Intended for healthcare professionals

Education And Debate

Is the English NHS underfunded?

BMJ 1999; 318 doi: (Published 20 February 1999) Cite this as: BMJ 1999;318:522
  1. Jennifer Dixon, fellow in policy analysisa,
  2. Sarah Inglis, medical studentb,
  3. Rudolf Klein, professorial fellowa
  1. aKing's Fund, London W1M 0AN
  2. bUniversity of Aberdeen Medical School, Aberdeen AB25 2ZD
  1. Correspondence to: Dr Dixon

    It has long been known that the NHS in Scotland, Wales, and Northern Ireland receives more funding per head of population than the NHS in England. 12 In 1995-6, for example, Scotland received 25% more, Wales nearly 18% extra, and Northern Ireland 5% more per capita than England. These differences have resulted largely from historical accident rather than differences in need: for the first 30 years of the NHS, public sector resources between countries were allocated on the basis of traditional arm wrestling between the Treasury and the Scottish Office, Welsh Office, and Northern Ireland Office.

    In the late 1970s, the Barnett formula was introduced.3 This put the allocation of resources toScotland on a more objective footing. Similar formulas were subsequently introduced for Wales and Northern Ireland. However, these formulas applied to the growth in public funding, and they did not seriously challenge existing historical patterns. Furthermore, they were based principally on population size rather than any other measures of need. The conclusion, drawn a decade ago, that NHS funding in Scotland, Wales, and Northern Ireland is in excess of these countries' entitlement relative to need can still be argued convincingly.4

    This state of affairs has an advantage—it provides a useful opportunity for natural experiment. The NHS is broadly similar in each of the four countries, but it is funded at different levels. It is inconceivable that the English NHS could receive, at a stroke, 25% more resources per capita in order to reach Scottish levels. This would require an extra £8.3 billion, more than six times the amount awarded to the NHS in 1997-8. But if it did, what does evidence from Scotland indicate that the extra funds would buy? Do the Scots get more doctors and nurses for their extra funding, or extra treatments? Are …

    View Full Text

    Log in

    Log in through your institution


    * For online subscription