The NHS is close to breaking point – can we now talk about reform?

Emily Carver

August 13, 2021

The NHS is close to breaking point. At the very least it’s creaking at the seams. There are currently 5.5 million people on the NHS waiting list. This is set to reach an astonishing 14 million people by next autumn, if IFS estimates are to be believed.

Against the backdrop of NHS staff being forced to self-isolate (only last month were they granted an exemption from the ‘pingdemic’), the British Heart Foundation now estimates that the number of people waiting for heart surgery in England could rise to almost double pre-pandemic levels by February next year. At the same time, increasing numbers of people are choosing to go private, to escape prolonged – and often painful – delays to their treatment.

It is a national scandal that millions of patients are being denied treatment – from minor procedures, to potentially life-saving surgery – for months on end. If the projections are correct, it is no longer farfetched to expect this backlog to lead to tens of thousands, even hundreds of thousands, of avoidable deaths. And it will be those with little means who will be left without.

Lockdown and social distancing were justified by ministers as necessary to prevent the health service from being overwhelmed. Many warned that the justification for lockdown to “protect the NHS” would be resurrected in the future, at times when the system is again under acute pressure.

It turns out such concerns weren’t conspiracy; last week it was reported that the government has drawn up contingency plans for “firebreak” style local and national lockdowns, should the NHS be forced back to the brink by a bad flu season or other seasonal pressures. Whether this comes to pass remains to be seen. But that the government is even considering bringing in such measures again is surely enough to warrant a serious debate over, not only our Covid strategy, but whether the health service remains fit for purpose.

Even before the pandemic, our healthcare system was underperforming on key metrics, including waiting times and health outcomes. And the myth that the NHS’ failures are simply down to underfunding is wearing thin.

A quick glance at the Office for National Statistics’ website shows that spending on healthcare is only moving in one direction – and that’s up. And yes, in real terms too. Since 2010, government health spending has gone up year on year; from £126.4bn in 2010/11 to £150.4bn in 2019/2020. With extra Covid spending, the budget increased again to £212.1bn in the last year.

Yet our politicians remain exasperatingly reluctant to consider that the NHS may not be the best healthcare model in the world.

If we look to comparable countries, we find that the UK is pretty average in terms of healthcare spending as a proportion of GDP, yet we are quite consistently below-average in terms of outcomes.

As Kristian Niemietz finds in a new paper for the Institute of Economic Affairs, there are many countries in the world that offer alternatives to the NHS, including Australia, which spends slightly less on healthcare as a percentage of GDP than the UK (9.3% compared to 10.3%) but has substantially better health outcomes, including higher cancer survival rates and lower heart attack and stroke mortality rates.

The recent publication of the Commonwealth Fund report this month, which compares the performance of healthcare systems of 11 high-income countries, showed shockingly that when it comes to healthcare outcomes – essentially keeping people alive – the UK slipped to 9th place. For a healthcare system which is supposedly the “envy of the world”, surely the case for reform has never been stronger?

It’s clear the NHS is repeatedly failing its patients. As the number of people waiting for basic – and essential – treatment continues to rise, management of our NHS will rightly come under more and more scrutiny. We can’t keep burying our heads in the sand, and more money will only go so far. If we can’t reform the NHS now, after a once-in-a-generation pandemic has revealed its systemic weaknesses, when can we?


Written by Emily Carver

Emily Carver is the Editor at 1828 and Head of Media at the Institute of Economic Affairs.

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