Breaking Point: How long does the NHS have left?
The NHS is going through a difficult time, with record waiting times, junior doctor strikes and significant underfunding. How long does the NHS have left before it is beyond saving?
7 minute read Once the envy of the world, the National Health Service has been making headlines for all the wrong reasons in recent years. Sky-high waiting lists, inability to access a GP, mass strikes by nurses, doctors and ambulance staff and ambulances parked for hours outside A&E departments are just a few of the horror stories we read daily.
In this article, we’ll take a look at the history of the NHS, the cost of running the health service, and ask the difficult, but necessary question: Is this the end for the NHS?
A brief history of the NHS
Arising from the ashes of the Second World War, the National Health Service was launched on 5th July 1948, by then minister for Health and Housing, Aneurin Bevan. The intention was to provide free at-the-point-of-use healthcare service to all, regardless of social or economic background.
Bevin laid out his vision for the NHS, stating:
“The essence of a satisfactory health service is that the rich and the poor are treated alike, that poverty is not a disability and that wealth is not advantaged.”
But it wasn’t all plain sailing. In 1951, the NHS budget was cut, resulting in Bevan’s resignation. In 1952, charges were introduced for glasses, prescriptions and dental treatment. Since then, the NHS has undergone numerous changes and reforms in a bid to make the service better and more cost-effective
With all of the negative headlines, are any of them working? And what does the future hold for the NHS?
How much does the NHS cost to run?
According to The Kings Fund, the Department for Health and Social Care spent £190 billion in the year 2021/22. That’s 11.3% of the UK’s gross domestic product (GDP).
This includes funding for GP services, ambulance, mental health, community and hospital services, and some social care services.
Of this money, £2.7 billion was spent on administration, such as departmental running costs, regulatory costs and business services.
In 2021/22, the total cost of staffing the NHS was £66.2 billion, which accounted for 45.2% of the NHS budget. This number doesn’t include GP salaries, employees from the Department of Health and Social Care, or other national bodies, such as NHS England.
How is the NHS funded?
The NHS is mainly paid for through general taxation and National Insurance contributions, with a small percentage being covered by patient charges.
General taxation funds around 80% of the NHS budget, with the remainder covered by National Insurance contributions. Total NI contributions to the NHS in 2017/18 were estimated to be just under £24 billion, which is just under 20% of the total budget.
Patient charges, such as for prescriptions and dental care, amounted to £1.6 billion in 2016/17.
Is the NHS worth saving?
Bevan’s vision of free at-the-point-of-use healthcare for all remains sacrosanct to most people in the UK to this day. Many of us aren’t old enough to remember the days before the NHS, but the idea that healthcare may be a privilege available only to the rich strikes fear into the hearts of many. We shake our heads at stories about healthcare in the US, where people have been made bankrupt, or even died due to the exorbitant cost of healthcare.
What isn’t disputed is that since its launch in 1948, the NHS has improved the health of millions.
Before mass vaccination was introduced, there were 8,000 cases of polio and 70,000 of diphtheria every year in the UK. Under the NHS, polio, diphtheria, whooping cough, tetanus, measles, mumps and rubella were virtually wiped out during the second half of the 20th century.
Infant mortality has also fallen dramatically from 34.5 in every 1000 live births in 1948 to just 3.8 in 2017.
Since the beginning of the NHS, deaths from our biggest killers have declined, with deaths from heart disease falling from 28.8% of all deaths in 1948 to 15.7% in 2017. Deaths from stroke have also reduced from 11.2% in 1948 to 6.2% in 2017.
What does the public think?
In a 2017 survey by the King’s Fund, 77% of those questioned think the NHS should be maintained in its current form. Around 90% still support the founding principles of the NHS and 66% would be willing to pay more tax to fund the NHS.
What do the health professionals think?
A new survey by the British Medical Association (BMA) revealed that 67% of junior doctors did not think the NHS in its current form would exist in 10 years’ time, blaming the government’s refusal to listen and instigate a long-term solution to the crisis among NHS workers.
A recent survey by the Nursing Times questioned almost 600 nurses and nursing support staff and found that 63% did not think that the NHS would still exist in another 25 years. However, 94% of those questioned said that the health service deserved to be protected.
Whether or not the NHS is worth saving is rarely up for debate. Most of us agree that it is. The bigger questions could be, can it survive in its current form? And what needs to be done to save our NHS?
So, what is the solution?
Clearly, there’s no straightforward solution to saving the complex problem of the NHS. In his book, Free for All: Why The NHS Is Worth Saving, author and doctor Gavin Francis explores the complexities of the health service and calls for “an urgent national conversation” about the future of the NHS.
In the book, Francis outlines some of his ideas to safeguard the future of the health service, including:
Putting pressure on elected officials to commit to funding the health service to ensure that we are in line with our European counterparts
Investing in GP services and community care, which currently accounts for 90% of NHS patients and yet receives less than 10% of the funding
Expanding hospital wards and community care capacity to cope with increased demand over the winter months
Supporting NHS staff by paying them properly, shifting their workload to free up capacity and time and expanding health promotion into areas such as the media to reduce pressures on hospitals and clinics
Keeping the frail and elderly out of hospital by building a network of home-care teams and intermediate-care hospitals
Reducing waste and building more energy-efficient buildings that not only benefit the planet but also save money that can be used for patient care
Is a change of government the answer?
Speaking at a Labour party conference in October 2023, opposition leader Keir Starmer outlined Labour’s plans for the NHS, stating that a Labour government will “get the NHS working around the clock and pay staff properly to do it”.
The Labour Party have identified three big shifts that they say are necessary to restore the NHS and make it fit for the future.
To shift the focus out of hospitals and into the community. Labour plans to do this by expanding community pharmacy, bringing back the family doctor, and recruiting 8,500 more mental health professionals to provide support in every community. Funding for this will be achieved by closing tax loopholes for private equity and private schools.
To move away from treating illness and instead focus on health prevention. This includes the creation of breakfast clubs in primary schools so that children don’t start the school day hungry. Labour also plans to tackle childhood obesity by banning junk food ads targeted at children. Breakfast clubs in schools will be paid for by scrapping the non-dom tax status.
To reduce red tape to speed up the implementation of new artificial intelligence that can rapidly read scans and interpret X-rays, allowing for faster, more accurate diagnosis and freeing up NHS staff.
The Labour Party also plans the biggest expansion of NHS staff in its history by creating 7,500 more medical school places and 10,000 more nursing and midwifery clinical placements per year. Labour also pledges to increase retention of current NHS staff by “looking more broadly at how public sector pay is set”.
The role of the private sector
Privatisation of the NHS is a topic guaranteed to raise strong emotions. Many consider it a slippery slope towards an American-style system, or one where shareholders, not doctors, make decisions about our health. Though a privatised system may mean faster appointments and more choices for patients, many fear it could make healthcare accessible only to the wealthy — the very thing the NHS was created to avoid.
Despite government denials, some feel the NHS is already gradually being privatised as more non-government bodies become involved in the financing and provision of healthcare. The boundaries between private and public healthcare, however, are not always clear cut and there have always been elements of privatisation within the NHS.
Dentists, optometrists and pharmacists have always been for-profit contractors, and most GPs are private partnerships. The NHS has long-established partnerships with the private sector for clinical services such as radiology and pathology and non-clinical services like building management and car parking. There are also agreements in place with private hospitals to provide extra capacity and relieve pressure on NHS services.
According to the King’s Fund website:
There is no evidence of widespread privatisation of NHS services. The proportion of the NHS budget spent on services delivered by the private sector has remained broadly stable over the past decade. However, there has been a recent rise in the number of people choosing to use the private sector, paying for their treatment, in the context of long NHS waiting lists and times”.
Other countries with public health services
The UK is far from the only country in the world with universal government-funded healthcare (government-funded healthcare for all citizens regardless of their income or employment status). Australia, Canada, and Spain all have their own versions of the NHS.
Australia
Australia uses a public-private model with publicly funded Medicare offering free universal healthcare. Individuals are encouraged to buy private health insurance through tax surcharges, which then go towards funding public healthcare. In the financial year 2021–22, health spending accounted for 10.5% of the gross domestic product (GDP) in Australia.
Canada
Publicly funded healthcare in Canada (informally known as Medicare) covers approximately 70% of healthcare costs, with the remaining 30% paid for through the private sector. Services not covered or only partially covered by Medicare include prescription drugs, eye care, and dentistry.
Approximately 65 to 75% of Canadians also have some form of supplementary health insurance, either privately, through their employers or secondary social service programs. For the year 2023, health expenditure in Canada was expected to amount to 12.1% of the nation’s GDP,
Spain
Spain’s Instituto Nacional de la Salud provides universal, free healthcare to all Spanish nationals, regardless of economic situation or participation in the social security network. It is funded primarily through taxation and is rated the 7th most efficient healthcare system in the world by the World Health Organisation (WHO).
Around 10% of the population also has complementary voluntary private insurance, which may be used to cover services such as dental care not covered under the universal plan. In 2022, health spending amounted to 10.4% of GDP in Spain.
Concluding Remarks on the NHS
We live in a very different world than the one in which Bevan created the NHS. Nevertheless, the ideology behind free-at-the-point-of-use healthcare remains deeply rooted in British values. While the NHS remains a political hot potato, an unanswerable riddle and a thorn in the side of successive governments, for the majority, the health service remains the life support of millions, and it seems we aren’t ready to pull the plug just yet.
Whether it be through a change in government, further restructuring or tax incentives to buy private insurance, the NHS must continue to adapt to the world around it if it is to survive.
