(Is the English NHS underfunded?)
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The NHS in Scotland, Wales and Northern Ireland receives more funding per head of population than the NHS in England. In 1995-6, Scotland received 25 per cent more, Wales nearly 18 per cent extra and Northern Ireland five per cent more per capita than England. In this week's BMJ Jennifer Dixon and colleagues from the King's Fund and the University of Aberdeen attempt to undertake an analysis of the implications for patients of these various levels of funding.
The authors found that devolution is already evident in the health service in the UK - "If national means the United Kingdom, there does not seem to be a national NHS". Dixon et al found that comparing data on NHS activity and interpreting the differences observed across the four countries, was extremely difficult. That said, they ascertained that the Scottish NHS buys more hospital beds and staff per capita and has higher rates of outpatient and inpatient activity than in the English service. Their research also showed that Scottish NHS trusts experience less financial pressure and that staff have a lower workload than in England. Higher funding in Scotland, Wales and Northern Ireland , however, did not seem to be linked to better patient health.
The authors conclude that a comparison of the four countries of the United Kingdom does not establish whether the NHS in England is underfunded in relation to the other countries. They say that it could be argued that the Scottish "providers" are less productive than their counterparts in England. Dixon et al conclude that "....the evidence could be used equally well by a Scottish assembly to argue for cutting health care expenditure....as by advocates of a larger budget for the NHS in England."
Contact:
Prof. Rudolf Klein, Senior Associate Fellow, King's Fund, London
Tel/Fax: +44 171 428 9767
rklein@kehf.org.uk