Smaller countries that spend less on healthcare are doing a better job than Britain

Germany spends a few percentage points more than the UK on healthcare, but uses a compulsory social insurance-based system. Healthcare delivery is decentralised, delivered by the public and private sectors. Germany has undertaken 1.3 million tests, compared to the UK’s 300,000, providing far greater ability to track potential cases. While Germany’s death toll is not as low as that of the Asian tigers, it does compare favourably to similarly sized neighbours such as France, and Italy. France spends more than the UK on healthcare, Italy spends slightly less.

While this is all speculative – we won’t know for some time how different countries have handled this crisis – it appears British bureaucracy has been lacklustre. Despite years of pandemic planning, modelled on a less threatening H1N1-like flu outbreak, we were slow to take Covid-19 seriously.

The NHS, in conjunction with the military and private sector in the case of the Nightingale hospitals and ventilators, has done an extraordinary job expanding critical care capacity. But this may not have been necessary had we stopped the spread.

The body responsible for infectious diseases is Public Health England. PHE began testing in January, but limited testing to a single laboratory. It was not until mid-February that testing was expanded to the entire PHE network, and even later the NHS. PHE rebuffed offers from companies, universities, charities, and even animal testing labs, to help.

On February 26, PHE announced there was “no current evidence to show that the virus is circulating in the community”. In retrospect, an epidemiological impossibility. We just weren’t testing broadly. The UK, perhaps uniquely, has given up on testing and case tracing in the community. The Government is only now involving pharma companies like AstraZeneca and GSK in testing, but this remains weeks away.

In 2018/19, less than a quarter of PHE’s budget was directed towards protection from infectious diseases, the organisation’s raison d’etre. PHE has become best known for its nanny state concerns about sugary soft drinks and chocolate bars. Perhaps a refocus is in order.

When this is over, the key lesson must not be that the UK needs to spend “more” on healthcare. We could spend twice as much (like the United States), but end up with the same dismal outcomes. Bigger leads to inflexibility. It will be far more important to develop an agile bureaucracy that is willing to work with the private sector.

Matthew Lesh is the head of research at the Adam Smith Institute

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