The NHS has seen wave after wave of change over the past 20 years as each successive government remakes the service to match its own ideology. The Conservative government of the early 1990s introduced market forces through GP Fundholding only to see its policies swept away by New Labour, which combined primary and community care in its 481 Primary Care Trusts (PCTs) and 28 Strategic Health Authorities (SHAs). History seemed to repeat itself in 2012, when the Conservative-Liberal Coalition government further concentrated commissioning power by abolishing PCTs and SHAs and creating 221 Clinical Commissioning Groups (CCGs).
Alongside this structural change, NHS funding has seen significant shifts over the same period. In 1999/2000, the cost of the NHS had already nearly doubled in 10 years to £40.2bn, yet New Labour’s 10-year plan saw a 50 percent real-term increase in its first five years alone, reaching £64.173bn in 2003/04, according to the UK Parliament figures. At present, the 2014/15 budget for the NHS stands at £113.035bn, yet the increase in terms of growth has not been as stable as it may appear. In percentage terms, healthcare expenditure rose from 6.6 percent of GDP in 1997 to 7.8 in 2003 before peaking in 2009 at 9.8 percent – an annual growth rate of 8 per cent. However, since 2010, annual healthcare growth has fallen to 1.6 percent in what the Kings Fund calls “the unprecedented slowdown in the growth of NHS funding in England”.
The general increase in funding from 2003 to 2013 has resulted in an NHS with:
- 37,843 additional doctors (bringing the total to 147,087)
- 23,531 more NHS nurses (making a total of 371,777)
- 13,974 extra qualified allied health professionals and 3,968 more health scientists (the total rising to 154,109).
So, how does the UK and its mighty NHS compare with other countries? In data reported by the NHS Confederation, while the UK spent 9.27 percent of GDP in 2012, the USA chalked up a massive 16.9 percent, France and Germany forked out 11.61 percent and 11.27 percent respectively, while Italy dipped a little below with 9.19 percent. Perhaps reflecting its lower expenditure, the UK has:
- 2.8 physicians per 1,000 people compared to 4 in Germany, 3.9 in Italy, 3.8 in Spain, 3.3 in France, 3.3 in Australia, 2.7 in New Zealand and 2.5 in Canada.
- 2.8 hospital beds per 1,000 people, compared to 8.3 in Germany, 6.3 in France, 3.4 in Italy, 3.0 in Spain and 2.8 in New Zealand.
Health spending, however, does not tell us how good a job the NHS does at delivering healthcare and improving the health of the nation. Looking at international comparisons, the NHS tops the list of healthcare systems according to the Commonwealth Fund, beating Australia, Canada, France, Germany, Netherlands, New Zealand, Norway, Sweden, Switzerland and USA.
Breaking this down, the NHS was rated as the best system for efficiency, effective care, safe care, coordinated care, patient-centred care and cost-related problems, and ranked second for equity (although it fared well in the category of healthy lives, where it came 10th).
Patient feedback data back up these findings; the 2013 Care Quality Commission inpatient satisfaction survey asked 62,400 respondents who had received in-patient care to rate their overall experience and 71 percent scored their overall experiences as 8 or above, while 27% percent rated their overall experience as 10 out of 10. What’s more, 81 percent of respondents reported that they were’always’ treated with respect and dignity while they were in hospital.
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