The numbers are striking in their enormous size: 7.6 million people are now on waiting lists in England, a figure that has been growing in recent years, breaking records in all but three of the last 30 months.
Therefore, English patients may have been surprised to hear that Steve Barclay is open to Welsh and Scottish patients on long waiting lists for treatment being able to request NHS care in England.
He also claimed that long waiting lists were far worse elsewhere, telling the BBC on Monday: “In England, we have virtually eliminated waits of over 18 months, whereas in Wales, for example, there are over 70,000 patients waiting more than 18 months.”
Where are waiting lists worst?
While the different systems make comparisons difficult, Barclay is right that there are disparities in waiting times across the four UK nations. The 7.6 million waiting list for England roughly speaking translates to one in seven of the population (although some individuals will be waiting for more than one treatment).
While Wales has the most comparable system to England, its waiting lists contain some patients that the English count does not (diagnostics, for example). That’s one outstanding treatment or test for every four people in Wales, with Digital Health and Care Wales estimating that one in six people are on waiting lists.
While Scotland and Northern Ireland differ in how they define their waiting lists, the best broadly equivalent figure is that one in nine people in Scotland are awaiting care, rising to a whopping 36% of people in Northern Ireland (although the latter figure includes some duplication, meaning the true number is lower). So, based on the available figures, England is doing better on this metric than Wales and Northern Ireland, but worse than Scotland.
What about long waits?
There is also wide divergence in the number of patients waiting more than a year for treatment.
England has made a concerted effort to eliminate very long waiting lists, resulting in a 99% fall in those waiting more than two years since January 2022. While 18-month waits are also falling significantly, yearlong waits are harder to unpick. About one in 20 people on a waiting list in England in June were not getting treatment for at least 52 weeks.
But while this equates to about one in every 150 people in England, things are worse elsewhere. Keeping the above disclaimers about comparability in mind, you are roughly twice as likely to have to wait a year or more in Scotland and Northern Ireland, where the best comparable figures stand at one in 80 and much worse in Wales, where one in 20 are waiting more than year for treatment.
Why are the differences so stark?
A spokesperson for Nuffield Trust said differences in demographics, resources and policy all fed into the disparities in waiting lists across the four nations.
“There are many differences across the devolved nations which might be relevant here, notably an older population in Scotland and Wales with more deprivation; higher nurse staffing and higher spending in both Scotland and Wales; and more doctors in Scotland,” they said.
“Although the NHS model remains recognisable in all countries, health policy has been slightly different, with England featuring more competition and private-sector involvement. Patients appear to spend slightly longer in hospital in Scotland compared with England, and quite a bit longer in Wales, which may make it difficult to treat as many patients with an equivalent number of beds and staff”.
How do health services work in the UK?
In the UK, health services are largely autonomous in each nation, since powers were devolved to Scotland, Wales and Northern Ireland in 1999. Each country controls its own health systems and the provision of health services, with Westminster retaining responsibility for England.
In Northern Ireland, the health services are integrated with social care and the system has been called Health and Social Care (HSC) since 1973.
How are they funded and how autonomous are the different health systems?
In all four nations, general taxation accounts for the majority of NHS funding, with the Treasury collecting revenues for the whole UK and agreeing the budgets for Whitehall departments and devolved administrations.
In the other nations, virtually all the funding comes from the Treasury; health spending is financed via the annual block grant funding from the UK government. The amount Scotland, Wales and Northern Ireland receive is calculated using the Barnett formula, which means the devolved governments get a set proportion of what goes to England. So if UK government ministers decide to increase the NHS budget in England, they must also fund an equivalent increase for Scotland and Wales.
Health expenditure in the United Kingdom in 2021/22 (of which NHS spend is the lion’s share) was highest in Scotland at £3,490 per person and lowest in England at £3,192 per capita.
Although the overall health budget is constrained to an extent by what the UK government decides to spend on the NHS in England, the Scottish, Welsh and Northern Irish administrations have a large amount of autonomy over how they run their health services.
In addition, England also raises some health income from patient fees, such as charges for prescriptions and some other services. Scotland, Wales and Northern Ireland have all abolished prescription charges, leaving England the only UK country where patients have to pay for prescriptions. And Scotland has some tax-raising powers.
