With less than two weeks left before voters head to the polls to elect the next UK Government, one of the biggest political footballs up for debate is - as ever - the future of the NHS.

All sides are promising to rescue the health service but the question of "how" tends to be answered by a mixture of vague reforms ("cut bureaucracy"), red herrings, or a sliding scale of increased spending.

The SNP is pushing for an extra £16 billion a year to be spent on health in England - equivalent to an extra £1.6bn for Scotland - while Reform has pledged an extra £17bn annually, and the Green party an extra £28bn a year by 2030, compared to promises of an extra £1bn by the Conservatives, £2bn by Labour, and nearly £6bn per year by the LibDems.


Health policy and the running of the NHS is devolved, of course, so whoever wins the keys to Number 10 on July 4 will be responsible for what happens in NHS England.

Nonetheless, the new UK Government's decisions on health and social care spending will influence the sums available to spend on public services north of the border, and UK-wide policies - such as welfare benefits - have implications for people living with long-term health conditions and disabilities.

It is also true that the UK shares many of the same problems when it comes to health and healthcare: an ageing population, rising obesity rates, collapsing social care, gridlocked A&E departments, huge hospital waiting lists, a shrinking GP workforce, and whole regions where patients cannot register with an NHS dentist.

Public satisfaction with the NHS is at an all-time low of just 24% according to the latest findings of the British Social Attitudes survey, and just 13% are satisfied with social care services.

So how do we fix it?

There is a general agreement that, historically, the NHS has been underfunded compared to similar OECD countries, resulting in fewer doctors, nurses, hospital beds, and scanners per head than the likes of Norway, Germany, France, or even our nearest neighbour, Ireland.

As of 2022, Ireland boasted 15.2 nurses and four doctors per 1000 inhabitants compared to 8.7 and 3.2 respectively in the UK.

The UK has comparatively few doctors than similar health systemsThe UK has comparatively few doctors than similar health systems (Image: OECD)

Nurses per 1000 inhabitants also lag behind other countriesNurses per 1000 inhabitants also lag behind other countries (Image: OECD)

When New Labour was elected in 1997, UK health spending as a percentage of GDP increased sharply, going from just under 7% to just under 10% by 2010.

It flatlined over the subsequently decade under Conservative-led austerity measures - a factor blamed for a UK-wide deterioration on a range of key targets, such as A&E performance and waiting times for elective surgery.

In response to the Covid pandemic, UK health spending in terms of GDP rose sharply and settled at 11.3% as of 2022.

That has propelled us towards the top of the OECD rankings. Only five countries - the US, Germany, France, Japan, and Austria - spend a larger percentage of GDP on health.

On the downside, we still trail behind similar wealthy countries when it comes to per capita spending: the UK spends $5,500 per person on health, compared to roughly $6000-$8000 in western Europe, Canada, and Australia.

The UK currently ranks 6th for health spending as a percentage of GDPThe UK currently ranks 6th for health spending as a percentage of GDP (Image: OECD)

On healthcare spending in US$$$ per capita the UK ranks lowerOn healthcare spending in US$$$ per capita the UK ranks lower (Image: OECD)

If the parties all want to increase investment in the NHS, the next question is how?

Only Reform proposes a shift away from the NHS model in favour of European-style insurance systems, which rely on a combination of government funding and patient contributions.

It can seem like an obvious solution: if our European neighbours have better resourced healthcare systems and better outcomes on a range of key measures, including cancer survival, then perhaps the answer might lie in the way they fund it?

Independent think tank, the King's Fund, explored the issue for a report published in June last year.

It concluded that while the UK's NHS "has fewer key resources than its peers" there was "little evidence that one ‘type’ of health care system or health care financing model achieves consistently better results than another".

Furthermore, the costs of transitioning from one system to another "can be significant".

In short, it is better to focus on improving an existing model of care than wasting time and money adopting something "radically different".

Reform wants to scrap the NHS funding model in favour of European-style insuranceReform wants to scrap the NHS funding model in favour of European-style insurance (Image: PA)

The simple reason our European counterparts have better-performing healthcare systems today is because they invested more than us over recent decades.

But Europeans, like us, are struggling with rising costs. In France, for example, insurance premiums are rising by around 10% this year.

Another recurring theme is use of the private sector.

Labour - currently on track for massive majority - promises to "use spare capacity in the independent sector" to bring down waiting lists (something echoed by Reform), but this is more complex than it sounds.

On the one hand, it is unclear how much spare capacity there really is in private hospitals.

With soaring demand from people willing to pay for their own operations, how amenable would independent providers be to ring-fence beds for (less lucrative) NHS contracts?

Secondly, most of the consultants and surgeons working in the private sector are also employed by the NHS.

If the NHS starts pouring money into the private sector to clear waiting lists, the risk is that it entices more staff to make the move while leaving the health service even more short-staffed with less cash to invest into its own hospitals, operating theatres, and infrastructure.

Labour said they would use 'spare capacity' in the private sector to clear NHS England waiting lists and 'incentivise' staff to work evenings and weekendsLabour said they would use 'spare capacity' in the private sector to clear NHS England waiting lists and 'incentivise' staff to work evenings and weekends (Image: PA)

That is not to say this doesn't happen already (NHS Scotland spent £128 million sending patients to private hospitals for quicker treatment between 2018 and 2023), but it is a question of scale.

Inevitably, the focus is on hospitals.

Labour also promises to "double" the number of CT and MRI scanners and deliver two million extra NHS operations, scans, and appointments each year by "incentivising staff to carry out additional appointments out of hours".

Absent from manifestos is any suggestion that long-squeezed general practice should get a larger share of the funding pot, nor any novel solutions to fund social care, despite repeated pleas that fixing the "gateway" and the "back door" of the NHS would deliver the biggest bang for our buck.

If we're willing to spend more, maybe the biggest rethink should be where - not how much.