The National Health Service (NHS) in Britain has always been cherished, with its universal healthcare and free services. However, critics have long complained about the quality of care provided. Today, the NHS is facing a crisis, and the determination to solve its problems seems to be lacking. As another winter crisis looms, it’s crucial for politicians and voters to confront some tough questions about how to address these issues.
One clear point is that the UK has historically spent less on healthcare compared to other similarly prosperous countries. While the US stands as an outlier with exorbitant per capita health spending, Britain also falls behind countries like Canada, Australia, France, Denmark, the Netherlands, and Germany in terms of spending per person on health. The shortfall became more evident during the pandemic, as the NHS lacked the necessary resources to meet the demands of the emergency. This predictable outcome can be traced back to years of constrained spending and inadequate investments.
The consequences are apparent. The NHS has higher rates of preventable deaths compared to other advanced countries, and survival rates for various cancers are below average. At present, over 7.4 million individuals are waiting for treatment, with many waiting for more than a year. Ambulance waiting times have soared, and getting an appointment with a general practitioner, who serves as the gateway to specialized services, has become unbearably slow. In the run-up to the pandemic, the UK had far fewer hospital beds, diagnostic scanners, doctors, and nurses than many of its peers.
Should anyone be surprised by these problems? During the decade following the financial crisis of 2008, the UK spent significantly less on healthcare than its European counterparts. To match the median spending of EU14 countries (members that joined before 2004) per person, the UK would have needed an additional £40 billion ($51 billion) per year. To reach Germany’s level, spending would have had to increase by 40%.
To address the shortage of healthcare professionals, Prime Minister Rishi Sunak’s government introduced a £2.4 billion plan to train, retain, and recruit more healthcare workers, aiming to fill approximately 110,000 vacant NHS jobs. However, this plan falls short of the required measures and funds. There are essentially two ways to bridge the gap: increase taxes to support higher spending or rely more on private healthcare provision. Yet, the country strongly opposes both these options.
However, this issue is not solely about money. The NHS operates on a command-and-control structure that discourages innovation and responsiveness to patient needs. The government has recognized this problem, but their reforms thus far have been timid. The implementation of “integrated care systems” that connect service providers by geographical area has been hampered by excessive targets and constraints. Local providers should be granted more autonomy and held accountable by local authorities. Germany and Finland, with their devolved care models, could serve as examples.
Another aspect that requires change is the NHS’s use of data. The fragmented and non-interoperable information hinders effective diagnosis, treatment, and preventive care. The government acknowledges this issue, but their proposals fall short of what is necessary.
The UK’s social care model is also faltering, further exacerbating the challenges faced by the NHS. With insufficient provision for those with chronic and long-term needs, hospitals find it difficult to discharge patients, resulting in increased costs and a drain on economy-wide productivity as family members quit their jobs to care for their loved ones. There were promises of reform last year, which were subsequently postponeddue to lack of funding.
The solution does not lie in simply pouring money into a broken system. Structural reforms are essential to ensure that new funding is spent efficiently. However, it is inevitable that there needs to be a combination of public spending (and thus higher taxes), increased reliance on cost recovery (through charges and co-payments), and a larger role for private provision if standards are to be reinstated and improved.
Maintaining a sense of reverence for the cherished post-war system, which recently marked its 75th anniversary in Westminster Abbey, hampers progress. As healthcare becomes more expensive, demographic pressures drive up costs, and citizens demand faster and better services, compromises will have to be made. Though it may be difficult for the country to consider, a new model is likely needed. The government should be honest with the voters and engage them in this decision. Nostalgia will not cure the current healthcare woes.