Finances and spending

This set of charts looks at spending on health services in the UK, and puts these levels of spending into an international context.

UK spending on public and private health care
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Source: Office for National Statistics

The chart shows the total UK health care expenditure broken down into publicly funded health care expenditure and private, out-of-pocket patient spending on health care. Out-of-pocket patient spending includes health care treatment, private health insurance, treatment in private hospitals, private dental care, purchase of pharmaceutical products and medical devices.

It does not represent spending by the NHS on independent sector providers.

Between 1997 and 2009, health expenditure growth was strong, increasing at an average rate of around six per cent per year. However, since 2009, there have been no real-terms increases. This coincides with the recent recession seen in the private economy, and the related period of public sector austerity.

Publicly funded health care accounts for 83 per cent of total health care expenditure and reached an estimated £127.5 billion in 2013 (represented in 2015 prices, adjusted for inflation). This is a relatively high proportion compared to many other OECD member countries.

The information on publicly funded health care expenditure is provided in Public Expenditure Statistical Analyses (PESA), which provides information on government spending plans and outturn. The report is published annually and covers public spending by department function, category and countries within the UK.

Health spending per head of population in 2014/15 prices
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Source: HM Treasury, Public Expenditure Statistical Analysis, July 2015

The chart shows UK public sector spending on health, per head by country, between 2009/10 and 2013/14. All prices are shown in real terms (in other words, they have been adjusted for inflation based on 2014/15 prices).

Overall health spending has fallen by £12 per person but there are variations between the different countries of the UK.

In England spending on health has remained relatively flat and in Scotland it has fallen by £51 per person, although Scotland starts from a higher base and remains the country that spends the most on health per person.

Wales has seen the largest decrease in spending on health: £125 per person over the time period. It fell particularly sharply between 2010/11 and 2012/13, with the reduction spread equally over the two financial years. This has led to it becoming the lowest spending country of the UK.

Northern Ireland is the only country that shows an increase in health spending over the time period, with an increase of £40 per person in real terms.


 

Total health expenditure as a share of GDP (2013)
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Source: OECD Health Statistics 2015

This chart shows total health expenditure as a share of GDP across 30 OECD countries, including the UK.

Total health spending accounted for 8.5 per cent of GDP in the UK in 2013, less than the OECD average of 9.0 per cent. European countries to which the United Kingdom is often compared, like France and Germany, typically spend a greater proportion of national income on health.

The United States spends by far the most on health as a share of its economy, at 16.4 per cent of its GDP in 2013. In the same year, Turkey spent the least, with only 5.1 per cent of its GDP going toward health. Historical data is available in our chart ‘Health spending as a share of GDP among OECD countries (2000-2013)’.

The figures include both public and private spending on current health care expenditure only. The data were accurate at the time of analysis (July 2015).

Share of GDP spent on health care among OECD countries (2000-2013)
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Source: OECD Health Statistics 2015

This chart shows total health expenditure as a share of GDP across 34 OECD countries, including the UK, since 2000. It is similar to the chart ‘Total health expenditure as a share of GDP (2013)’, but it provides more context by presenting the data in a time series.

The countries displayed by default on the chart include the UK, the OECD average and the countries with the highest (United States) and lowest (Korea or Turkey) health expenditure as a share of GDP. The shaded region indicates the full range of spending. Other country series can be turned on and off by selecting them below the chart.

In 2013, in UK the health spending accounted for 8.5 per cent of GDP compare to 9.0 per cent on average across OECD countries. Looking over time, we also see that the UK’s health spending as a share of GDP has risen since 2000. It stood at only 6.3 per cent in 2000, but in 2013 was 8.5 per cent. This is not uncommon in OECD countries, though since the financial crisis in 2008 health spending as a share of GDP has levelled off or even fallen slightly in many OECD countries.

Data for all countries are not available for all years. If no information is available for a country in a given year, the OECD calculates the average based on the nearest available.. Additionally, there are a number of changes to the methodology indicated in the data that may not allow for a consistent comparison for all country series. Data were accurate at the time of analysis (July 2015).

 


Resources

The following two charts focus on one area of service provision within the NHS: the availability of hospital beds. Both charts are based on data from NHS England.

Average daily number of overnight beds available and occupied in England (1987/88-2014/15)
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Source: NHS England, KH03 data collection

The chart above shows the trend in the average daily number of overnight beds available in NHS hospitals in England between 1987/88 and 2014/15. Since 2000/01, data has been available for the average number of occupied beds, in addition to available beds.

In 2014/15, the average daily number of available overnight beds in English NHS hospitals was 137,088; of these, 89 per cent were occupied. Over this time period, the average daily number of beds has more than halved, and yet the occupancy rate has remained relatively steady at between 84 per cent and 89 per cent. 

This has been possible despite rising demand because of medical and health service advances that have both shifted the setting of care for patients and led to a switch to day cases treatment (an increase in day-only beds is seen over a similar time period).

Our analysis shows that demand for treatment will continue to rise in future as the population changes. The NHS will have to continue to find new ways to deal with this.

NHS England collects quarterly information on all NHS organisations that operate beds, ordinary or day case (the KH03 collection). The collection provides the total number of available bed days and the total number of occupied bed days by consultant main specialty and sector (general and acute, mental illness, learning disability and maternity). Prior to 2010/11 the KH03 was an annual return collecting beds by ward classification. Since the data are collected as a snapshot census, the data presented in this analysis after this time point show quarter 4 of each financial year to represent the full financial year. Data were accurate at the time of analysis (July 2015).

Average daily number of day-only beds available and occupied in England (1987/88-2014/15)
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Source: NHS England, KH03 data collection

The chart above shows the trend in the average daily number of day-only beds available in hospitals in England between 1987/88 and 2014/15. Since 2010/11, data have been available for the average number of occupied beds, in addition to available beds.

The number of day-only beds has risen as more procedures are carried out as day cases and no longer require an overnight stay.

In 2014/15 an average of 12,573 beds were available each day in NHS hospitals in England. Of these, an average of 86 per cent were occupied.

NHS England collects quarterly information on all NHS organisations that operate beds, ordinary or day case (the KH03 collection). The collection provides the total number of available bed days and the total number of occupied bed days by consultant main specialty and sector (general and acute, mental illness, learning disability and maternity). Prior to 2010/11 the KH03 was an annual return collecting beds by ward classification. Since the data are collected as a snapshot census, the data presented in this analysis after this time point show quarter 4 of each financial year to represent the full financial year. Data were accurate at the time of analysis (July 2015).


Workforce

The final set of charts presents data about the NHS workforce from the Health and Social Care Information Centre

NHS Hospital and Community Health Service (HCHS) and General Practice full-time equivalent staff by category: 2004-2014
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Source: Health and Social Care Information Centre, National Workforce Statistics

This chart shows the total number of full-time equivalent NHS Hospital & Community Health Service (HCHS) and General Practice staff broken down into specific categories between 2004 and 2014.

In 2014, there were 1,187,606 staff in the NHS – this is 144,228 more staff than in 2004.

Qualified nursing staff represented nearly a third of all NHS staff in 2014, the largest single category of staff, with 328,577 nurses. Support to clinical staff comprised a slightly smaller proportion of staff, at about 26 per cent.

The smallest major workforce category was qualified ambulance staff, with only 17,700 staff in 2014.

This data set shows the number of staff employed at the end of September each year. Several staffing changes and methodology changes mean that direct comparison throughout a series should be treated with caution.

Average annual per cent change in NHS Hospital and Community Health Service (HCHS) and General Practice workforce: 2004-2014
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Source: Health and Social Care Information Centre, National Workforce Statistics

The chart above shows the average annual percentage change in the number of all full-time equivalent (FTE) NHS staff between 2004 and 2014.

The total number of all NHS staff has increased by 14 per cent between 2004 and 2014, with an average annual increase of 1.3 per cent. However, the size of increase varies by staff role type.

The total number of doctors has increased from 109,483 in 2004 to 141,421 in 2014 – an average annual increase of 2.6 per cent. Nurses, ambulance and infrastructure support staff see a comparatively modest growth in numbers. Also, ambulance staff saw a decrease in numbers between 2005 and 2006, which can be associated with changes in the way the ambulance service was organised.

Some of the non-clinical staff categories have seen decreases in numbers, especially management, and those working to maintain facilities.

 

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