Analysis published by the Health Foundation's REAL Centre has found that over the decade before the pandemic, the UK spent around a fifth (18%) less on average than the EU14 on day-to-day health care costs (per person living in the country).
The UK’s total health care budget was £187bn per year, on average, between 2010 and 2019 (unadjusted for inflation overtime). But if UK spending per person had matched the average across the EU14 over the pre-pandemic decade, then total UK spending per year would have been £227bn – a difference of £40bn more on average every year.
The analysis also looked at comparisons with the UK’s closest European neighbours. In every year between 2010 and 2019 the UK would have had to spend an additional £73bn more to match Germany’s spending per person (39% extra). When compared to France the UK would have to spend an additional £40bn extra every year (21% extra). Just four countries (Spain, Portugal, Italy and Greece) in the EU14 spent less per person than the UK over the same period.
The charity also looked at capital health spending on vital buildings, technology and equipment comparative to European neighbours. Comparing capital spending with the EU14 countries for which data are available it found that between 2010 and 2019, cumulative UK investment in capital health infrastructure would have needed an additional £33bn to match the total EU average invested over that period (around 55% higher than actual investment).
The authors argue that the findings set the context for the challenges the UK faced during the pandemic with the UK having lower-than-average resources for its health care system. The UK has fewer practising physicians per person and fewer hospital beds per person compared to the EU14. This contributed to a healthcare system that was already stretched before the pandemic with the proportion of people in the UK self-reported as needing treatment but could not get it was one of the highest in Europe.
The findings also show that, in response to Covid-19, the UK had the highest increase in health spending in 2020 relative to 2019 amongst European countries. In the UK, spending increased by 14% compared to the EU14 average of just below 6%.
Anita Charlesworth, Director of Research and the REAL Centre at the Health Foundation, said:
‘As the government wrestles with how to put the public finances on a sustainable footing, health spending is under the spotlight as it accounts for almost a third of overall public service spending. With 7 million people on NHS waiting lists, staffing shortages, ambulance response times falling, over-crowded A&E departments and patients struggling to access general practice and mental health, the NHS is arguing it needs more, not less, funding. The NHS’s own analysis suggests there is a gap of £6–7bn between current funding and the immediate pressures on the service.
‘Over the last decade, health spending in the UK has been consistently lower than in other comparable EU countries and it’s the cumulative impact of that lower spending that is apparent in the challenges facing the NHS today. The NHS has less capacity, making recovering services after Covid a much steeper challenge. It’s important that health services are as efficient as possible, but in the end access to high quality services of a similar standard to our European neighbours can’t be sustained if we consistently spend less. . Either we are going to have lower quality health care relative to other countries or we spend more. Balancing the public finances will mean tough choices, with potentially harsh consequences for many years to come.’