Covid-19: Starting position for NHS risks leaving UK trailing the pack in the race to recovery

This will mean longer waits for treatment, further rationing of care and the danger that health outcomes in the UK will worsen.

Press release

Published: 24/07/2020

The National Health Service is at risk of a slower and more fraught path to recovery than most comparable international systems due to its starting position going into the Coronavirus pandemic and the severity of our outbreak, according to a study by the Nuffield Trust think tank.

The analysis compares measures taken by the NHS in England against health systems in 31 countries in response to Covid-19 and examines the starting position of those countries’ health systems in terms of staffing, hospital beds and money for equipment and buildings [1]. The comparator countries include Germany, France, Italy, Sweden, Spain and the United States.

Resuming health services during the Covid-19 pandemic: What can the NHS learn from other countries? finds that many of the tactics taken by the NHS in England to reshape services, build extra hospital capacity, bring back recently retired staff and strike deals with the private sector have been mirrored in other countries. Every country in the study cancelled or delayed non-urgent or elective procedures to free up more capacity for Covid-19 patients and a majority created designated Covid-19 hospitals or treatment centres.

Despite the incredibly hard work of NHS staff in responding to the pandemic with speed and resilience, the UK as a whole went into the pandemic with fewer doctors, nurses and hospital beds per person, lower levels of spending on buildings and equipment, and higher levels of hospital bed occupancy. In combination with the UK’s more severe outbreak, this means the NHS may face a tougher recovery than health systems across the countries analysed.

Key findings relating to health system capacity include:

  • The UK’s National Health Services rank in the bottom third of 31 comparable countries when it comes to four of the six measures of healthcare capacity: capital spending, doctors per person, hospital beds per person and acute bed occupancy.
  • Low bed numbers and high occupancy rates within the NHS mean it has had less flexibility than other health systems to deal with the immediate surge of demand. Germany had over three times the hospital beds and nearly twice as many nurses per person than the UK [2].
  • While the UK ranks among the average for waiting times of the health systems analysed, its position is likely to deteriorate given that many parts of the NHS are working with outdated buildings and chronic workforce shortages. Even with last week’s government funding announcement of an additional £3bn to help expand elective capacity over winter, this is unlikely to be sufficient to address service backlogs and manage the growing number of people on waiting lists.
  • Outdated NHS buildings and properties will mean that reconfiguring facilities to support social distancing measures or Covid-free zones will be more difficult.
  • Restarting services has forced all health systems to make difficult choices about how to prioritise services, manage infection control and build flexibility in terms of staff and beds.

The report also considers the differences in countries’ outbreaks and the pandemic response, pointing to evidence that the UK entered the period with stark socioeconomic and racial inequalities relative to other countries, which may have made the virus deadlier and multiplied its spread. The UK’s outbreak was also more spread out, with London seeing 17% of total cases in the country compared to 69% of Finland’s cases in the Helsinki region and 60% of Portugal’s cases in the Porto region.

The report argues that, while the trajectory of the NHS’s recovery will be determined heavily by its starting position at the start of the pandemic, it is not set in stone. The author says that there is now an opportunity to learn from and sustain positive changes the service has made in response to the outbreak and for government to work across sectors to redress the inequalities that threaten system recovery and sustainability. Other factors, like infrastructure to test, track and trace cases and access to PPE will also play a role, as well how effectively systems are able to make decisions and coordinate action across different sectors and levels of government. 

Report author and Nuffield Trust Senior Research Fellow Sarah Reed said:

“Covid-19 has tested the resilience of even the most well-prepared health systems, but the NHS’s relatively poor starting position when it comes to beds, staffing and spend on buildings and equipment is likely to make the path to recovery long and fraught.

“The NHS and its staff pulled out all the stops to react to the pandemic with impressive speed and resilience, avoiding the harrowing scenes in hospitals seen in other countries. But in the face of our devastating outbreak, the longstanding issues with bed capacity and workforce shortages that have been with us long before Covid-19 will continue to slow the health service down compared to other systems in the race to recovery.

“Looking ahead, this will mean longer waits for treatment, further rationing of care and the danger that health outcomes in the UK, which already lag behind many other similar countries, will worsen.”

Notes to editors

  1. The 31 countries are: England (the UK for the analysis of baseline healthcare capacity), Australia, Austria, Belgium, Canada, Czech Republic, Denmark, Estonia, Finland, France, Germany, Greece, Hungary, Iceland, Ireland, Italy, Latvia, Lithuania, Luxembourg, Netherlands, New Zealand, Norway, Poland, Portugal, Russia, Slovenia, Spain, Sweden, Switzerland, Turkey, United States.
  2. National level data refers to the National Health Services collectively across the UK, while comparisons between individual measures taken in response to the Covid-19 pandemic refer to actions taken by the NHS in England.
  3. Germany had 8 hospital beds and 13.2 nurses per 1000 inhabitants compared to 2.5 hospital beds and 7.8 nurses per 1000 inhabitants across the UK 
  4. The countries were selected by the availability of data from the WHO Regional Office for Europe, the European Commission, and the European Observatory on Health Systems and Policies Covid-19 Health System Response Monitor and the Organisation for Economic Co-operation and Development (OECD).
  5. The Nuffield Trust is an independent health think tank. We aim to improve the quality of health care in the UK by providing evidence-based research and policy analysis and informing and generating debate.

For more information or to arrange an interview, please Mark Dayan on 07920 043844/