Analysis: U.K.???s national health service continues to deteriorate

This article originally appeared on

Shortages of medical care are endemic in government run health care systems.

Over the Christmas holidays, the waits for emergency care in the British National Health Service (NHS) reached what the British press called ???crisis??? levels. Compared to last year, twice as many ambulances had more than half-hour waits outside of over-crowded emergency rooms.

According to the Independent newspaper, in December and January more than 7,000 surgeries were canceled due to lack of beds. NHS waiting times for cancer treatment are the highest in six years, and the Daily Mail reported that 12.5 percent of patients, more than 39,400 people, waited more than 18 weeks for hospital treatment in November.

This year, government managers reacted to long-standing NHS budget problems by again refusing hospital requests to increase reimbursements in line with increases in demand for services. On January 29th the hospitals that provide 75 percent of all NHS care refused to approve their annual NHS budget offers. The rejection is unprecedented. The hospitals say that additional budget cuts would mean that they can no longer ???guarantee safe and effective care.??? Eighty percent of English hospitals are said to be running a deficit.

Initial explanations for the latest deterioration in NHS performance focused on a hospital bed shortages supposedly caused by a surge in unexpected admissions through overloaded emergency departments. But US hospitals have handled a similar surge without a widespread crisis. According to the Kings Fund, a research and advocacy organization in the U.K. focused on health care, total annual visits to NHS emergency facilities rose from 16.5 million to 21.7 million over the last decade. Most of the growth was in the urgent care units introduced in 2003-04. Visits to emergency departments equipped to handle major health crises rose by 1.6 million, about 12 percent.

But the US health system handled a 23 percent increase in emergency department visits between 1997 and 2007 without triggering a nationwide hospital bed shortage. In 2007 its emergency rooms fielded 116.8 million visits. The nation???s 9,000 mostly private urgent care centers handled another 147 million patient visits. There is no obvious difference in hospital beds. In 2013, the Kaiser Family Foundation reports the US and Britain both had 30 hospital beds per 10,000 people. However, the US has more nurses per 10,000 people, 98.2 compared to Britain???s 94.7, and more physicians, 27.7 compared to 24.2.

The US and Britain are also similar in that officials responsible for entities that have care and capacity problems???the NHS in Britain and the Veterans Administration and Medicaid in the US???blame population structure, budget cuts, lack of primary care, and too little capacity for their problems. In various official interviews conducted by the Independent, British officials blamed current problems on an aging population, staff shortages, inadequate spending, and a lack of spare capacity capable of handling spikes in demand. British politicians blamed budget cuts for home care services, claimed that a lack of primary care was the problem, and cited closing emergency departments as creating too much stress in the remaining ones.

A major problem is that many officials do not understand that centrally run systems always have these problems. The US private health sector, which handled a huge increase in emergency room usage without hospital shortages, has developed is more decentralized and has developed a variety of alternatives to hospital based care. Decentralized decision making and pricing stimulates people to find new ways to treat patients and encourages hospitals to be more productive and responsive to changing patient needs.

Professor Sir Bruce Keough, NHS England???s National Medical Director, seems to understand the difference. In a January 20, 2015, interview with The Guardian newspaper, he reportedly said that without ???massive??? changes in the way the NHS treats patients, including less reliance on hospitals, it could become ???unaffordable??? because ???the model of delivery and service that we have at the moment is not fit for the future.???

Exactly right.

Linda Gorman( is director of the Health Care Policy Center at the Independence Institute.