The United Kingdom’s Struggles to Become the Powerhouse of Healthcare By: Rachelle Madison
The United Kingdom, like other countries, has strived for implementing an efficient and effective healthcare system.[1] The United Kingdom possesses a universal healthcare system, referred to as the National Health Service (“NHS”).[2] With this universal system, the United Kingdom legally must provide public healthcare to all permanent residents.[3] In order to provide healthcare to all permanent residents, the United Kingdom has created a legal system that allows for the entire population to both contribute and benefit from the system.[4] In the United Kingdom, eighteen percent (18%) of all the citizen’s income tax goes towards healthcare, allowing for healthcare services to be paid for by general taxation.[5] As a result, only ten percent (10%) of the United Kingdom’s gross domestic product (“GPD”) is spent on healthcare, which allows the United Kingdom to comfortably provide each citizen with free healthcare coverage at the point of need.[6] With the United Kingdom demonstrating that healthcare is a legal right, rather than a luxury, they are portrayed as a powerhouse system of healthcare.[7]
In an attempt to further solidify a healthcare powerhouse, the United Kingdom has created a comprehensive malpractice legal system to constantly improve the quality of care.[8] In the instance where a patient is not satisfied with their quality of care, the NHS has a standard complaint process in place.[9] This complaint process is designed to allow the patient’s concerns to be heard and the physician to provide an explanation to the patient regarding the cause of events, while simultaneously preventing the costs and time consuming process of a medical malpractice legal proceeding.[10] In addition to the patient being heard, the physician or healthcare provider may issue the harmed patient a proper apology and a detailed analysis of the proper steps being taken to prevent repeatable actions.[11] In the situation where the complaint process is not sufficient and the patient has to pursue a medical malpractice claim, the system is designed to be favorable in compensating the patient for negligent medical malpractice.[12] With the universal healthcare system, complaint process, and the medical malpractice legal system, the United Kingdom has solidified itself as a powerhouse healthcare system…in theory.[13]
However, despite these proactive efforts, there remains cracks in the system. Like any healthcare system, the United Kingdom’s universal healthcare system struggles to diminish all healthcare inequalities, which the NHS defines as “unfair and unavoidable differences in health across the population, and between different groups within society.”[14]These healthcare inequalities are influenced by environmental factors such as where one was born, lives, works, education, and socioeconomic status.[15] These factors and inequalities differentiate the quality of care received throughout the population.[16] More specifically, individuals deprived of income, employment, education, housing, safety, and positive living conditions, are subjected to the worst healthcare inequalities in regard to access, experience, and outcomes.[17] To counter these healthcare inequalities, the United Kingdom has restructured its legal system to meet the needs of patient litigants and implemented health promoting policies and programs; enforced programs to improve cultural competence among healthcare providers; and expanded the use of the community healthcare workers to address the healthcare needs within ethnic minority groups.[18]
Nevertheless, in spite of these legal improvements to create a dominant healthcare system, the United Kingdom is straining under the weight of an aging and increasing population, funding constraints, and the lingering effects of the COVID-19 pandemic.[19] In 2022, the NHS was expected to start its recovery from being perceived as a Covid-and-emergencies-only service.[20] During December 2022 and January 2023, media reports highlighted severe NHS challenges including: ambulances unable to offload patients, patients lying at home with fractures, long emergency department waits, and overcrowded hospital corridors.[21] The Royal College of Emergency Medicine estimated 300 to 500 weekly deaths due to these delays.[22] Strikes by ambulance workers, nurses, and doctors over pay and working conditions further led to the cancellation of thousands of operations and appointments.[23] Waiting lists for specialist consultations have grown to over seven-million, up from 4.4 million pre-pandemic.[24] The primary causes are long-term underinvestment in health services, insufficient resilience to handle the pandemic surges, pension penalties causing physician retirement, and burnout.[25]
Public satisfaction and confidence in the NHS has sharply declined due to the broken promises of reliable emergency care.[26] Both major political parties agree that more funding alone is not the answer, but disagree on what reforms should be put in place.[27] Regardless, the Conservative government faces accusations of underfunding the NHS to push patients towards private healthcare.[28] The current state of the NHS causes misery for patients and frustration for health professionals.[29] Citizens affected by the Conservative government’s underfunding of the NHS urged fellow citizens to vote for the Labour government.[30] Following the election on July 4, 2024, the Labour leader, Keir Starmer officially became prime minister of the United Kingdom.[31] Starmer has promised to ease the health service crisis without imposing tax increases or deepening the public debt.[32] However, only time will tell the future of the NHS and how it will influence the global health paradigm as the NHS has been a model for many health systems that aim to be an effective and efficient powerhouse.[33]
[1] Anup Shah, Health Care Around the World, Global Issues (Sept. 22, 2011) https://www.globalissues.org/article/774/health-care-around-the-world.
[2] Josh Chang et al., The UK Health Care System, http://assets.ce.columbia.edu/pdf/actu/actu-uk.pdf (last visited Feb. 27, 2024).
[3] Id.
[4] Shah, supra note 1.
[5] Chang, supra note 2.
[6] Chang, supra note 2.
[7] Shah, supra note 1.
[8] See generally, Richard Goldberg, Medical Malpractice and Compensation in the UK, 87 Chi-Kent L. Rev. 131 (2012), https://scholarship.kentlaw.iit.edu/cgi/viewcontent.cgi?article=3828&context=cklawreview.
[9] Thomas Powell et al., NHS Complaints Procedures in England, House of commons Library (Oct. 22, 2019), https://researchbriefings.files.parliament.uk/documents/CBP-7168/CBP-7168.pdf.
[10] Id.
[11] Id.
[12] Goldberg, supra note 8.
[13] See generally, Richard Goldberg, Medical Malpractice and Compensation in the UK, 87 Chi-Kent L. Rev. 131 (2012), https://scholarship.kentlaw.iit.edu/cgi/viewcontent.cgi?article=3828&context=cklawreview; Thomas Powell et al., NHS Complaints Procedures in England, House of commons Library (Oct. 22, 2019), https://researchbriefings.files.parliament.uk/documents/CBP-7168/CBP-7168.pdf; Josh Chang et al., The UK Health Care System, http://assets.ce.columbia.edu/pdf/actu/actu-uk.pdf (last visited Feb. 27, 2024).
[14] NHS, What are Healthcare Inequalities ?, NHS England, https://www.england.nhs.uk/about/equality/equality-hub/national-healthcare-inequalities-improvement-programme/what-are-healthcare-inequalities/ (last visited Feb. 13, 2024).
[15] Id.
[16] Id.
[17] Id.
[18] See Commission on Race and Ethnic Disparities: The Report, (2021), https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/974507/20210331_-_CRED_Report_-_FINAL_-_Web_Accessible.pdf; Richard Goldberg, Medical Malpractice and Compensation in the UK, 87 Chi-Kent L. Rev. 131 (2012), https://scholarship.kentlaw.iit.edu/cgi/viewcontent.cgi?article=3828&context=cklawreview.
[19] Danica Kirka, Crisis in the UK’s NHS Shows Why Conservatives are Struggling After 14 Years in Power, AP News (June 28, 2024), https://apnews.com/article/britain-election-nhs-crisis-nathaniel-dye-a9d6ad4a3b5acd3e35a9acf9b5ee2c5a.
[20] David Hunter, At Breaking Point of Already Broken? The National Health Service in the United Kingdom, N. Eng. J. Med. (July 8, 2023), https://www.nejm.org/doi/full/10.1056/NEJMp2301257.
[21] Id.
[22] Id.
[23] Id.
[24] Id.
[25] Id.
[26] Id.
[27] Id.
[28] Id.
[29] Id.
[30] Kirka, supra note 19.
[31] Jill Lawless, He’s Derided as Dull, But Keir Starmer Becomes UK Prime Minister with a Sensational Victory, AP News (July 5, 2024), https://apnews.com/article/uk-election-keir-starmer-profile-labour-e98d16e0810273f6041b61747e084aae.
[32] Id.
[33] Hunter, supra note 20.