Britain’s NHS is close to a national religion, but the public’s faith is being tested as never before. A senior health official estimates up to 500 people a week are dying due to emergency care delays, as ambulances back up outside swamped hospitals. More than 7mn people are waiting for elective treatment. Nurses are striking over pay. The country needs to break the cycle of sticking-plaster fixes that allow the NHS only to limp on until the next crisis, and take a hard look at how to make it fit for the future.
Frontline staff blame today’s woes on a capacity squeeze that reflects a lack of long-term investment and strategic planning. Senior managers say vested interests and poor IT have thwarted repeated attempts to raise efficiency. Both have some truth.
What is clear is that the hospital system has insufficient beds and people to meet the demands being placed on it. Even pre-Covid, England’s 100,000-odd general and acute beds — down 40 per cent from the 1980s — were on average 92 per cent full year-round. When demand spikes, in a pandemic or a flu outbreak, the system falls over.
Hospitals have more doctors and nurses than in 2019, though this is partly offset by higher sickness levels and less overtime working among a burnt-out post-pandemic workforce. And with 133,000 jobs unfilled in NHS England — almost one in 10 — the service has fewer staff than it projected it would need. Hospitals are treating fewer people than pre-pandemic, partly due to creaking infrastructure and IT.
Yet while the NHS was shielded from the worst of Conservative “austerity” spending cuts in the past decade, the other legs of healthcare’s three-legged stool — social care and public health — were not. Hospitals have 13,000 people occupying beds who are clinically fit to discharge but can’t be accommodated in community or social care. This bed “blocking” causes delays in emergency and elective care. With social inequality rising, more people are getting sick — and with GP numbers stagnant since 2015, more are going to hospitals.
Injecting temporary funds into social care, and using beds in hotels and private hospitals, can help. But stabilising the NHS long-term will require sweeping reform of social care — a huge undertaking that governments have repeatedly ducked — and revolutionising illness prevention.
The health system also needs sustained investment in people, buildings and technology to restore capacity. Managing it in an age when technology is keeping people alive — though often infirm — for longer, and expanding what health systems can and are expected to do, will mean raising more revenue, though increasing taxes is politically difficult for both main parties.
So Britain needs an open and sober national debate on what it is prepared to spend on health and — without sacrificing core principles — how the NHS is organised and financed. A review should look at whether the UK could learn from the structure or funding of systems in France and Germany, which use social insurance models. Both achieve better outcomes than the UK, though both spend a bit more as a share of their economies.
Comparative studies, however, suggest no one healthcare model is intrinsically superior; better results depend most on quality of management. A review should probe whether hospitals are being asked to do too much and primary care should be revamped to do more. It should tackle how to improve long-term planning, on which the UK has fallen down.
The taxpayer-funded NHS model has made it a constant political football and fuelled short-termism. A review should be led by independent experts to stand a better chance of driving a consensus. Similar initiatives have failed before. But the worst NHS crisis in memory, outside the pandemic itself, might finally create the conditions for one to succeed.