Articles | Research and Innovation | University of Exeter

United Kingdom’s redistributive health system faces major challenges

A new health system review for the United Kingdom (UK) reveals recent developments in financing, governance, organisation and delivery of health care in one of the world’s most comprehensive health systems.

The UK report is the result of a collaboration between the European Observatory on Health Systems and Policies and its Partners including Dr Emma Pitchforth at the University of Exeter, the London School of Economics (LSE), The Health Foundation and the Nuffield Trust, member of the Health System and Policy Monitor (HSPM).

The newest issue in the Observatory’s Health Systems in Transition (HiT) series, ‘United Kingdom: Health system review 2022’ explores the latest reforms of the health system in the four constituent countries of the UK, including the response to the COVID-19 pandemic and its effects.

It identifies key strengths of the health system including high levels of protection against the financial consequences of poor health, the systematic allocation of resources for diverse geographical needs, a robust and transparent approach to health technology assessment, and comparatively high levels of performance for certain chronic diseases, such as diabetes and kidney disease.

Certain aspects of the UK’s response to the COVID-19 pandemic are also praised, such as the national vaccination programme, willingness of health workers to adapt in unprecedented circumstances, and implementation of system-level changes. These include expanding critical care services and the rapid increase in uptake of remote consultations to prevent transmission of coronavirus.

On the other hand, this crisis has also shown that more could be done to overcome the lack of integration between health and social care, poor coordination between UK countries, and challenges in getting data to flow in real time.

The COVID-19 pandemic has also exposed ongoing health system challenges. For example, persistent inequalities in health outcomes, chronic underfunding of health and social care, and lower levels of doctors and nurses than most other high-income countries leave the country vulnerable to acute shocks such as COVID-19 and growing waiting lists for elective care.

The report highlights that there are four separate health care systems responsible for organising and delivering health services in England, Scotland, Wales and Northern Ireland. While UK residents enjoy access to the National Health Service (NHS) based on clinical need rather than ability to pay, free access to social care services depends on different criteria across the UK’s four nations.

Reforms across all UK countries are targeting greater integration of care and cross-sectoral partnerships, with the aim to improve the health and well-being of local populations. Northern Ireland is the only UK constituent country where the NHS and social care are fully organisationally integrated, but in practice many barriers still exist to deliver integrated care to patients. Whereas, in England, Scotland and Wales, efforts to promote such integration are currently focused on the establishment of integrated care systems, integrated joint boards, and regional partnership boards.

Date: 7 June 2022