governments have waxed lyrical about the importance of the NHS. But they haven鈥檛 put their money where their mouths are. Britain actually spends relatively little on health, suggesting it is of a lower priority than most governments suggest. In 2013, the UK鈥檚 GDPEH was 9.1%, placing it equal 17th out of the other 21 Western countries. Western European averaged 10.3%, Germany 11.3%, France 11.6% and the US 17.1%. This means that for every 拢100 the UK spent on healthcare, the financially prudent Germans spent 拢124.
The UK鈥檚 chronic underfunding of health becomes even more pronounced over time. Over the last 30 years, Britain鈥檚 average GDPEH is just 6.9%, the lowest of all the Western nations we compared it to. France and Germany, by comparison, spent an average of 9.4%, or 拢136 for every 拢100 spent by the UK.
While every country we monitored increased their GDP expenditure on health over time, Britain鈥檚 GDPEH fell in the years 1984, 1985 and 1987 under Thatcher; in 1984 and 1997 under John Major鈥檚 premiership; and in 2011 and 2013, under the coalition government of David Cameron, dropping from its highest level of 9.4% in 2010 down to 9.1% in 2013.
As people live longer, every Western country faces growing demands on its health services. Yet Britain鈥檚 funding of healthcare continues to be below the Western European average.
Value for money?
So what has happened? Secretary of State for Health Jeremy Hunt鈥檚 was accompanied by a proportional cut in funding. The plug has been pulled on bursaries for , and the government has complained that the NHS spends too much on . And yet, as the figures above show, compared to other nations, Britain already gets the NHS on the comparative cheap.
But what about clinical outcomes? Do Britons suffer as a result? We hear so many scare stories in some mainstream media, not least of 鈥渦necessary鈥� deaths. Yet over the past 20 years, that the UK has enjoyed the second biggest reduction among the 21 nations of total adult deaths in those aged 55-74, down 48%. This compares to 36% in the US and significantly less than 17 other countries.
Britain also had the , down 28% and significantly better than 14 countries over the period. Indeed, compare these numbers with its relatively low GDPEH spend, and the UK鈥檚 health system is the second most cost-effective in the world.
But not all is well with the NHS. For example, while every nation reduced its child mortality (those aged up to four) between 1990-2013, that the UK鈥檚 rate fell by 42%, a decent drop but a smaller reduction than that seen among adults. also had significantly bigger reductions in child mortality than Britain. If the UK had seen the same reduction over the period as Portugal 鈥� which used to have the highest rate in the West but has since seen dramatic improvements 鈥� on average in this century there would have been 1,042 fewer grieving parents every year.
But is this the fault of the NHS? Not really. Britain also ranks among Western nations. So along with having one of the lowest funded health systems, British children can also be considered comparatively 鈥渄isadvantaged鈥�, with all the health problems that can entail.
Hunt often quotes the into Mid Staffs but tends to ignore the paragraphs related to resources, that there was 鈥渁 mismatch between the resources 鈥� and needs of the services 鈥� without protest or warning 鈥� they failed 鈥� because of the 鈥� the system around them鈥�.
The NHS can only be judged by comparing it with other countries. It achieves proportionately more with relatively less and for that it should be applauded. But as more is demanded of it, it will fail. Britain as a whole needs to appreciate that it gets the NHS on the comparative cheap 鈥� and demand that the government at least matches the spending of the other Western nations, or risk losing it forever.
, Professor of Psychiatric Social Work,
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