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NHS 'Strikingly' Short of Doctors and Nurses

The NHS has "strikingly low levels" of doctors, nurses, and other key clinical staff compared with similar countries, according to a think-tank analysis which identified a range of deficiencies in its funding and performance.

UK spending on health was less on average per person than that of comparable countries, according to a report by The King's Fund , published ahead of the 75th anniversary of the founding of the NHS. 

Publication came after the Prime Minister signalled at the weekend that it would be publishing its long-awaited NHS workforce plan this week. In an interview for "Sunday with Laura Kuenssberg" on the BBC, Rishi Sunak said its publication would amount to "one of the most significant announcements in the history of the NHS". 

In their analysis, King's Fund researchers found that the UK health system performed relatively well on some measures of efficiency, such as spending on administration and the rate at which cheaper generic medicines were prescribed. The NHS also offered good protection for people from the "potentially catastrophic costs" of ill health when compared with the health systems of 18 other countries.

The report, How does the NHS compare to the health care systems of other countries? rated the UK's health care against that offered by 13 European countries, plus the US, Canada, Australia, New Zealand, and Japan.

NHS Spending 'Average at Best'

It found that health spending as a share of gross domestic product in the UK was below the average in 2019 but increased to just above average in 2020 during the first year of the COVID-19 pandemic. Based on OECD data, UK health spending was 9.9% of GDP in 2019, 12% in 2020, and 11.9% in 2021. After adjusting for pandemic spending, the UK was "average at best" in the amount it spends on health care, compared with the other countries studied.

However, the UK performed poorly against its peers in capital investment and had "substantially fewer" key physical resources, including hospital beds, computerised tomography, and magnetic resonance imaging scanners, the analysis found.

Workforce Pressures

Workforce pressures were found to be a common concern amongst all the countries in the study. Some countries, such as Canada, Japan, and the US, had fewer physicians per person in the population, whilst other, including Greece, Italy, and Spain, had fewer nurses per person. "But the UK has strikingly low numbers on both of these staffing measures," researchers highlighted. 

The UK was above average for the share of doctors and nurses who were trained in other countries, according to the analysis. The share of doctors in the UK who trained abroad was 30.3% in 2019, surpassed only by Australia, Ireland, and New Zealand – where the share was between 32.5% and 42.6% – but higher than 12 other countries, including the US (25%), Germany (13.1%), and Italy (0.9%).

The UK employed 15.4% of nurses who were foreign trained, with only New Zealand and Australia relying more heavily on staffing from overseas, at 26.6% and 18.1% respectively. By comparison, the figure was 8.9% for Germany, 6.1% for the US, and 1.3% in the Netherlands.

The King's Fund found that waiting times for common procedures, including knee, hip, and cataract operations, were "broadly middle of the pack" before the onset of COVID-19, compared with the basket of similar countries. However, the fall in activity for those procedures during the first year of the pandemic was "dramatically sharper" in the UK than in peer countries.

On many measures of health status and health care outcomes, including cancer survival, the UK performed "substantially less well than its peers" and was "more of a laggard than a leader", researchers warned.

The study found little evidence to suggest that one individual country or model of health care system performed consistently better than another across a range of performance indicators. It concluded that countries offered better health care for their populations predominantly by reforming their existing model of health care rather than by adopting an alternative model.

Muted Birthday Celebrations

Siva Anandaciva, chief analyst at The King's Fund and author of the report, commented that as the NHS approached its 75th birthday, "the much-loved British institution has sadly seen better days".

Mr Anandaciva, a former head of analysis at NHS Providers , said: "While the UK stands out in removing most financial barriers to accessing health care and the NHS is run relatively efficiently, it trails behind its international cousins on some key markers of a good health care system. The pressures of the COVID-19 pandemic on our health service compounded the consequences of more than a decade of squeezed investment in staff, equipment and wider services that keep us well. 

"This leaves the NHS delivering performance that is middling at best and the UK must do much more to reduce the number of people dying early from diseases such as heart disease and cancer." 

Renewed Calls for a Fully Funded Workforce Plan

Commenting on the findings, Sarah Clarke, president of the Royal College of Physicians, said : "We spend less on health than the average, have less equipment and fewer beds and significantly lower numbers of clinicians. Doctors tell us their workload is out of control and that rota gaps are impacting patient care. We know many NHS doctors feel demoralised – it is vital that they feel supported and valued. 

"We need the Government to deliver its workforce plan now, fully funded, before the health service goes from crisis to disaster."

NHS Providers described the findings as "worrying". Its director of policy and strategy, Miriam Deakin, said the report underlined the need "for more investment to improve NHS performance, capital funding to upgrade buildings, and the publication of the Government's long-awaited NHS workforce plan to boost staff numbers."

A spokesperson for the Department of Health and Social Care (DHSC) said the Government would soon be publishing its long-awaited workforce plan "to ensure we have the right numbers of staff, with the right skills to continue cutting waiting lists and delivering high quality services". There were "record numbers of staff working in the NHS with over 53,600 more people compared to a year ago – including over 5400 more doctors and over 12,900 more nurses," the spokesperson added.

The DHSC stressed that the Government had committed up to £14.1 billion to improve services and cut waiting lists, which was one of the top five priorities set out at the start of the year by the Prime Minister.

On a visit to an NHS health screening facility in Nottinghamshire earlier today, Mr Sunak, who was pressed to comment on the King's Fund report, was reported as conceding that there was "work to do" but that he could "fix" outstanding issues. 

The King's Fund analysis was commissioned by the Association of the British Pharmaceutical Industry, but was not involved in its development, research, or creation, the think tank declared.