NHS in Crisis

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Just like Canada is known for its universal healthcare, Britain also boasts of a widespread and inclusive healthcare program: the National Health Service. Established on July 5th, 1948, it was a landmark moment in the country’s administration and for Prime Minister Attlee. This report highlighted free health care as a part of a larger welfare reform designed to alleviate unemployment, poverty, illness as well as improve education. The principles behind the program included its funding through general taxation rather than national insurance, universal healthcare for all (including visitors to the country) and it’s free provision at the point of delivery, no longer basing treatment on the ability to pay. The administration of the NHS falls to Parliament, the Secretary of State for Health, and the Department of Health. However, daily running of the NHS is overseen by NHS England, a government-funded body distinct from the Health Department. Meanwhile, the government owns the hospitals and care providers like ambulance services, mental health services, district nursing, and other community services. The government has an immense amount of responsibility and control over the NHS budget and the services it provides. In addition to all services being free at the point of service, many different groups, such as students,the elderly, pregnant women and people with disabilities are exempt from copayments for certain services like dental and vision care, prescriptions and transportation costs. Out-of-pocket healthcare costs accounted for 15 percent of total expenses in the UK, with 37% spent on long-term care services, including residential care, and 35% for medical goods. All of this puts a certain strain on government expenditure, with 89% of prescriptions in 2016, dispensed free of charge and the government spending around 9.8% of GDP on health care. Public expenditures, mainly related to the NHS, accounted for 79.4 percent of this amount.  

For all its touted services, the reality is that the NHS is facing a severe crisis. In December 2022, ambulance and A&E services posted their worst figures in recorded history. People waiting for hours for an ambulance while in critical condition and patients awaiting treatment for 12 hours in emergency rooms, paint a worrying picture. The NHS finds itself in such a precarious situation due to a culmination of poor political judgement, the pandemic and decades of underfunding. 

 A first important aspect to note is the increase in the elderly population in the UK. These people tend to require more medical care, while the younger population has decreased and less and less wish to work in the medical sector. The NHS has suffered from Britain’s policy of austerity for years, with its budget rising by only 1.4% in the past 10 years compared to the 3.7% boost it experienced closer to its foundation. This has led to chronic shortages of beds, equipment and most importantly, staff. Wages for medical staff, from medical secretaries to specialists, paramedics and nurses, have all declined between 4.4% and 8.2%. This has led to major staff shortages and a lack of retention and recruitment. These fewer workers also have to put up with more hours, leading to stress, burnout and mental strain. Furthermore, large cuts implemented on outside social care and mental health facilities are a huge burden on the NHS hospitals, as people have nowhere else to go to get care. An example of staff shortage is the crucial lack of GPs in the UK. In the NHS Long Term plan, there was the idea of moving care from hospitals to community health services, which are more accessible, to relieve the pressure on hospitals. However, a recent report indicated that in 2021, there were 1,756 fewer fully qualified full-time GPs compared to 2015, with 0.45 fully qualified GPs per 1,000 patients in England. This means that as the number of patients increases, the average number of patients for each remaining GP has gone up by 16%. Instead of helping relieve the strain on hospitals and emergency care services, the lack of GPs is only making it worse. 

Another crushing blow to the NHS came from Brexit. On 31st January 2020, the UK officially left the EU. The resulting changes in immigration meant a higher cost and more bureaucracy for visas. Medical staff working in the UK were then uncertain if they could remain, while prospective workers found themselves in limbo over job opportunities.  In 2021, around 37,035 doctors from the EU and (EFTA) were working in the UK. However, there would have been 41,320, or 4,285 more, if Britain’s decisions to leave the EU had not prompted a decrease in medical recruitment from the European Union. This has left four major medical specialties- anaesthetics, children, psychiatry, and heart and lung treatment-with even greater shortages. Additionally, Brexit has had an even more shocking effect on nurse recruitment. In 2015-2016, 9,389 nurses came from the EU bloc to work in the UK, this number plummeted to 663 in 2021-2022, with the UK having 58,000 fewer nurses than if the numbers arriving pre-Brexit had continued. This can be explained by the fact that a large majority of nurses come from outside England, notably India and the Philippines. With EU free movement restricted and new costly and complex visa regulations enacted, fewer medical professionals have come to work in the NHS, exacerbating the crisis.

Finally, the last aspect which blew up the NHS crisis was the Covid-19 pandemic. While people mistakenly blame the pandemic for the NHS crisis, this is not the case. As outlined above, the pressure on the NHS was years in the making. The NHS was struggling with bed shortages, an aging population, and massive staff shortages when the pandemic hit. Conditions for healthcare workers were disastrous. Per a BMA report, healthcare workers were among those with higher infection rates, with minority and disabled doctors’ physical health negatively impacted more than their peers. Workers suffered from burnout, overwork, distress, anxiety, exhaustion, trauma, and isolation. Calls to the BMA’s counselling service increased by (37%) in the first year of the pandemic, and many admitted considering leaving their profession. Crucially, many doctors lost their lives due to Covid-19, with new safety procedures implemented much later by the government. Patients were also severely affected by the lack of organization. During the peak of the pandemic, multiple practices were put on hold and millions of operations were cancelled. The NHS “backlog” increased exponentially, and over 7 million people were on a hospital waiting list. In addition, the original lack of beds was made worse because the few available beds were then occupied by COVID-19 patients, who required long-term care, instead of by other kinds of patients. 
Overall, the NHS crisis was caused by insufficient government spending, a lack of workers, Brexit and the COVID-19 pandemic. Even now, shocking stories of patients treated in the back of an ambulance, in corridors, waiting rooms and cupboards or not at all, are becoming public knowledge. Medical workers have staged strikes all over England protesting long hours, small wages and poor work conditions. A solution some people have found to avoid year-long waiting lists is to take out private insurance. In 2022, the number of patients paying directly for private hospital care increased 34% compared to 2019. Private hospitals and healthcare services have expanded, with over 15 million new patients flocking to private care services. This has led to concerns about healthcare becoming a two-tiered system in the UK, with wealthier people able to afford private care, while the less fortunate rely on a struggling NHS system. Politically, polls show that healthcare is now a top voter priority.  The healthcare system, and emergency health particularly, is seen as a basic responsibility of the government. As such, its collapse is seen as the administration’s failing. The Conservative government needs a solution but none seem to be forthcoming. Recently, Prime Minister Rishi Sunak abandoned a promised tax increase to fund social care to appease tax-averse Conservative MPs, and rejected plans for reform of care costs. Unfortunately, a decade of mismanagement will not seem to be rectified in a few years. Ambulance and emergency room wait time will remain tragically long, while medical staff recruitment and training will take time. However, through new social reforms, more funding and better recruitment, maybe the NHS will someday inspire the pride it once did.