“Since 2008, the focus shifted onto achieving efficiency savings in the health system by increasing productivity. A funding gap has emerged between meeting the increasing health needs of the population and the limited resources that have been made available to achieve this. Some of the increasing demand is the result of natural demographic changes, such as the large cohort of ‘baby boomers’ ageing, but technological and medical advances and increased patient expectations have also played a role. Reduced access to long-term care has also added pressure on hospital services. Demographic changes are projected to increase spending on long-term care from 1.5 % of GDP in 2020 to 2.7 % in 2070, while public spending on health care would increase from 8.1 % GDP in 2020 to 9.4 % in 2070, which contributes to the identification of fiscal sustainability risks in the medium and in the long-term (European Commission, 2019b).

“In 2017, analysis of projected demand and historical funding growth rates suggested that at least GBP 4 billion more for the NHS was needed in 2018/19 to stop patient care deteriorating. Spending was projected to fall by 0.3 % in 2018/19 without considerable investment. The government announced an increase in NHS spending (March 2018) and published the Long Term Plan for the NHS in England (January 2019). It sets out how an increase of GBP 33.9 billion by 2023 (a 3.4 % annual increase in real terms) should be spent. Most of the new spending is for clinical care, while new spending on capital, public health and staff training are not included. This injection of funds allowed hospitals to reduce or overcome their deficits, but access to the new funds was conditional on providers making further efficiency gains, and it is not clear how this can be achieved. Providers are still overspending because of increased demand – particularly in urgent and emergency care.”

“A key driver of the overspending against budgets is the increase in temporary staffing. Temporary staff are used to manage workload in the face of increased unplanned demands, high levels of vacancies, sickness/absence and staff turnover. Workforce shortages are due to the insufficient supply of domestic health workers as well as doctors and nurses leaving the workforce early. Migration policies which hamper international recruitment are also cause for concern. A drop in international recruitment has the potential to cause great pressure in social care due to substantial staffing shortages (Health Foundation, King’s Fund & Nuffield Trust, 2018).”

“While care has never been delivered the same way across the United Kingdom, the health care system is now perhaps more divided than ever, as health policy decisions are made at the level of individual nations. Nevertheless, despite this diversity in the way the systems are organized, some aspects of the regulatory framework continue to operate on a United Kingdom-wide basis in line with European standards.

“United Kingdom Government
“The United Kingdom Treasury (i.e. ministry of finance) determines the budget for health and other social services in England, and Scotland, Wales and Northern Ireland receive a proportionally similar budget according to the Barnett formula (discussed in Section 3.3.3), based on the Cabinet’s decisions for England. The United Kingdom Department of Health (i.e. ministry of health) is responsible for the health system in England, some United Kingdom-wide regulatory matters and international collaboration where the Department of Health represents not just England, but the whole United Kingdom in dealings with the EU or UN agencies, for example. The Department of Health regularly meets with counterparts in the devolved administrations in Scotland, Wales and Northern Ireland.”

Source: Cylus J, Richardson E, Findley L, Longley M, O’Neill C, Steel D. United Kingdom: Health system review. Health Systems in Transition, 2015; 17(5): 1–125.

Health Systems Facts is a project of the Real Reporting Foundation. We provide reliable statistics and other data from authoritative sources regarding health systems in the US and sixteen other nations.

Page last updated Sept. 22, 2022 by Doug McVay, Editor.