The NHS is not in crisis - here's why
13 January 2017
Health Services Research Research methods & EBM
Leading nurses and doctors have reported that current NHS conditions are the “worst they have ever experienced”, and have warned the British prime minister that lives are at risk. But the last 20 years of news headlines suggest that long waits, job losses and problems with bed-blocking are a systemic problem that won’t go away.
Yet, in 2000, the Telegraph reported that the NHS faced its worst ever bed crisis – hospitals were at breaking point – two months before the influenza outbreak was predicted. In 2002, the BBC told us that homeless people were failed by the NHS as their only option was to turn to already overstretched A&E departments. In 2005, one-third of hospital trusts reported services were facing severe cuts, and three-quarters were facing significant funding shortfalls. And, in the following year, The Guardian reported that one hospital trust was shedding 720 jobs, after accumulating deficits of £31.5m. Job losses were deepening the mood of crisis in the NHS.
More or less every year, headlines have stated that the NHS is in the midst of a crisis. Evidently this makes for good reading, fires everyone up and overtly politicises the NHS – but is throwing more money at the problem the real solution?
In 1997, the UK government spending on the NHS was £33.5 billion. At that time, chronic under-investment meant that there were significant problems with long waiting times and waits of more than 18 months for an operation were not uncommon. However, in 2005, the Labour Party manifesto promised to rescue the NHS by reducing waiting times, increasing the workforce and tripling spending compared with 1997 levels.
So what did the extra investment achieve? In 2008, The Guardian was reporting how the financial crisis would harm the NHS. Despite a surplus of £2 billion, trusts were being warned to budget for lower incomes. In 2010, the Telegraph reported that the vulnerable and the elderly would fill much-needed hospital beds and exacerbate the problem of bed blocking due to local authority budget cuts.
In 2011, the NHS 111 telephone service was in crisis: one in eight calls to the service were going unanswered. On January 12 of the same year, hospitals were reporting they were overwhelmed due to a 42% increase in bed blocking compared with the previous year. And in 2012, the BBC once again told us the NHS workforce was in crisis, a warning echoed by Labour Shadow Health Secretary Andy Burnham in 2015.
By now, I hope you get my point: the NHS and crisis are an inextricably linked news phenomena, one , like four-hour wait targets, that seemingly won’t go away.
Continual undermining of the NHS and politicisation is not helpful. Let’s be clear: there are many parts of the NHS that are amazing and, on a daily basis, continually outperform other countries’ healthcare systems. A 2014 US-based Commonwealth Fund report ranked the UK first out of 11 other countries for quality of care access and efficiency.
Spending more money, therefore, does not necessarily translate into better care: despite spending 2.5 times more per capita on health, the US was outperformed by the UK on all 11 measures. In 2005-06, spending was already £76.4 billion – it will soon be £120 billion. Throwing more money at the problem is no guarantee of success.
Twenty years of struggles, intense difficulties and crises have informed us that bed blocking and long waits have continually formed part of the health system. The solution will not be easy and the current problems with waiting targets is a distraction from the main problem: social care services need to transfer into the NHS to create a greater level of coordinated care for the most vulnerable. And at the same time, the NHS needs to be brave and rid itself of irrelevant, low-value interventions that are undermining progress towards a compassionate, evidence-based healthcare system.
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Nick Fahy is a senior researcher and consultant in health policy and systems at the University of Oxford. He also blogs about health and Brexit at www.nickfahy.org