Executive summary
summary
This report on the United Kingdom health system provides an overview of how
the national health services operate in England, Northern Ireland, Scotland and
Wales. It does not seek to compare the performance of health services in the
four nations that make up the United Kingdom; instead it reviews key features
and recent developments in service organization, governance, financing and
delivery within the four nations and across the United Kingdom as a whole.
Introduction
The United Kingdom, located off the northwest coast of the European
mainland, comprises Great Britain (England, Scotland and Wales) and
Northern Ireland. It has a population of around 64 million, 80% of whom
live in England. The economy of the United Kingdom was particularly hard
hit by the global financial crisis of the late 2000s, with the highest fall in GDP
per head of any EU country between 2007 and 2009 (24.3%, compared with
the EU average of 5.8%). This contributed to an increase in the unemployment
rate that remained at 6.1% in 2014 (although this remains well below the EU
average of 10.2%).
Despite the description as a “national” health service (NHS), in practice the
health system has never been the same across the four nations. This variation
has increased with the transfer of powers for health care and public health to
Northern Ireland, Scotland and Wales from 1997 onwards, in a process termed
“devolution”. Scotland, Wales and Northern Ireland have pursued an approach
emphasising partnership between purchasers and providers in the health system,
while market forces play a greater role in the English health system.
xviii Health systems in transition United Kingdom
For the United Kingdom as a whole, life expectancy increased between 1980
and 2013 from 73.7 to 81 years (slightly above the EU average of 79.9 years), and
mortality rates from most cancers and circulatory diseases decreased. However,
chronic disease and disability have not declined as much as in other western
European countries; thus while individuals live, on average, longer, they do so
in relatively poor health. These averages across the United Kingdom also mask
considerable variation, both geographically (Scotland has poorer health than
the rest of the United Kingdom) and between socio-economic groups. While
tobacco use has declined, it remains the leading risk factor for poor health.