In the United Kingdom, the healthcare system is divided into two categories: the famous National Health Service (NHS), funded by the government and providing free healthcare to all UK residents, and the private sector. Within the UK, the NHS operates in four separate national systems: England, Northern Ireland, Wales and Scotland, each with its own policies and organizational structures.
National Health Service (NHS) in the United Kingdom
The National Health Service was created in 1948 in the United Kingdom. The belief at the heart of the NHS is the principle that good healthcare should be available to all, regardless of their ability to pay: all UK residents, including expats, are entitled to free healthcare through the NHS. The NHS diagnoses and treats diseases, but also plays a major role in preventing ill health, and improving the physical and mental health of the population. In 2007, 2010, 2014 and 2017, the NHS was ranked the best healthcare system in the world by the Commonwealth Fund.
The values and responsibilities of the NHS are established by the NHS Constitution. Beyond that, medical treatments in the UK are regulated by dedicated institutions. In England and Wales, the National Institute for Health and Clinical Excellence (NICE) sets guidelines for all medical practitioners as to how various conditions should be treated and whether or not a particular treatment should be funded. In Scotland, these guidelines are set by the Scottish Medicines Consortium.
The average number of hospital beds offered by the NHS in the United Kingdom was 2.5 beds for 1000 people in 2018. This number has decreased from 4.1 per 1000 people in 2000, which is an overall trend for most high-income countries. England has a lower number of hospital beds per 1000 people than Northern Ireland, Wales and Scotland. All together, the services provided by the NHS deal with more than 1 million patients every 36 hours.
The NHS system
To benefit from the NHS, UK residents have to register with a General Practitioner (GP), who is in charge of providing primary healthcare, and make referrals to further services when necessary. Beyond UK residents, other nationals visiting the UK can access emergency treatment and family planning services free of charge, but they will need to pay for additional health insurance to access other services. In England, there are over 36 000 GPs, operating in over 8300 practices.
Hospitals provide secondary care services in the UK, and involve a referral from a GP for most medical treatments other than emergency treatment. NHS hospitals, run by NHS Trusts, are free, while independent hospitals run by private companies or charities charge patients. Additionally, around 80 NHS walk-in centers, open 365 days a year and outside office hours, provide healthcare to patients in the UK - mainly to deal with minor injuries and illnesses.
The NHS also provides ambulance services for all emergencies, through organizations such as the British Red Cross, St Andrews Ambulance Association, St John Ambulance, and country or regional air ambulance trusts for transport services by air.
Finally, the NHS offers Community Health Service to provide preventive health services, act as a liaison with local governments over matters of public health, and cooperate with social service departments.
Through the NHS, most medical services are provided free of charge, however some services involve some charges, including ophthalmic treatment, dental treatment (ranging from £22.70 to £269.30 for Band 3 treatment) and prescriptions (£9 per item).
NHS governance and costs
The National Health Service (NHS) operates under a framework where each government establishes legally binding objectives and budgets through an annual mandate. As an example, the NHS Long Term Plan, introduced in 2019, outlines the strategic direction for NHS England until 2029. At the local level, 5-year plans are implemented to achieve the goals of the Long Term Plan.
Services provided by the NHS are mostly publicly funded through direct taxation. However, in recent years, many private companies and charities have become more involved in running services. Nowadays, it is more similar to a public-private partnership.
in 2017, the UK's total public healthcare expenditure reached £197.4 billion, equivalent to 9.6% of the annual GDP. This percentage reached 10.2% of the UK’s GDP in 2019. This positioned the UK as the 10th highest healthcare spender in Europe in terms of GDP percentage. Within the UK, the NHS constitutes the largest area of public expenditure, with hospitals accounting for over two-thirds of the NHS budget.
Private medicine in the United Kingdom
Patients can choose private medicine, paying out-of-pockets or through private insurance plans. Traditionally, private healthcare was not well developed in all regions of the UK, and most patients still relied on the NHS. However, more recently, private medicine is increasingly perceived as a way of having quicker access to specialists, with better facilities and shorter waiting times for appointments. Therefore, the market for private medicine is quickly expanding in the UK.
A current NHS crisis?
The current state of the NHS is cause for concern: falling wages, budget cuts, and staff shortages have created a crisis. Patients are experiencing significant delays in receiving non-urgent medical treatment. As of the end of 2023, 7.3 million patients in England were on waiting lists, with approximately 400,000 of those waiting for over a year.
As a result, the demand for private health care is increasing, which is a shift for the UK, previously known as having one of the world’s best healthcare systems. According to David Furness, policy director at the Independent Healthcare Providers Network, an industry body for private healthcare companies: “people are going private, many for the first time, and the key factor driving that is the challenge in accessing NHS care”.
In 2022, the number of patients relying on private hospital care increased 34% compared to 2019. Significantly, the American group HCA Healthcare has now over 30 facilities in London and Manchester, and will be opening a £100 million private hospital in Birmingham. Many other private actors are also opening more and more private facilities in the UK.
Sources:
Anderson M, Pitchforth E, Edwards N, Alderwick H, McGuire A, Mossialos E, Hernández- Quevedo C (2022), The United Kingdom: Health System Summary, 2022. WHO/European Observatory on Health Systems and Policies, Brussels
NHS. Guide to the Healthcare System in England, Including the Statement of NHS Accountability. May 2013
https://www.cnn.com/2023/02/06/business/nhs-strikes-private-healthcare-uk/index.html
https://www.britannica.com/place/United-Kingdom/Higher-education
https://www.nytimes.com/2023/12/07/opinion/nhs-britain-universal-health-care.html