What’s the NHS annual budget? How many doctors and nurses are there? What’s the cost of an operation?
How much does it cost?
In 2020/21 the Department for Health and Social Care spent £192 billion. This money is used to fund a wide range of health and care services, including GP services, ambulance, mental health, community and hospital services, which are commissioned by the NHS, and public health. It also funds some social care services, which are mainly commissioned by local authorities. £2.5 billion of the Department for Health and Social Care’s budget is spent on administration costs for the department and the health and care system, such as departmental running costs, regulatory costs and business services, eg, the NHS payroll. The total budget for 2020/21 was more than £50 billion higher than in 2019/20 as a result of the Covid-19 pandemic. The funds raised through the Health and Care Levy and other additional funding commitments will see the department’s budget reach more than £170 billion a year from 2022/23.
What percentage of GDP does the United Kingdom spend on health compared to other countries?
In 2019 the UK spent 10.2 per cent of its GDP on health, which is in line with the average among comparable countries. The provisional estimate for 2020 is that this has risen to 12.8 per cent due to the increased funding allocated to tackling the Covid-19 pandemic.
How much of the NHS budget is spent on the workforce?
The NHS is one of the world’s largest employers with around 1.2 million full-time equivalent staff in England, as of June 2021. Consequently, the wage bill for the NHS makes up a substantial proportion of its budget. In 2019/20, the total cost of NHS staff was £56.1 billion which amounted to 46.6 per cent of the NHS budget. These statistics don’t include salaries for GPs or employees from the Department of Health and Social Care and other national bodies, such as NHS England and NHS Improvement. GPs and GP practice staff are indirectly funded by the NHS, but the flow of money to GPs is more complex.
What’s the cost of going to A&E?
The cost of an individual going to A&E depends on the type of A&E an individual attends — from a major, consultant-led department in a hospital to an urgent care centre or walk-in clinic — and the type of treatment they receive. For someone who attends an urgent care centre and receives the lowest level of investigation and treatment, the average cost in 2021/22 is £77. For an individual at a major A&E department who receives more complex investigation and treatment, the costs start at £359.
What’s the cost of an ambulance trip to A&E?
In 2019/20, the average cost of a patient being taken to A&E by ambulance was £292. Ambulance call-outs that didn’t result in a trip to A&E cost an average of £206.
What’s the cost of an operation?
The cost of an operation depends on a range of factors, such as the complexity of the procedure and how long the patient stays in the hospital. In the NHS in England, the national tariff outlines the average cost of procedures. These average costs are then adjusted to take into account of local variation, such as higher costs of staffing in London (this is known as the market forces factor).
For example, in 2021/22 an appendix removal operation for a child without complications costs, on average, £2,817, and the average cost of an emergency coronary artery bypass graft without complications is £9,212. The cost of a hip fracture procedure varies from £2,094 to £7,266 depending on the complexity of the procedure and the condition of the patient.
The national tariff system will be amended as part of wider health and social care reforms in 2022.
What’s the cost of a GP appointment?
A recent study estimated that, in 2020, the average 9-minute GP consultation costs £39.23.
What does the money buy?
When it comes to health and care funding, it can be hard to make sense of the numbers discussed and what they actually mean for patients, staff and the system. Below we outline what £1 billion in health and social care spending would buy in 2019/20.
How many doctors, nurses and managers are there in the NHS in England?
In June 2021 there were 123,727 doctors, 332,341 nursing staff (including midwives and health visitors) and 33,907 managers in the NHS out of a total workforce of 1.2 million (all figures are full-time equivalent). Between 2011 and 2021, the number of doctors and nurses rose while the number of managers is broadly similar (doctors increased by 28 per cent and nurses by 11 per cent between March 2011 to March 2021). NHS vacancy statistics estimate that there are almost 100,000 in the NHS, as of Q2 2021/22 (including more than 8,000 medical professionals and nearly 40,000 nursing staff). This includes vacancies in hospitals and in the community. However, these numbers are only estimates as there is not yet a standardised method for reporting NHS vacancies.
Compared to 2011 the number of doctors and nurses, while the number of managers is broadly similar
How many groups commission care?
Since 2013, clinical commissioning groups (CCGs) have been responsible for planning most primary, community and hospital care services, including urgent and emergency care, in their local area. As of 1 April 2021, following a series of mergers, there are 106 CCGs in England. Subject to the successful passage of the Health and Care Bill through parliament, CCGs will be abolished at the end of March 2022, with their functions and most of their staff transferring to integrated care systems (ICSs), which will be placed on a statutory footing. As well as commissioning, ICSs will also focus on integrating health and care services, improving population health and reducing health inequalities. Since April 2021, 42 ICSs have been operating across England.
How many NHS hospitals are there in England?
Working out the number of hospitals in England is challenging. All NHS hospitals are managed by acute, mental health, specialist or community trusts and as of 2021, there were 219 trusts, including 10 ambulance trusts. However, the number of NHS trusts does not correlate to the number of hospitals as many trusts run more than one hospital, for example, Manchester University NHS Foundation Trust runs nine hospitals.
How many available beds are there in the NHS? Is the number of beds decreasing or increasing?
There were 136,878 consultant-led beds available in the NHS, as of Q2 2021/22. The total number of beds in the NHS will be higher as this doesn’t include critical care beds or those where the patient is under the care of a nurse rather than a consultant.
The graph below shows the number of available consultant-led beds in England has halved over the past 30 years. Proportionally, the largest falls have been in beds for people with learning disabilities, and people with mental illness and long-term beds for older people. Medical advances that mean patients don’t have to stay in hospital for as long and a shift in policy towards providing treatment and care outside the hospital have contributed to the reduction in bed numbers.
Within elective care, the number of referrals to outpatient services increased from 4.1 million in Q1 2008/09 to 5.9 million in Q1 2019/20. This represents an overall increase of 42 per cent — an average increase of 3.2 per cent a year. Before the pandemic, elective admissions were also increasing — from 6.7 million in 2008/09 to 8.5 million in 2019/20, largely due to an increase in day-case admissions.
The number of patients referred for an outpatient appointment increased by 42 per cent between Q1 2008/09 and Q1 2019/20
This growth in demand is also reflected in general practice. Routine reporting on the number of GP appointments has only been available since March 2018 and estimates there are more than 300 million GP appointments available a year. While we can’t show equivalent trends as we have for A&E or elective care, a research study using a sample of GP data estimated that the total number of face-to-face and telephone consultations increased by 15.4 per cent between 2010/11 and 2014/15.
What has been the impact of Covid-19?
The Covid-19 pandemic completely changed the activity profile for the NHS. In 2020/21, fewer people attended a major A&E department — a decline of 22 per cent (3.5 million attendances) compared to the previous year. At the same time, hospital patients needed more intensive care — there were nearly 2,000 more critical care beds in acute trusts in January 2021 compared to the end of 2020. Hospitals cancelled routine procedures to ensure Covid-19 patients could be treated; this meant the backlog of patients waiting for treatment grew to nearly 6 million by October 2021. Infection prevention controls, such as separating Covid-19 positive patients from negative patients, also limited hospital activity levels.
Many services had to change the way they operated. Pre-pandemic, GPs were conducting around 3 million telephone appointments a month, but during the pandemic, it is estimated that the number peaked at 11 million (March 2021).
Some areas of activity are expected to return to normal as the country recovers from the pandemic. For example, type 1 A&E attendances in June 2021 were already higher than pre-pandemic levels. The backlog of people waiting for care means some activities, such as routine operations, are likely to be affected for years.
The average day in the NHS
There is no ‘average day’ for the NHS. Each day varies depending on the day of the week, the environment (eg, the season), social and cultural events (eg, bank holidays) and disaster events (eg, global pandemics). But if there was an average day (pre-pandemic) for the NHS in England, it might look like this.
On an average day in the NHS…
- More than 1 million people would attend a GP appointment
- More than 250,000 people would attend an outpatient appointment
- More than 30,000 people would call 999
- Nearly 45,000 people would attend a major A&E department, and about 20 per cent of A&E patients would be admitted to hospital
- Around 750 patients would go into critical care
Sources Kings Fund 2019/20/22 data