As one of the oldest and proudest institutions in the UK, the NHS is viewed by most as an invaluable asset to British society. In recent years, there have been many concerns raised about the potentially insufficient levels of funding and resources which the NHS has access to. Could it be in crisis? Here are some factors to consider.

Funding

The amount of money the NHS has access to as part of its overall budget is decided by the government, and constant criticism has been directed at the Conservatives for not allocating the NHS enough funding to allow it to properly and effectively function.

This sentiment has been felt by many patients and staff alike, who, it has been suggested, are overworked and underpaid. Therefore, there are concerns that the quality of healthcare and treatment in the NHS is on a downhill trajectory as a result of underfunding, which has caused staff levels to be cut as well as a shortage of beds in many hospitals.

Privatisation

Another concern at the forefront of people’s minds is the potential privatisation of the NHS, which would involve the selling off of sections of the national institution to private companies. Although none of the major political parties have overtly stated that they will do this, there have been accusations against the Conservative government that it is their intention.

Privatisation could lead to the end of an NHS which is free at the point of use, with people having to pay hefty bills for treatment. This would completely change the nature and philosophy of the NHS, and could mean people would have to either go without necessary treatment or earn extra income to be able to afford it.

Overcrowding

It has been well documented that shortages in hospital beds are becoming common, with the severity of this being felt particularly during the winter months. This was one of the factors which led the Red Cross to declare that there was a ‘humanitarian crisis’ last winter.

The fact that hospital bed availability has become so critical could mean severely delayed treatments for those who find themselves joining a lengthy waiting list for a hospital bed. That being said, the NHS has not reached breaking point just yet, and there is still a possibility that the situation will improve if the NHS is given greater funding/resources.

The Future

Since Theresa May announced the snap election back in April, Labour and the Conservatives have been vying for political dominance. Both parties have pledged to invest more money in the NHS in order to lessen the funding shortages, but Labour’s promise of £30bn seems far more substantial than the Conservatives’ £8bn.

The fact that both parties are promising more funding indicates that they both acknowledge the future of the NHS hangs in the balance, and that there is national demand to help the institution recover its reputation as a world class health service.

The evidence circulating at the moment seems to suggest that the NHS is suffering as a result of austerity cuts and insufficient funding. With an upcoming general election looming, the future of the NHS could well be in the hands of the public vote.

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4 Comments

  1. Steve Iliffe says:

    A good question Zak! It depends a bit on what you mean by crisis. I can think of six ‘Yes’ answers and five ‘No’ answers.
    Yes 1: At any given moment some part of the NHS is in crisis because it has too much work, not enough staff or the wrong facilities. Service bottlenecks develop and are opened by applying resources to them which takes resources from somewhere else, which develops another bottleneck. This fire-fighting is very much a feature of planned economies, so is probably intrinsic to the socialist NHS.
    Yes 2: Competition for resources requires crises to be generated, a process of ‘dramaturgy’ (exaggerating to get attention). The current BMA campaign for more doctors and more kit requires the NHS to be “on its knees”. A rational approach might be to prioritise nursing recruitment and retention, but the BMA is unlikely to stop pursuing the interests of doctors. Competition for resources is very much a feature of planned economies, so is probably intrinsic to the socialist NHS.
    Yes 3: Reducing the growth of the annual NHS budget from 3-4% to 1-2% forces services to economise and change, and these processes are painful and threatening, so a crisis grows from them. We will hear more of this in the coming two years, because the easy economies and changes have been done. On the positive side, Teresa May’s humiliation and Labour’s resurgence may help the NHS budget a bit.
    Yes 4: There are major staffing problems, with more nurses leaving the discipline than joining it, and professionals gaming/milking the need for locums by offering their employment through agencies that cost the NHS a lot.
    Yes 5:A ‘crisis of confidence’ can develop if authoritative bodies (like the BMA) talk up crises, or if there are repeated reports about ‘crisis of the NHS’ which promote group-think. The crisis becomes a factoid – a truth established only be repetition.
    Yes 6: The ‘burden’ of an ageing population and the ‘selfishness of baby boomers’ are part of an apocalyptic demography actively promoted by the Right to create a sense of crisis about the sustainability of the NHS.

    No 1: The financial deficits of NHS hospitals have been met by mobilising reserves, dipping into capital budgets, re-routing transformation funds and selling off surplus lands. Massive debts have been (mostly) avoided and some hospitals have built cash reserves. Of course this may not last if the squeeze (see Yes 3) continues
    No 2: Staff recruitment continued to grow up to 2015/6 except for managers and psychiatrists. Hospital consultant number increased by 45% after 2009 — hardly a sign of crisis.
    No 3: Patient satisfaction remains at a high level, and may have improved slightly during the last two ‘crisis’ years. If there is a crisis of the NHS, it is elsewhere.
    No 4: Most of the worst experiences of last winter—like long trolley waits—occurred in a handful of hospitals.
    No 5: Staff surveys do not show a demoralised workforce, despite the NHS’s culture of bullying and campaigners’ insistence that staff morale is plummeting.
    No 6: Some problems, like nursing shortages, could be rectified by simple changes in the labour market, for example with restoration of the nurse student bursary, introduction of ‘golden handcuffs’ or use of ‘golden hellos’ for returners.

  2. ajpenn says:

    Quick thoughts on No 1-6:
    No 1: The demand side rises/squeeze will certainly continue. A lesser point, but is the land really surplus, particularly with growing demand (will we be buying it back at higher prices in the future)? Is some of it ‘surplus’ because they’ve closed non-surplus facilities and are now selling it off?
    No 2: Don’t forget the denominator – demand from demographic change, growth; rise in co-morbidity. What are the figures for non-consultants, in relation to the demand side? Did the non-consultant Drs strikes influence this recruitment?
    No 3: Reminds me of all the potential problems with polls! For example, are the polls representative, are patients accommodating for the much published strain on staff, what impact is the ‘crisis’ coverage having on participation (do people think it’s worth bothering when they have bad experiences at the moment)?
    No 4: A sign of things to come? What about the rest of the NHS: primary care etc?
    No 5: Do staff experiencing problems take the time to fill out these surveys, are they too demoralised to bother, are they representative, are the questions valid?
    No 6: Yes, but how long would this take, would there be delay while potential students are convinced it’s worth going into nursing following recent years, how would this compare to/meet the rising need for staff?

  3. ajpenn says:

    P.S. in 2010 I could get a GP appointment (as a T1 diabetic with other health issues) same day, now it takes 12! In 2010 waiting times for heart bypass ops were 18 weeks, now it’s 18mths – and I’ve been told by a GP that his patients are dying while waiting. Only a small sample, but it’s a crisis for them and I!

  4. healthaudit says:

    A crisis point is a turning point.
    It could be a crisis therefore but it depends on what will happen in the future.
    And, it depends on what you see as the current trajectory of the NHS.
    Every which way you look at it it seems unlikely that the NHS will plod on as before.
    On Funding it is more likely that the NHS will be affected by Brexit than decisions on funding. If recruitment difficulties follow as EU staff leave then wages might have to rise to compensate, which will require more funding.
    On Privatisation a greater proportion of private provision does not necessarily lead to worse healthcare provision: it depends on the rules of access to that provision and the willingness of governments to pay the additional costs associated with private provision.
    Overcrowding depends on your views of the increasing population, responsiveness of government to that increase , the social care policies of the government and the view that capacity is not a problem but that it is the internal organisation of the NHS.
    On the Future this again is uncertain. But that is not a new thing. It just shows that we will all have to be on our guard if future changes are not in the direction we would wish them to be.
    What seems to be breaking down is the consensus on all these issues meaning who controls the story of the NHS controls the future direction.
    The managerialist story that conflicts can be managed by a combination of modest increases in funding and a level of reorganisation putting more onus on self funded social care and user charges remains plausible but is facing mounting criticism.
    The right wing story that the NHS has to crash and burn to allow a phoenix to arise US style from the ashes fails to take account of the blowback that such policies would incite.
    The left wing position that the NHS faces a conspiracy to snatch its most prized symbol of successful collective provision away is correct if you accept the ring wing position exists; and the left wing position is also correct in identifying the managerialist position as unduly complacent in the face of comparisons with health services in comparable countries i.e. France and Germany , the reality that social care has been cut resulting in rising demand and bed blocking in the NHS and that the responsiveness of politicians and the NHS funding system to rising pressure (from immigration in hotspots e.g. Kent and Lincolnshire; from the elderly (Eastbourne, Hastings) and from PFI projects (East London, SE London, Peterborough etc) has been slow and ineffective.
    A crisis could be exploited by the right or left and ignoring it could make problems worse in the future.
    C’est La Vie!

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