England spends the least on healthcare but has highest life expectancy, audit of UK’s four nations shows

The four health departments of the United Kingdom should work closely together to investigate variations in performance and learn lessons from each other to save taxpayers’ money and improve care, says a public spending watchdog.

The National Audit Office published a report Healthcare Across the UK: A Comparison of the NHS in England, Scotland, Wales and Northern Ireland1 on 29 June, which analysed the key trends and differences in the NHS between the four countries in the UK.

Responsibility for health services has been devolved to the administrations in Scotland, Wales, and Northern Ireland since 1999, and these administrations have powers to choose how much money to spend, their policy priorities, and how to deliver services.

Significant differences are clear between the countries, such as for life expectancy, which is lowest in Scotland (75.9 years for men and 80.4 for women) and highest in England (78.6, 82.6).

UK spending on health services has more than doubled in cash terms in the past decade, from £53bn (€66bn; $83bn) in 2000-01 to £120bn in 2010-11.

However, spending per person varies, and in 2010-11 England spent the least on health per person (£1900), compared with Northern Ireland (£2106), Wales (£2017), and Scotland (£2072). Variations are also evident in health outcomes, staffing, and quality.

Scotland has the most general practitioners per person—80 per 100 000 people in 2009, compared with 70 per 100 000 in England and 65 per 100 000 in both Wales and Northern Ireland. Scotland also has the most medical hospital staff and nursing, midwifery, and health visiting staff per person.

Accurate and easily comparable data on the efficiency and quality of healthcare are not so clear, says the report, and the authors do not say which of the four countries provides best value for money.

In 2008-09, average lengths of stay in hospital ranged from 4.3 days in England to 6.3 days in Wales.

In addition, hospital waiting times have fallen in all four nations in recent years, but there are notable variations in how long patients wait for common procedures. Waiting times in 2009-10 tended to be lower in England and Scotland than in Northern Ireland and Wales.

Across the four countries, there were significant improvements in levels of healthcare associated infections—in the four years to 2010-11, rates of meticillin resistant Staphylococcus aureus (MRSA) infection dropped by a third or more in all nations.

Amyas Morse, head of the National Audit Office, said: “We publish this report at a time when the NHS across the UK is under increasing pressure to use resources more efficiently. Funding is tighter, while the demand for healthcare continues to grow as a result of an ageing population and advances in drugs and technology.

“We consider that there would be value in the health departments in the four nations carrying out further work to investigate the variations in performance and identify how they can learn from each other to achieve better value for money for taxpayers and better care for patients.”

The report was prepared in collaboration with the Wales Audit Office and the Northern Ireland Audit Office, and with the advice and assistance of Audit Scotland.