The value of health care capital provides an estimate of the resources available to help staff deliver quality services efficiently to patients.

While health care is a service-intensive industry, capital also plays a crucial role in delivering care. A key measure of the capacity of the workforce is the capital to labour ratio. This presents an estimate of the resources available to each worker to deliver health services.

Since 2000, the UK has seen a large increase in the number of health care workers. This is consistent with a growing and ageing population leading to increased health care activity. Despite this increase there are major ongoing issues in the NHS workforce in England, with an estimated 100,000 vacancies in NHS trusts alone as demand for NHS services grows. Similarly, since 2000, most of the other countries analysed also had significant increases in the size of their health workforce.

We can combine the data on capital and the workforce to estimate the value of health care capital per health care worker across these countries (see note 1 below).

More capital per worker is generally viewed to be a positive contributor to productivity as staff can work more efficiently with more and newer facilities and equipment at their disposal. It influences the productivity of staff and contributes to both the total quantity and quality of health care that staff can deliver.

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The falling value of health care capital combined with an increase in health care workers means that capital per worker in the UK has fallen by 35% since 2000, a far greater fall than any other country. Of the countries analysed, most have increasing trends in capital per worker. As noted earlier, the health care workforce data is somewhat crude as it does not differentiate by type of worker. Some of this could be explained by differences in the composition of workforces between countries, for example more doctors and fewer support staff.

There were three periods with different trends in the UK. From 2000 to 2005, the UK had declining health care capital per health care worker, then from 2005 to 2010 the ratio stayed broadly flat. Since 2010 there has been another significant decline in capital per worker which is consistent with the UK’s relatively low spending on capital over this period (while the workforce continued to increase).

Using the broader definition of ‘health and social work’, the trends in capital per worker were similar – a large decline in capital per worker in the UK of 30%. The value of capital in health and social work increased over this period, though at a slower rate than the other countries.

Value of health care capital per health care worker

In the next chart, we examine the same data but in actual values rather than an index. It shows that in 2000, the UK was about average in terms of the value of health care capital per health care worker.

Since then, it has fallen to near the bottom of the ranking (together with France but higher than Greece), to just above half the average value of the countries analysed. It would take a nearly doubling of the value of capital to bring the UK up to the average value of health care capital per worker in these countries and over 50% more to bring capital per worker values back to their 2000 levels.

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Machinery and equipment

The chart below shows the same ratio as the previous chart, but only using the value of machinery and equipment. The UK has had the lowest value in every year since 2006. Since 2006, other countries with low values are increasing while the UK has a declining trend. 

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The data also shows that countries such as Austria and Denmark have more than five times the value of machinery and equipment per worker compared to the UK. However, it does not tell us what type of machinery and equipment it is, nor where it is in the health care system (in primary care or hospitals, for example). This may seem a very large gap, but it is consistent with the international comparisons of specific data we have on medical equipment. For example, Austria and Denmark have more than three to four times the number of CT scanners per capita. There could also be classification differences between countries, where some countries classify certain structures within buildings as machinery and equipment, while others do not.

Next section: Discussion and conclusion

  1. For comparison to capital values, we use the same industry for health care workers in the previous section. This includes all health care workers in the UK, so will include those not substantively employed by the NHS. It also doesn’t reflect the type of health care workers.
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