The NHS has always had problems compared to the rest of the developed world - and its allowed them to get worse

January 10, 2023

There is a chart that's been doing the rounds in recent weeks which seems to tell a stark, if not shocking, story about Britain's healthcare system.

It shows the amount various countries invest in their health systems (capital spending, as economists call it). What you see, if you colour in the area covered by these countries - which include Austria, Germany, France and the US - is a gradually rising trend.

You see that countries have been gradually increasing the amount they're spending on hospitals, on beds, on equipment and all the other things that constitute long-term health investment.

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Now look at the UK.

By stark contrast, its line rises in the middle of the pack until around 2010, at which point the line falls precipitously. By the end of the chart it is well shy of the area covered by the rest of those countries.

The lesson is pretty clear: the level of underinvestment in Britain is a significant outlier compared with the rest of the developed world.

But as with much about the healthcare system, this story isn't quite as simple as that.

For if you add a few other countries onto the chart - places like Spain and Japan whose healthcare systems are not all that different to the UK, and for that matter most of continental Europe, all of a sudden things look somewhat different.

Now, the UK line, while certainly having dropped from the middle of the table, is no longer an outlier.

It's a helpful reminder that while there is no doubting the struggles faced by Britain's health system at present, the story is invariably far more complicated than is sometimes portrayed.

Actually, the number of GP treatments and first cancer appointments is up sharply since 2019 (not necessarily a sign of good news, but a sign that some parts of the system are successfully increasing their output).

However, these days, signs of success are outnumbered by signs of strain.

Emergency admissions, elective admissions, procedures from waiting lists, outpatient appointments - all have fallen sharply since before the pandemic.

The share of people waiting more than two weeks to see a cancer consultant has risen from barely 5% a few years ago to more than 25% in recent months.

The striking thing is that this has all happened despite quite a sharp increase in staff numbers.

There are significantly more junior doctors, senior managers, clinical support staff, consultants and nurses than there were before the pandemic.

Yet despite there being more doctors and nurses, the system is struggling to satisfy demand.

In part, this is because demand is unusually high at the moment. COVID cases are rising, as are other winter illnesses.

Waiting lists have been mounting ever since the pandemic and are unlikely to begin falling for some time.

For all sorts of reasons, the country is, to put it bluntly, sicker than usual.

In part it is because of something else: Britain is struggling to free up hospital beds for incoming patients.

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The proportion of hospital beds which are occupied for more than seven days is significantly higher this winter than in any of the past half decade.

This means that even with all the doctors and nurses we have at present, there is simply no capacity to treat patients.

But in part it comes back to that chart we began with.

The UK may not be a complete outlier when it comes to investment in health, but that doesn't mean it has invested enough.

The problem is that this country always had low numbers of hospital beds compared with its population. It always had low numbers of MRI machines and astoundingly low numbers of CT scanners compared with the rest of the developed world.

And instead of rectifying these shortcomings in recent years, it has allowed them to worsen.

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