The NHS turns 75!
A stat a day keeps the Doctor away
This week marked the 75th anniversary of Britain’s National Health Service, or NHS, an institution that the British hold in higher regard than almost everything else in life
The organisation formally started in 1948, having been set up by the National Health Service Act 1946, becoming the world’s first healthcare system to provide healthcare for all citizens, not based on some form of insurance or payment
However, the NHS in 1948 was quite different to the healthcare system we have now…
Back in 1948, 68,000 doctors and 11,700 nurses were all brought under one single entity. Now there are 3x as many doctors and 10x more nurses, while the NHS’s budget is roughly 12 times higher than when it was first founded (this is despite the number of hospital beds falling 4x from 480,000 to 120,000 in 2018)
So for today, we look at what makes the NHS so great (or, as you’ll see, not so great)
How big has the NHS become?
The NHS covers almost all aspects of British healthcare, from emergency care to supporting people in the community (and many other forms of care in between)
To do this, the NHS has 217 separate NHS Trusts¹ which employs the majority of the NHS’s workforce of 1.9 million (this makes the NHS the largest employer in Europe) and maintains 140,000 hospital beds
On top of this, the NHS provides funding for GPs practices, dentists, optometrists and plenty of prescriptions for the country’s sick, among plenty of other forms of care
And the shear size of the NHS is not surprising considering the number of patients it supports. On an average day, the NHS will have 1.6 million patient interactions! Yes, every day!
But this also puts a big strain on the NHS. In total, the treatment waiting list has reached 7.2 million¹
What are some of the other challenges facing the NHS?
Wait times in other places are also getting longer
Back in 2011, roughly 5% of patients would wait longer than 4 hours to be seen in Accident & Emergency (A&E). By December 2022, this had risen above 50% of patients for the first time before coming down slightly in 2023. While the pandemic has impacted this to some extent, it was already rising steadily before the pandemic, reaching 30% at the end of 2019
At the very least, though, before the pandemic very few patients would have to wait as long as 12 hours before being admitted (the highest was a few thousand at Christmas each year). But this number recently peaked to c. 55,000 a month towards the end of 2022!
Ambulance response times have not been much better:
- Before the pandemic, ambulances would typically respond to Life Threatening calls (Category 1) in 7 minutes, in line with targets. This was closer to 9 minutes, on average, in 2022
- For Non-Life Threatening Emergency calls (Category 2), the target of 18 minutes has consistently been missed, although only just at 20 minutes before 2020. However, in 2022, responses to these callouts fluctuated between 40–60 minutes
- Category 3 and 4 calls, have faired just as badly. Responses to both of these were roughly 3 x slower than the targets set c. 7 and 9 hours, respectively
The same can be said for how long it takes to be treated:
- The number of Hospital Treatments have almost completely recovered since the pandemic, but still remain 8% below January 2020 levels for admitted treatments and 1% below for treatments administered via outpatient clinics (non-admitted)
- The target of seeing 93% of people with a Cancer Referral within 2 weeks was often met before 2018, but more recently has hovered around 75-80%
- You then need to wait even long for your Cancer Treatment. Approximately 60% of people wait more than 6 weeks to start their course of treatment vs. the 85% target
- Even receiving a Diagnostic Test used to be straight-forward, with the target of providing these within 6 weeks almost always met between 2008 and 2020. Now 30% of patients have to wait longer before even their tests are done
These delays all needs to be put in the context of a series of strikes, which have plagued the NHS over the last couple of years
For example, Ambulance response times went from 60 to 90 minutes for Emergency (Category 2) calls during the January 2023 strikes
In all, Nurses, Junior Doctors, Physios and Ambulance workers have all held their own strikes. Recent estimates suggest that these strikes have resulted in a combined 650,000 appointments to be cancelled (only making growing waiting lists worse)
And these, aren’t due to end soon. Junior Doctors are starting their next wave of strikes this month and Consultants (more senior doctors) are due to only provide “Christmas-level care” on 20-21st July
Some could say this is understandable considering the conditions NHS staff have to work under. A survey from Unison (one of the unions representing NHS staff) showed:
- Almost two-in-three NHS staff work overtime, yet 70% are not paid for the additional time they work
- 70% don’t feel like they’re valued by their employers
- 83% have had to work more for less money
- 77% are not satisfied with their pay
On the topic of pay, pretty much all NHS types of employees have had their pay decrease in real terms. For some, like Ambulance staff, it has fallen by c. 5% since 2010. But for others, like Midwives, Junior Doctors and Consultants, this fall is as high as 15%
How does this compare to other countries?
A lot of comparisons are made to the American healthcare system, but with a very different and inequitable funding model - this is not necessarily a fair (or helpful) comparison
Instead, let’s compare to some of Britain’s closest European neighbours
While the UK Government spends a lot on healthcare, this is nothing unusual compared to other western countries
In 2019 (pre-pandemic), the UK spent 9.9% of its GDP on Healthcare, just below an average of other OECD countries. Germany, France, Belgium, Sweden, Japan, Australia and a number of other countries all spent between 10–12% of GDP, with the United States being the only country spending substantially more at 16.7%
Italy (8.7%), Greece (8.2%) and Ireland (6.7%) were the only countries to spend substantially less than the UK as a proportion of the size of their economy
So what impact do these different levels of funding have on these healthcare systems?
- Not only does Britain spend less than others, but it also has fewer doctors (3 per 1,000 people vs. 3.7 on average) and nurses (8 per 1,000 vs. 11 on average)
- The UK has 2.5 hospital beds for every 1,000 people vs. 3.2 beds on average in other countries. Germany has 3x more (at 7.9 beds per 1,000) while Sweden is the only major western country with fewer (2.0 beds)
- And the UK relies on foreign trained staff more than most other countries. 30% of doctors in the UK were trained abroad, along with 15% of nurses. Only Australia and New Zealand have a higher proportion of foreign trained medical professionals (NZ has the highest with 43% and 27%, respectively)
Finally, the UK’s fall in procedures between 2019 and 2020 was very much an outlier vs. other countries:
- Hip replacements in Britain dropped by 46% between these years, but didn’t fall by more than 20% in any other country
- Knee replacements dropped by 68% in the UK, but by no more than 35% in any other western country
- Cataract surgery dropped by 47%, while the average for other western countries was c. 20% with no other country experiencing a fall of more than 37%
But one thing the British will not claim is that the NHS is expensive. Only 9% of respondents in 2022 said that the “cost of accessing treatment” was an issue in their own personal experience, compared to c. 20% for most other western countries and 55% in the United States
Note¹: this is the most recent count of NHS trusts available, but some are in the process of merging which means the true number may be slightly different
Note²: that’s 7.2 million treatments being waited for, most likely by less than 7.2 million people
Check out more GoodStats about Britain:
- We’re going Underground! Mind the Stat!
- Three Strikes and you’re out… Or how about 1.6 million?
- The BBC — a timeless British institution… but can it get back with the times?
