The question of reforming the NHS has been bounced around news cycles for many years in the UK. However, with operation waiting lists at an all time high and user satisfaction rapidly falling, finding an answer has never been quite so pertinent.
Medical professionals and NHS staff have been on the front pages of national newspapers, highlighting the dire state of hospitals around Britain. The Guardian’s news report gave a deep insight into the problems staff face in King’s college hospital, London. There are enormous backlogs of operations, up to 7.1 million in fact. The NHS is suffering from poor worker retention, as staff are pushed to burnout with long hours and unpaid overtime. The impact of long hours and below inflation pay rises has resulted in the first ever nurses strike in British history. Nursing staff have already walked out on the 15th of December, with another 12 hour strike planned for Tuesday. There’s no doubt the NHS faces a crisis, but where does it come from? What is the solution?
There are some commentators on the political right who view the NHS as a deeply bureaucratic and inefficient institution. Robert Colvile, columnist at the Sunday Times, states that other European countries have a healthier mix between public, private and charity sectors in their healthcare systems. The NHS benefits from private sector experience in procurement of resources and taking off the weight of large patient numbers. Some experts in the medical profession concur. The NHS is not fundamentally flawed but in need of minor reform. Supplementing free services with insurance payments or direct payments would relieve the financial burden of the NHS. It will also reduce the number of people seeking surgery as they are incentivised by personal costs.
While Colvile may be right about decentralisation, it is an unsubstantiated belief that the ‘monolith’ of the NHS is inefficient compared to its European counterparts. Productivity in hospitals increased 16.5% between 2004-2016. In comparison, the average UK workplace increased productivity by 6.7%. Moreover, 2% of staff are in managerial positions, compared with 9.5% in the average UK workforce. The UK also ranks above Germany, France, Switzerland and Sweden in efficiency, according to the CommonWealth Fund.
Funding is ultimately one of the biggest factors in providing adequate healthcare. Spending on healthcare is the highest it’s ever been (outside of the Covid pandemic) but as medical technology develops and the population ages, spending has to increase to maintain the same level of service. Spending has to increase by 4% year on year. Between 2009-2018 spending increased by 1.5% in real terms. Coupled with cuts to mental health and social care services, the NHS has been left with more responsibility and insufficient resources. Social care is an essential part of healthcare infrastructure. It allows patients to be discharged from hospitals and therefore frees up beds. The number of patients in beds for more than seven days has increased by 14%. Patients in beds for more than 21 days increased 24%.
The chronic staff shortage in hospitals has only compounded these issues. Staff are leaving in droves, 40,000 leaving this year alone. The main factors being the effects of inflation and inhumane working hours that leave nurses and doctors with burnout, attempting to pick up the work of multiple staff members. Some nurses are even resorting to food banks. Overworked and demoralised staff are a danger to patient welfare as they may be unable to make swift and well-informed decisions. The government has called nurses' pay demands of 19% unrealistic but the result of poor pay has damaging long term effects. Without proper pay, there is little incentive for the best and brightest workers to join the NHS, especially compared to lucrative private sector contracts. The staff who do remain with the NHS are then pushed out by shortages of workers, deepening the crisis. If the government wants to save the NHS it has to begin by reviewing doctors and nurse’s pay packets.
Unfortunately, one of the biggest factors in the plight of the NHS cannot be solved with money. Covid continues to plague hospitals, first by allowing the backlog of operations to grow to its highest ever level and by reducing available beds for non-covid patients. Hospitals still maintain a policy of separating covid patients from the general population. The consequence of this being a lower number of beds available now, than in the pre-pandemic period. Tom Waters, a senior researcher at the Institute for Fiscal Studies, found a huge spike in disabilities requiring complex healthcare since 2021. This is in conjunction with the long-covid phenomenon, whereby people have faced long term illness after contracting the virus.
In any case, it is clear that the NHS and all related health services are chronically underfunded, which is driving the decline in quality of service. If this government is truly committed to the NHS they will seek greater funding for local governments to pay for social care and give nurses the pay rise they deserve.
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