Britain's Health Service Needs a Cash Transfusion

Where are all the beds?

Photographer: Christopher Furlong/Getty Images

Britain’s impending withdrawal from the European Union has drawn attention away from a different kind of crisis -- the one afflicting its National Health Service. Either the NHS will need a lot more investment, or Britons will have to prepare for a seriously impaired health-care system.

Having to wait for non-emergency treatment is one thing -- the cost, perhaps, of a service that’s free at the point of delivery. Five-hour waits for emergency care, last-minute cancellations of surgeries for lack of beds, and post-operative patients parked in hospital corridors are something else.  

The NHS is buckling under the weight of an aging population, rising costs and chronic underinvestment. The U.K. spends 8.5 percent of gross domestic product on health care, much less than France and Germany (10.9 and 11 percent) to say nothing of the U.S. (over 16 percent). Spending is planned  to rise by 4.2 billion pounds by 2020, but that will barely dent the problem.

The squeeze is felt in every part of the service, because cuts in one part of the system affect services in others. For instance, reductions in social care have denied services to some 400,000 people over 65, according to the Nuffield Trust. As a result, hospitals cannot discharge patients with non-medical needs, blocking beds for others.

For most Britons, free health care on demand is an article of faith, dating back to the system’s founding in 1948. But the country seems unwilling or unable to allocate the necessary funds. The U.K. budget deficit has fallen in recent years, but it’s still too big at 4 percent of GDP, and public debt stands at more than 80 percent of GDP. Higher taxes, the most straightforward option, are no more popular than sitting in a casualty department hour upon hour.  

There’s doubtless waste in the system. The NHS spends 80 million pounds a year handing out paracetamol, an over-the-counter painkiller. The service absorbs 1 billion a year in the cost of missed appointments. Some of this can be pared back, though such economies have been tried before, and they’re never equal to the task.  

In the end, you can have a high-quality health-care system, or one that costs as little as the U.K. spends, but not both. It’s a dilemma that Britain has been trying to ignore for years. Sadly for those patients in the corridors, Brexit is looming, and another tough choice is the last thing the government needs.

To contact the senior editor responsible for Bloomberg View’s editorials: David Shipley at davidshipley@bloomberg.net.