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What’s happening in the NHS and what lies ahead?

21 Jul 2024

What is happening in the UK?

At one point the National Healthcare Service (NHS) was idolised across the Globe; however, in the 21st century the NHS has been cast into a detrimental state of crisis. In the last year, Britain’s healthcare service experienced the longest period of industrial action in the history of the NHS. A six day walkout resulted in the postponement of over 113,000 appointments, procedures and operations. Additionally, recent surveys have indicated that a third of doctors in the UK are likely to relocate abroad, and of those considering 79% cited pay as a driving factor, with 75% stating they felt “undervalued professionally.”


In recent years, persistent staff shortages in specific areas have been a significant challenge. Whilst staff numbers have grown since 2019, recruitment to the NHS has been ineffective and hasn’t dealt with gaps in the number of qualified junior doctors and General Practitioners (GPs). Since 2015 the overall number of GPs has seen little growth, and the figure for GP partners in this time has decreased. Furthermore, as the GP workforce has declined, the NHS faces a record high of 63.37 million patients registered to GP practices in May 2024.


The incoming Labour government has pledged to deliver an extra two million, operations, scans and appointments every year. In order to reach this target, the Labour Party has suggested spare capacity in the private sector will be utilised. Despite suggestions that the NHS is moving towards a private model, Health Secretary Wes Streeting has unequivocally maintained that the NHS will remain free at the point of use.


As exposed throughout the Covid-19 pandemic the NHS has suffered from constrained capacity. Prior to the Pandemic, bed occupancy had already risen to 90% and increased pressure during Covid has resulted in the rationing of care. Insufficient capacity has also been a driving factor in the failure of increased funding and additional staff to improve the NHS. Without modern buildings, equipment and beds more staff can only do so much. Moreover, with increasing population and life expectancy, the NHS will need to expand to keep up with the increase in patients.


What is in it for you?

For UK readers, the current issues facing the NHS are felt most keenly. Waiting lists are longer, urgent care has become less reliable and people are losing confidence in the NHS. Between 2019-2022, the number of people paying for private insurance nearly doubled, from around 12% of the population to 22%, which has vastly increased the size of the private health industry as more and more turn to it for procedures which they used to rely on the NHS for.


This not only has an effect on those who need treatment from the NHS but also on the nation's economy. With longer waiting lists productivity decreases as fewer are able to work and more are needing to take sick days. This has led to them being taken up at the highest rate since 2004 leading to 185.6 million work days lost in 2022, the highest level recorded. This in turn impacts government finances as less tax revenue is generated, and more consequentially, the population becomes sicker. Because of this, the Office for Budget Responsibility, estimates that by 2028-29 the state will be forced to spend almost 50% more on disability benefits. This will either lead to cuts in the amount given to each recipient, tax rises, or cuts to other public services.


For our readers in the US and elsewhere, the state of the NHS serves as an example of how a universal state-run healthcare system could operate. Whilst there are numerous benefits to this model, including far more negotiating power with pharmaceutical companies bringing medicine prices down. The system comes with numerous drawbacks and is ultimately dependent on the government to provide the health services with enough resources, as well as to ensure it is efficiently run, which some would argue it has failed to do.


For our readers in Australia and Canada, you may be more likely to be seen by a British doctor, with those two nations being the most popular destinations for British medicine graduates going abroad. In late 2023 a survey was done which suggested that around a third of medicine students were planning on going abroad after they had completed their studies. 


For those in Eastern European nations such as Poland, Lithuania, Latvia, as well as France, you may be more likely to see a British patient in your waiting rooms as the ONS is estimating that 348,000 UK residents travelled abroad for healthcare, more than double the number in 2018. 


What happens next?

In the short term, it looks extremely unlikely the situation will change drastically, the only party which offered large scale structural changes to the NHS was Reform UK which advocated for greater privatisation. Labour on the other hand are focusing on making the existing NHS more efficient with what they hope will be better outcomes for patients. 


Labour's plans for the NHS contain relatively few spending pledges, with key points including building towards a national care service, which would operate on a localised basis. Additionally, they have committed to expanding the number of places at medical courses and accelerating technology adoption in healthcare whilst keeping costs down by its simplifying procurement. 


The Labour manifesto speaks of a 10-year plan to transform the NHS. If their plans work or not remains to be seen. In the coming weeks and months we can expect to see the health secretary focus firstly on labour disputes, particularly with the junior doctors whose strike action has been suspending pending negotiations, as well as attempting to update the background systems which keep the NHS running; these include everything from the IT system to methods of medical equipment acquisition. 


For at the moment neither party is willing to consider any kind of fundamental change to the NHS's mission or structure, something which has been enormously altered and expanded since its creation in 1945, in part for political reasons as the NHS remains one of the UK's most widely supported institutions. With tight budgetary constraints, the government cannot afford high cash injections, forcing the health secretary to balance between cost efficiency and addressing the long-term issues which have been plaguing the NHS for years.


The Polis Team in London

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