UK’s National Health Service is beloved. And now, it’s fraying.
The National Health Service is the pride and joy of the UK and is loved by the public more than any other British institution for providing safety and protection to all without preconditions.
But it faces a crisis like never before. The healthcare system is being strained beyond its capacity, causing record delays in emergency services and raising the national level of excess deaths to higher levels than during the pandemic.
Why we wrote this
The British people rely on the National Health Service like no other institution. With the NHS ‘on the brink of collapse’, the country is worried about the future of its long-established safety net.
At the same time, NHS doctors, nurses and frontline workers feel so overworked, underpaid and undervalued by the government that pays them that they are picketing in a way the UK has never seen before.
“In the last 10 years in this country we have not attempted to grow our workforce at the pace required, and we have not invested in the basic facilities you need for modern healthcare,” said Siva Anandaciva, principal analyst at Nonprofit The King’s Fund. “As a result, you basically have a system that isn’t tough enough to withstand shock. When you get multiple shocks, it’s no wonder wait times and patient care are where they are today.”
They call at any time of the day or night. The man who said he couldn’t play with his kids if he hadn’t had surgery. The woman who is grateful for a frontline worker who has offered help and support during a family crisis. A 10-year-old who underwent surgery in the wake of the pandemic.
This is Hopeline19, a free phone line that was used as a way for the grateful British public to leave messages of support for UK National Health Service (NHS) workers. Within days of its September 2021 launch, around 17,000 people had called the service. Today, 18 months later, 6,000 people are still calling every week.
“I don’t know if you hear this on your 10-minute break or the only break you’ve had from a 12-hour shift, but I want to thank you from the bottom of my heart,” said one caller.
Why we wrote this
The British people rely on the National Health Service like no other institution. With the NHS ‘on the brink of collapse’, the country is worried about the future of its long-established safety net.
The pride and joy of the country, the NHS is loved by the public more than any other British institution, including the royal family, the armed forces and the BBC, for providing safety and protection to all without preconditions. But it faces a crisis like never before — with dwindling confidence in its ability to effectively support both its workers and the public. The healthcare system is being strained beyond its capacity, causing record delays in emergency services and raising the national level of excess deaths to higher levels than during the pandemic.
At the same time, NHS doctors, nurses and frontline workers feel so overworked, underpaid and undervalued by the government that pays them that they are picketing in a way the UK has never seen before. In doing so, they gain the support of a public eager to protect those who form such an important social safety net.
This has drawn new attention to a fact that Chancellor Jeremy Hunt acknowledged last month: “The NHS is on the brink of collapse… with doctors and nurses on the front line who are frankly under unbearable pressure,” he said.
“The NHS,” says Alastair McLellan, editor of the Health Service Journal, “has reached the point where it can no longer save your life.”
Britain’s favorite public institution
The NHS was launched on July 5, 1948. It was the first universal health care system funded by taxes and is “free at the time of delivery,” meaning treatment is paid as needed rather than according to a person’s ability. The service has endured two monarchs, 15 prime ministers and 29 health ministers.
But healthcare spending has stalled in the UK over the past decade. The UK invests around 0.3% of GDP in health investments, less than any other G-7 country. This is now reflected in the deteriorating health of the UK population, which is slowing economic growth for the first time since the industrial revolution, former Bank of England chief economist Andy Haldane said in a recent speech.
Today the NHS situation is dire. A record 7.21 million people were waiting for treatment in England at the end of October. Around 4,000 patients spend more than 12 hours a day in emergency rooms, a record that far exceeds the target of four hours. Most alarmingly, figures from the Office of National Statistics show that the number of deaths, on average, is now higher than during the pandemic, with a quarter of them attributable to the disruption of emergency care.
There are two main problems, Mr. McLellan says, and one of them has nothing to do with treatment. Rather, it is logistical.
Patients are stuck in emergency departments (referred to in the UK as ‘accident and emergency’ or A&E) instead of being transferred to hospital beds because the wards are manned by people who are medically fit to walk but who cannot be discharged , because they lack this necessary care at home. Up to a third of the beds in some facilities are occupied by people in this situation.
“If you can’t get people out of the hospital, you can’t get people out of the ER,” says Mr. McLellan. “If you can’t get people out of the ER, you can’t get them out of the ambulance queue outside the ER. And when an ambulance is waiting in front of the emergency room, it doesn’t respond to life-threatening calls.”
The second, extremely pressing issue is staff shortages, exacerbated by the post-Brexit brain drain of thousands of foreign-born healthcare professionals, including 4,000 European doctors.
Many of the remaining hospital workers forego breaks and work free overtime to maintain standards of care, and sell annual leave to make ends meet or resort to food banks.
That stress has taken its toll: in the year leading up to last June, 1 in 9 nurses left the NHS and a survey by the Royal College of Nursing (RCN) found that 6 in 10 were considering or planning to resign. More than 30,000 nursing positions are already vacant.
At a time when the country is still feeling the effects of COVID-19 and suffering from a cost of living crisis, recession and energy crisis, the NHS is under greater pressure than at any time in its history, says Siva Anandaciva, Principal Analyst with The King’s Fund, a not-for-profit organization working to improve health and care in England.
“We ran our system in what I would say is the red area on the dial for a long, long time,” he says. “In the last 10 years in this country we have not attempted to grow our workforce at the pace required, and we have not invested in the basic facilities you need for modern healthcare.”
“As a result, you basically have a system that isn’t tough enough to withstand shock. When you get multiple shocks, it’s no wonder wait times and patient care are where they are today.”
Stand up against the government
For the first time in its 106-year history, the RCN called a strike this month and demanded a pay rise. The nurses went out for two days and the strikes will continue into the spring if they don’t reach an agreement. The action was supported by 59% of Brits, according to a recent poll.
“Anger has turned into action, our members are saying enough is enough,” RCN Secretary General Pat Cullen said in a statement. “Our members will no longer tolerate a financial knife edge at home or bad business at work.”
Ambulance workers also went on strike for 24 hours on Wednesday.
While the strikes are primarily about pay, frontline workers also cite underfunding and understaffing, which they say create working conditions that leave them no choice but to go on strike. A recent survey by the GMB union found that 1 in 3 ambulance workers were involved in a delay that had resulted in the death of a patient.
“Our caregivers have higher PTSD scores than recent combat zone returnees,” said Claire Goodwin-Fee, founder and CEO of Frontline19, a service that launched Hopeline19 and provides psychological support to frontline workers.
Regardless of how things stand at the moment, Brits are almost united in their desire to see the NHS survive and – eventually – thrive.
“Generally speaking, people on the street are big fans of the NHS and supporters of the health workforce, which we’ve seen throughout the pandemic,” says Ms Goodwin-Fee. “I’ve never met anyone who wanted to get rid of it.”
