Britain’s National Health Service (NHS)

Britain’s system of socialized medicine, known as the National Health Service (NHS for short), is widely perceived by US voters as synonymous with poor healthcare, hence an unacceptable model for healthcare reform. That is the reason that Obama’s reform is so timid – the fear of being perceived as a move toward the British system. ‘Obamacare’ (aka ‘Romneycare’) does not offer even a public insurance option, much less move to a single payer system or socialize the delivery of medical care. But in the UK, voters are surprisingly satisfied with their healthcare system. Opinion polls reveal that satisfaction with the NHS in the UK climbed to 64% in 2009, nearly double the 34% approval rating recorded when the Conservatives, led by Margaret Thatcher John Major, left office in 1997.

The Conservatives, under David Cameron, returned to power in May of last year, in coalition with the Liberal Democrats, following elections in which no party was able to win a majority of seats in Parliament. The new government has promised more choice to NHS patients, but an austerity budget limits increases in NHS funding to increases in the consumer price index, equivalent to zero growth in real terms. If service deteriorates, satisfaction with the NHS will no doubt fall as well.

Satisfaction with the NHS is at its highest level ever. When Labour entered office in 1997, only a third of people (34%) were satisfied with the NHS, the lowest levels since our survey series began in 1983. By 2009, satisfaction stood at 64%, the highest level since the survey began. ….

While satisfaction with the NHS among Conservative supporters fell initially when Labour came to power, it rose 12 percentage points between 1996 and 2009, reaching a high of 61% in 2009. [Click on chart for a clearer view.]


John Appleby and Ruth Robertson, “A healthy improvement? Satisfaction with the NHS under Labour“, chapter 4 of  British Social Attitudes 27th Report (National Centre for Social Research, London, December 2010) – summary of the chapter.

UK residents tend to be more satisfied than US residents with their respective systems of healthcare. In a 2009 online survey carried out in 14 countries, 79% of UK respondents rated the quality of healthcare in their country as good, compared to 55% of US respondents. [Click on chart for a clearer view.]


Bobby Duffy, Anna Quigley & Kate Duxbury, National Health? Citizens’ views of health services around the world (Ipsos Social Research Institute, December 2010)

The NHS is a huge bureaucracy, which makes even more remarkable the high levels of satisfaction expressed by its patients. How large is the NHS? That information and more is available from the NHS web page:

The NHS was born out of a long-held ideal that good healthcare should be available to all, regardless of wealth. That principle remains at its core. With the exception of charges for some prescriptions and optical and dental services, the NHS remains free at the point of use for anyone who is resident in the UK. That is currently more than 60m people. It covers everything from antenatal screening and routine treatments for coughs and colds to open heart surgery, accident and emergency treatment and end-of-life care.  ….

The NHS employs more than 1.7m people. Of those, just under half are clinically qualified, including 120,000 hospital doctors, 40,000 general practitioners (GPs), 400,000 nurses and 25,000 ambulance staff.

Only the Chinese People’s Liberation Army, the Wal-Mart supermarket chain and the Indian Railways directly employ more people.

The NHS in England is the biggest part of the system by far, catering to a population of 51m and employing more than 1.3m people. The NHS in Scotland, Wales and Northern Ireland employ 165,000, 90,000 and 67,000 people respectively.

The number of patients using the NHS is equally huge. On average, it deals with 1m patients every 36 hours. That’s 463 people a minute or almost eight a second. Each week, 700,000 people will visit an NHS dentist, while a further 3,000 will have a heart operation. Each GP in the nation’s 10,000-plus practices sees an average of 140 patients a week.

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