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12 March 2020

The viral statistic on spare hospital beds reveals a real problem for the government

One of the NHS’s strengths is its efficient allocation of beds – but during a pandemic that could become a major weakness.

By Stephen Bush

Is the NHS the envy of the world? Well, the answer depends on a different question: “what’s wrong with you?” Like most public healthcare systems it does some things very well and some very badly, but one way the NHS is genuinely world-leading is its highly efficient allocation of hospital beds.

That’s the real story behind a graph that is intermittently doing the rounds on social media, showing the NHS at or near the bottom of a list of spare beds per head in the OECD. The health service in England, Scotland and Wales is close to the bottom of the list in terms of spare beds per head of population. That isn’t, however, the result of the pressure of relatively low increases in NHS spending and cuts elsewhere since 2010. It was true at the end of a period of record investment by the last Labour government too.

The advanced economies you tend to find towards the bottom of that OECD list – Denmark, New Zealand, Canada, Sweden and the United Kingdom – all provide universal healthcare in slightly different ways, but what they have in common is that the taxpayer funds hospital care. There is no incentive to have more beds than they “need”. Most of the time, this is a good thing: it’s a benefit of providing free-at-the-point-of-use hospital care via government payment. Whether those countries are experiencing periods of higher or lower health spending, they continue to be near the bottom of the OECD list. 

By contrast, in advanced economies where universal healthcare is provided through social insurance, healthcare providers (for a number of reasons that we don’t need to get into here) are incentivised to have more capacity than they actually need. 

Which is better? Well, again, it ultimately comes back to the question of “what’s wrong with you?”. But from the narrow perspective of “tackling Covid-19”, the answer is almost certainly open and shut: the efficient model of the NHS and other similar models of hospital provision is not the system you’d design to tackle serious pandemics.

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Over the past ten years, NHS spending has risen while the rest of the public realm has felt the bite – increasing the pressure on the “core” NHS. But were I in Downing Street, it would not just be the decisions made over the past decade that would be keeping me awake at night – nor those made over the coming months – but those decisions made over the past seven decades. Why? Well, I suspect that when the dust settles on the Covid-19 outbreak, what will really matter in terms of public opinion is “how did we do relative to our equivalent neighbours?”. For a variety of reasons – its lack of a meaningful safety net, the incompetence of its president – the United States will likely finish bottom of the pile. But what will matter is whether the British government can point to its European neighbours and say it has performed about as well. 

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If it can’t, then the government’s reluctance to go in hard on early quarantine measures will inevitably be blamed – even if the real problem is decisions made over the last decade or longer.