Issues facing the NHS - FAQs


Information about issues facing the NHS such as the shortage of doctors in the UK, the numbers of junior doctors leaving the NHS and the number of patients using private healthcare. Q How many consultants do we need?
A The Department of Health say:
  • Increase the number of consultants by 7,500 and the numbers of GPs by 2,000 by 2004 (from a 1999 baseline)
  • Increase the number of GPs and Consultants employed by the NHS by 10,000 by 2005 (from a 2000 baseline)
  • Plan to achieve an increase of 15,000 doctors by 2008 (from a 2001 baseline). This will include: 1,000 cancer consultants by 2005; increasing total numbers of cardiologists to 685 and cardithoraic surgeons to 217 by 2004, (enabling single handed cardiologist posts to be eliminated).
Reference: Improvement, Expansion and Reform: The Next 3 Years - Priorities and Planning Framework 2003-2006. See http://www.dh.gov.uk/assetRoot/04/07/02/02/04070202.pdf.
Q Why is the UK so short of doctors?
A It is impossible to provide a definitive answer to this question - different people will have different views.

Q Why does the UK spend less than European countries on healthcare?
A “The percentage ratio of public private spending is 83:17 in the UK as against 69:31 in the Netherlands, 70:30 in Australia and Canada and 76:24 in France and Germany. Indeed if public expenditure on healthcare alone is considered, in 1998 the UK government was already close to achieving its target of matching the EU average level of spending, i.e. even before the Prime Minister, Tony Blair committed it to a dramatic expansion in the rate of spending in January 2000. UK public spending on healthcare in 1998 represented 5.7% of gross domestic product (GDP)as against the unweighted EU average of 5.9%. Given the acceleration of public spending since then, the UK is not so far off the higher, weighted EU average of 6.4%. If Britain still appears to be a laggard in terms of healthcare expenditure, and if the funding issue dominated decisions and debate in the Chancellor of the Exchequer’s budget in 2002, it is n large part because private spending remains conspicuously lower : 1.1% of GDP as against an EU average of 2.0% unweighted or 2.1% weighted.”

Reference: The public-private mix in the UK, Rudolph Klein – Chapter 4, The Public Private Mix for Health, Ed. A Maynard, The Nuffield Trust 2005.

Health expenditure as a percentage of GDP, 2001

Country % of GDP
United States 13.9
Switzerland 10.9
Germany 10.7
Canada 9.7
France 9.5
Greece 9.4
Portugal 9.2
Iceland 9.2
Belgium 9.0
Australia* 8.9
Netherlands 8.9
Sweden 8.7
Denmark 8.6
Italy 8.4
Norway 8.3
New Zealand 8.2
Austria 7.7
Japan* 7.6
United Kingdom 7.6
Spain 7.5
Czech Republic 7.3
Finland 7.0
Hungary 6.8
Mexico 6.6
Ireland 6.5
Poland 6.3
Korea* 5.9
Slovak 5.7
Luxembourg 5.6

* 2000
This table can also be found at http://www.oecd.org/dataoecd/18/55/16308844.xls.

Total expenditure on health %GDP

Country 1960 1970 1980 1990 2000 2001 2002 2003
Australia 4.1   7 7.8 9 9.1    
Austria 4.3 5.3 7.6 7.1 7.7 7.6 7.7  
Belgium   4 6.4 7.4 8.8 9 9.1  
Canada 5.4 7 7.1 9 8.9 9.4 9.6  
Czech Republic       5 7.1 7.3 7.4  
Denmark     9.1 8.5 8.4 8.6 8.8 9
Finland 3.8 5.6 6.4 7.8 6.7 7 7.3  
France 3.8 5.4 7.1 8.6 9.3 9.4 9.7  
Germany   6.2 8.7 8.5 10.6 10.8 10.9  
Greece   6.1 6.6 7.4 9.7 9.4 9.5  
Hungary         7.1 7.4 7.8  
Iceland 3 4.7 6.2 8 9.2 9.2 9.9  
Ireland 3.7 5.1 8.4 6.1 6.4 6.9 7.3  
Italy       8 8.1 8.3 8.5 8.5
Japan 3 4.5 6.5 5.9 7.6 7.8    
Korea       4.2 4.6 5.3 5.1  
Luxembourg   3.6 5.9 6.1 5.5 5.9 6.2  
Mexico       4.8 5.6 6 6.1  
Netherlands     7.5 8 8.2 8.5 9.1  
New Zealand   5.1 5.9 6.9 7.9 8 8.5  
Norway 2.9 4.4 7 7.7 7.7 8.9 9.6 10
Poland       4.9 5.7 6 6.1  
Portugal   2.6 5.6 6.2 9.2 9.3 9.3  
Slovak Republic         5.5 5.6 5.7  
Spain 1.5 3.6 5.4 6.7 7.5 7.5 7.6  
Sweden   6.9 9.1 8.4 8.4 8.8 9.2  
Switzerland 4.9 5.4 7.3 8.3 10.4 10.9 11.2  
Turkey   2.4 3.3 3.6 6.6      
United Kingdom 3.9 4.5 5.6 6 7.3 7.5 7.7  
United States 5 6.9 8.7 11.9 13.1 13.9 14.6  

Copyright OECD Health Data 2004, 3rd edition, see http://www.oecd.org/dataoecd/13/13/31963469.xls.

Total expenditure on health, per capita US$ PPP

Country 1960 1970 1980 1990 2000 2001 2002  
Australia 93   684 1300 2379 2504    
Austria 77 190 762 1344 2147 2174 2220  
Belgium   147 627 1340 2288 2441 2515  
Canada 121 289 770 1714 2541 2743 2931  
Czech Republic       553 977 1083 1118  
Denmark     943 1554 2353 2520 2583  
Finland 62 190 584 1414 1698 1841 1943  
France 69 206 699 1555 2416 2588 2736  
Germany   266 955 1729 2640 2735 2817  
Greece   171 464 838 1617 1670 1814  
Hungary         847 961 1079  
Iceland 57 163 698 1598 2559 2680 2807  
Ireland 42 117 511 791 1774 2059 2367  
Italy       1397 2001 2107 2166  
Japan 29 144 559 1105 1958 2077    
Korea       329 777 943 996  
Luxembourg   161 637 1533 2682 2900 3065  
Mexico       290 494 536 553  
Netherlands     750 1419 2196 2455 2643  
New Zealand   205 488 987 1611 1710 1857  
Norway 49 140 659 1385 2747 3258 3409  
Poland       298 578 629 654  
Portugal   54 283 661 1570 1662 1702  
Slovak Republic         591 633 698  
Spain 16 97 363 865 1493 1567 1646  
Sweden   305 924 1566 2243 2370 2517  
Switzerland 166 350 1031 2040 3111 3288 3446  
Turkey   24 76 165 446      
United Kingdom 84 160 472 977 1839 2012 2160  
United States 144 347 1055 2738 4538 4869 5267  

Copyright OECD Health Data 2004, 3rd edition, see http://www.oecd.org/dataoecd/13/53/31963451.xls.

Q How many patients use private healthcare?
A “The number of subscribers to private insurance schemes almost trebled between 1979 and 2000 – most of the rapid growth occurring in the 1980s, thereafter flattening out – rising from 1,292,000 to 3,685,000. The number of persons covered by these schemes increased from 5% of the UK population in 1980 to 11.5% in 2000.”
Ref: The public-private mix in the UK, Rudolph Klein – Chapter 4, The Public Private Mix for Health, Ed. A Maynard, The Nuffield Trust 2005.

The number of people with private medical insurance (PMI) and non-insured medical expenses policies in the UK remained static at 4.155 million in 2003.

Total people covered by PMI policies or non-insured medical expenses schemes was 7.5 million at the end of 2003, 12.7% of the population.

  1994 2003
Persons covered by PMI 6.61 million 6.64 miilion
Non-insured schemes 0.18 miilion 0.91 miillion
PMI Providers    
Persons covered company paid schemes 4.13 million 4.68 miilion
Persons covered personal sector schemes 2.49 million 1.96 million
Value of UK PMI market £1.6 billion £3.0 billion
Claims of UK PMI market £1.3 billion £2.3 billion

Reference: See http://www.laingbuisson.co.uk/PMI.

Q Number of surgical procedures carried out in the UK
A See table below:

England 2003-04 - http://www.dh.gov.uk/assetRoot/04/09/70/92/04097092.pdf.

Finished Consultant Episodes Number Percentage
Ordinary Admissions 9,417,004 71.5%
Proportion of the above episodes with an operation: 35.9%  
Day cases 3,757,476 28.5%
Proportion of the above episodes with an operation: 88.6%  
Total 13,174,480 100%
Proportion of the above episodes with an operation 51%  

Wales 2003-04 - http://www.statswales.wales.gov.uk/TableViewer/download.aspx

Specialty In-patient cases  
All specialties 503,457  
Total acute 405,503  
Geriatric medicine 23,255  
Maternity total 59,161  
Mental illness total 15,365  
Learning disabilities 160  
Pathology total 13  
Occupational medicine -  
Special care baby units 3,084  
High dependency unit 1,090  
Intensive therapy unit 1,888  
Paediatric intensive therapy 122  
Bone marrow unit 221  

Scotland - http://www2.isdscotland.org/acute_activity/surgical.asp?page=proc1

  2000 2001 2002 2003 2004
Operations performed 956,377 964,077 931,381 927,321 965,528
Principal operations 742,404 751,410 723,060 708,399 730,660
Admitted from waiting list 412,671 408,008 383,709 366,554 386,885
Percent Day cases 63.5 64.9 64.4 63.5 64.1

Northern Ireland - http://www.dhsspsni.gov.uk/stats&research/order.asp

  2003/2004  
All Programmes of Care 482,449  
Acute Services 406,214  
Maternity and Child Health 50,873  
Elderly Care 12,916  
Mental Health 10,078  
Learning Disability 2,368  

Q How many junior doctors leave the NHS each year because they are turned down for flexible training opportunities?
A There have been a number of studies that have tried to calculate the proportion of doctors that leave the NHS and to determine the factors which lead to this decision. Studies have found that between 15 per cent and 20 per cent of doctors leave UK medicine within a few years of graduation. A relatively small number of these will leave the profession altogether many others choose to practise overseas.

A survey of British Medical graduates from 1974, 1977, 1983, 1988 and 1993 (see reference 1) Loss of British trained doctors from the medical workforce in Great Britain; Michael J Goldacre, Trevor W Lambert & Jean M Davidson, Medical Education: 2001;35:337-344 found that 85 per cent of doctors were working in the NHS 2 years after graduation, 82 per cent after 5 and 10 years, 81 per cent after 15 years, and 77 per cent after 20 years. Allowing for loss and part-time working, the whole-time equivalent available to the NHS at 15 years after graduation was 60 per cent of women and 80 per cent of men.

A survey of doctors qualifying in 1999 (see reference 2) Reasons for considering leaving UK medicine: questionnaire study of junior doctors' comments; Philip J Moss, Trevor W Lambert, Michael J Goldacre, Penelope Lee;BMJ 2004;329:1263 (27 November), found that 16 per cent of respondents reported that they were probably not or definitely not going to continue to practise in the UK, practise medicine or both. Of those doctors who indicated that they were considering leaving the UK but staying in medicine, 65 per cent (682) gave reasons for leaving that concerned lifestyle, such as a preference for living outside the United Kingdom; 41 per cent (433) gave reasons concerning working conditions in UK medicine; and 18 per cent (184) gave positive work related reasons, such as wanting to work in developing countries. Of the doctors who were considering leaving medicine altogether. Of the doctors considering leaving medicine, 75 per cent (210) cited working conditions, 23 per cent (63) cited lifestyle reasons, and 9 per cent (24) cited positive interests in a different career. Of the 169 doctors who said that they would probably or definitely leave the United Kingdom but remain in medicine, 78 per cent (132) specified lifestyle reasons. Of the 42 who said that they would probably or definitely leave medicine, 67 per cent (28) cited working conditions.

The BMA cohort study BMA Cohort study (see reference 3), ninth report, June 2004 has tracked the careers of a cohort of 1995 medical school graduates. The study found that on average at any point over the period looked at for the ninth report (2002/03) 85 per cent of the cohort were working as a doctor in the UK. In other words 15 per cent were not practising medicine in the UK for one reason or an other on a permanent or temporary basis.

Eight years after graduation from medical school, 7 per cent (34/490) of the cohort have left the UK medical workforce. These doctors have either left medicine as a career altogether or are working overseas and do not intend to return to the UK. 68 per cent (23/34) of those who have left medicine permanently were female. The reasons given by those who have left medicine as a career are outlined in the chart below.

Reason for leaving

 Number of students
Attracted to alternative career 7
Dissatisfaction with medicine as a career 10
Family commitments 5
NHS working / pay conditions 6
Other 2

References

  1. Loss of British trained doctors from the medical workforce in Great Britiain; Michael J Goldacre, Trevor W Lambert & Jean M Davidson, Medical Education; 2001;35:337-344
  2. Reasons for considering leaving UK medicine: questionnaire study of junior doctors' comments; Philip J Moss, Trevor W Lambert, Michael J Goldacre, Penelope Lee; BMJ 2004;329:1263 (27 November)
  3. BMA Cohort study, ninth report, June 2004
Q What does this cost the NHS financially?
A Figures released in the 2004 Unit Costs of Health and Social Care report (see reference 1) Unit costs of health and social care 2004 compiled by Lesley Curtis and Ann Netten; Personal Social Services Research Unit, Cornwallis Building, The University of Kent, Canterbury, Kent, CT2 7NF suggest that it costs £219,001 to train a doctor to registration (i.e. undergraduate education and pre registration training costs). This figure includes:

£38,372 Living expenses / lost production costs
£50,870 Tuition
£129,759 Clinical placement costs

These figures are not necessarily costs solely to the NHS, some of the training costs are borne by the trainee themselves others by the DfES/University and others by society as a whole.

The report also quantifies the additional postgraduate training costs. For SHO training these amount to a further £18,299 (tuition and replacement costs) and for SpR training a further £43,310 (tuition and replacement costs).

Although some return on this investment is gained for every year the doctor works in the NHS, if doctors leave the NHS/UK medical workforce at any point in their career some of this investment will be lost. If doctors leave the profession early in their career the financial impact is significant.

References
  1. Unit costs of health and social care 2004 compiled by Lesley Curtis and Ann Netten; Personal Social Services Research Unit, Cornwallis Building, The University of Kent, CT2 7NF.

    © British Medical Association 2008

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