The National Health Service (NHS) in the UK was created after the end of WWII as the crown jewel of the British Labour Party. Even though being among the most developed countries, UK has its fair share of problems with regards to healthcare. These problems are far bigger than what the politicians are willing to debate over or act upon. Lately their actions have worsened the system, and their proposal to remove the limit on public workers’ salaries would only enlarge the black hole that is the NHS. It is suffering from chronic problems which are typical of a centralised and ineffective system.


Although, at first glance, the National Health Service is almost completely free at the point of use — with the exception of NHS Scotland, where even prescriptions are free of charge — reports show that the health service is taking a heavy toll on the taxpayer. In 2016/17, the budget for the entire system is a staggering £122.6 billion, and while that sum might seem like a lot, it is highly insufficient in its current state. According to the Office for Budget Responsibility, NHS’s budget must be increased by 4% above inflation every year to help it cope with population increases, patient demand, and medical advances. This increase will inevitably be covered by a surge in National Insurance rates, which even now consume about 8% of the mean income in the UK.


NHS Scotland totally covers the expenses for healthcare users’ needs and partly those for other services. Due to the structure of NHS funding in the UK, the Scottish NHS receives £1200 per capita above the national average. Even so, this system is far from the utopia it is presented to be. As far as general practitioners are concerned, the service is poor, even in comparison with the poorest EU member state (which also happens to be my home) —Bulgaria. After scheduling an appointment, the wait usually takes between 1 and 2 weeks. The alternative is to call early in the morning on the same day, often unsuccessfully. Furthermore, patients are frequently limited by the general practitioners to discuss only 1-2 of their medicals problems at a time, leaving other complaints for another visit.


The attempt to create a digital patient record system came to a crashing end 4 years ago. The total amount wasted was nearly £10 billion, which was several times more expensive than expected. This failure is one of the biggest and most expensive ones in the history of public procurement spending. The mistakes of the ruling class are that they 1) tried to create a unified centralised system and 2) vastly underestimated the considerable amount of funding it would take to create and maintain such an overextended system. Digitalisation of the healthcare system would have been much easier and cheaper had private companies been allowed to create their own decentralised systems, which would have worked much more efficiently.


One of the main reasons that taxpayers are willing to pay such high prices is that they have no idea how much of their taxes the government uses to pay for certain goods and services. For example, it costs the NHS a staggering 20 times more to get a pack of paracetamol than at high street shops. The NHS spends £3.83 per pack of prescribed ibuprofen. In comparison, in most shops, ibuprofen can be found for 20-40p. In England in 2016, the NHS prescribed 22,900,000 packs of the medicine, resulting in a £87,600,000 cost to the system. This example is but one of many, yet it is indicative of pretty much everything within the system and clearly supports the argument for decentralisation. A centralised healthcare system is more expensive than a private one because, when someone else is financing such a system directly (government, NHS, etc.), it becomes very difficult to estimate how much it would cost the user — and the taxpayers themselves rarely have an incentive to do so. However, when the user is faced with the end price, it is in his best interest to search for alternatives (hospitals, clinics, medication, etc.) and to weigh out the price/quality ratio according to his preferences. This mechanism by itself will force the private companies to rearrange their business models to the liking of their customers or face the risk of losing money. After all, the client has the final say in a completely market based system.

The UK’s NHS is like a religion with overzealous followers. That religion is statism. It prevents most people from understanding the underlying problems of the system, often, because they don’t WANT to see them. This further obstructs its effectiveness and fails to reduce preventable deaths. At the end of the day, it is a matter of human lives vs. statism: the bureaucrats’ negligence stands in the way of effective healthcare.

This article was originally published in Bulgarian on