Analysis: U.K.’s National Health Service Continues to Deteriorate

Published February 19, 2015

The United Kingdom’s single-payer health care system provides an important model, and cautionary tale, for those who advocate such a system in United States.

Over the Christmas holidays, the waits for emergency care in the British National Health Service (NHS) reached what the nation’s press called “crisis” levels. Compared to 2013, twice as many ambulances had more than 30-minute waits outside of overcrowded emergency rooms.

According to the Independent newspaper, in December 2014 and January 2015, more than 7,000 surgeries were canceled because of a lack of beds. NHS waiting times for cancer treatment are the highest in six years, and the Daily Mail reported 12.5 percent of patients, more than 39,400 people, waited more than 18 weeks for hospital treatment in November 2014.

In 2015, government managers reacted to longstanding NHS budget problems by again refusing hospitals’ requests to increase reimbursements to meet increases in demand for services. On January 29, hospitals providing 75 percent of all NHS care refused to approve their annual NHS budget offers. The rejection is unprecedented. The hospitals say additional budget cuts would mean they can no longer “guarantee safe and effective care.” Eighty percent of English hospitals are said to be running a deficit.

Initial explanations for the latest deterioration in NHS’ performance focused on hospital bed shortages supposedly caused by a surge in unexpected admissions through overloaded emergency departments. But U.S. hospitals have handled a similar surge without a widespread crisis.

U.K., U.S. Beds Comparable

The Kings Fund, a UK research and advocacy organization focused on health care, reports total annual visits to NHS emergency facilities rose from 16.5 million to 21.7 million over the past decade. Most of the growth was in the urgent care units introduced from 2003–04. Visits to emergency departments equipped to handle major health crises rose by 1.6 million, about 12 percent.

The U.S. health care system, however, handled a 23 percent increase in emergency department visits between 1997 and 2007 without triggering a nationwide hospital bed shortage. In 2007, U.S. emergency rooms fielded 116.8 million visits. The nation’s 9,000 mostly private urgent care centers handled another 147 million patient visits.

There is no obvious difference between the United States and United Kingdom in the per capita supply of hospital beds. In 2013, the Kaiser Family Foundation reported the United States and Britain both had 30 hospital beds per 10,000 people. However, the United States has more nurses per 10,000 people, 98.2 compared to Britain’s 94.7, and more physicians, 27.7 in the United States compared to 24.2 in the United Kingdom.

Centralized Decision-making at Fault

The United States and Britain are also face another similarity: Officials responsible for entities experiencing care and capacity problems—the NHS in Britain and the Veterans Administration and Medicaid in the United States—blame population structure, budget cuts, lack of primary care, and too little capacity for their problems.

In various interviews conducted by the Independent, British officials blamed current problems on an aging population, staff shortages, inadequate spending, and a lack of spare capacity capable of handling spikes in demand. British politicians blamed budget cuts for home care services, claimed a lack of primary care was the problem, and cited closing emergency departments as the cause of stress in remaining ones.

A significant problem is many officials do not understand centrally run systems inevitably create these problems. The U.S. private health care sector, which handled a huge increase in emergency room usage without hospital shortages, is more decentralized and has developed a variety of alternatives to hospital-based care. Decentralized decision-making and pricing stimulate people to find new ways to treat patients and encourage hospitals to be more productive and responsive to changing patient needs.

Professor Sir Bruce Keough, NHS England’s National Medical Director, seems to understand the difference. In a January 20, 2015, interview with the Guardian newspaper, he reportedly said without “massive” changes in the way the NHS treats patients, including less reliance on hospitals, the system could become “unaffordable.”

“[T]he model of delivery and service that we have at the moment is not fit for the future,” said Keough.

Linda Gorman ([email protected]) is director of the Health Care Policy Center at the Independence Institute.