A national treasure, tarnished: Can Britain fix its health service?

Fifteen hours after she was taken out of an ambulance at Queen’s Hospital with chest pains and pneumonia, Marian Patten was still in the emergency room, waiting for a bed in a ward. Patten, 78, was luckier than others who arrived at this teeming hospital, east of London: She had not yet been wheeled into a hallway.

For months, doctors at Queen’s have been forced to treat people in a corridor because of a lack of space. As the ambulances kept pulling up outside, the doctor supervising the ER, Darryl Wood, said it was only a matter of time before nurses would begin diverting patients into the overflow space again.

“We’re in that mode every day now because the NHS doesn’t have the capacity to deal with all the patients,” Wood said.

Despite her ordeal, Patten was sympathetic. Decades ago, she said, the National Health Service saved her husband’s life when he had a heart attack. “It’s got to cope with a lot more people,” she said. “You can’t be grumpy about it.”

Her stoicism captures the reverence that Britons have for their cradle-to-grave health system, but also their rueful sense that it is broken.

As it turns 75 this month, the NHS, a proud symbol of Britain’s welfare state, is in the deepest crisis of its history: flooded by aging, enfeebled patients; starved of investment in equipment and facilities; and understaffed by doctors and nurses, many of whom are so burned out that they are either joining strikes or leaving for jobs abroad.

Interviews over three months with doctors, nurses, patients, hospital administrators, and medical analysts depict a system so profoundly troubled that some experts warn that the health service is at risk of collapse.

“Doctors and nurses face an endless stream of patients filling beds,” said Matthew Trainer, the CEO of the NHS trust that runs Queen’s and another nearby hospital, the King George. “For the clinical staff, that removes a sense of hope – that sense that what you’re doing matters.”

More than 7.4 million people in England are waiting for medical procedures, everything from hip replacements to cancer surgery. That is up from 4.1 million before the coronavirus pandemic began in 2020.

Mortality data, exacerbated by long wait times, paints a bleak picture. In 2022, the number of excess deaths rose to one of the highest levels in the last 50 years, and those numbers have kept rising, even as the pandemic has ebbed.

In the first quarter of 2023, more than half of excess deaths – that is, deaths above the five-year average mortality rate, before the pandemic – were caused by something other than Covid-19. Cardiovascular-related fatalities, which can be linked to delays in treatment, were up particularly sharply.

Proliferating labor unrest only adds to the crisis, throwing hospitals that were already barely coping into near paralysis. While Patten waited for a bed at Queen’s, doctors were picketing outside, protesting starting wages that are comparable with those earned by baristas in the hospital’s lobby.

Seeking to solve the problem, Prime Minister Rishi Sunak last month announced a 15-year plan to recruit and train 300,000 nurses and doctors, budgeting 2.4 billion pounds (about $3 billion) for the first five years. But critics point out that the plan does not fund wage increases.

The NHS has always managed to deliver a level of care that justified its giant footprint in British public life, and it is hard to imagine a vibrant Britain if the service is not stabilized.

Politically, however, Britain’s fiscal austerity exacerbated the system’s failings. Covid exposed a legion of problems – including poor management and corroded facilities – that had been incubating inside the service since Conservative-led governments began curbing budget increases in 2010.

Health care spending rose by an average of less than 2% a year from 2010 to 2019, compared with 5.1% from 1998 to 2008. Britain spent less a year per person on health care than the wealthiest European Union countries during the decade of austerity, and now has fewer doctors and hospital beds per capita than its European neighbors.

“Austerity has made matters a lot worse,” said Nigel Edwards, the CEO of Nuffield Trust, a health research organization. “There’s been lots of salami-slice savings over the years, which has made the system much more fragile.”

No mainstream politician proposes to privatize the NHS. And in some ways, the service remains a marvel, one of the world’s most comprehensive, taxpayer-funded health care providers – “free at the point of delivery,” in the words of its utopian motto. It still offers annual physical exams, mammograms, vaccinations and other services at a level that visiting Americans find impressive.

Indeed, jaundiced observers say the NHS is perpetually in crisis. But this time, the problems are of a different order, magnified by Britain’s faltering economy and its convulsive, post-Brexit politics. Experts say its model of universal access has become unsustainable, and there is no clear blueprint to reinvent it.

These problems are compounded by a breakdown in primary care, which has made it all but impossible for many people to get an appointment with their family doctor. With a shortage of general practitioners and nowhere else to turn, the ER has become the first stop for millions of sick Britons.

A quasi-sacred institution

During the darkest days of the pandemic, people gathered once a week to cheer and bang metal pots for the NHS. Children colored “Thank you NHS” signs that were placed in the windows of No 10 Downing St Boris Johnson, the former prime minister who was treated for Covid at an NHS hospital, was among those who turned out to clap.

Protecting the health service has become an article of faith for British leaders of all parties. Sunak, who has made shorter wait times one of the five bedrock goals of his government, regularly reminds Britons that his father was a physician and his mother a pharmaciSt

“When I talk about the NHS,” he said in January, “I’m not just talking about a prized public service, I’m talking about my family’s life calling.”

Such devotion was not inevitable. In the service’s early decades, Britons were wary of public health care, fearing it would meddle in their relationships with their family doctors. Those suspicions crested in the 1980s with the free-market revolution of Margaret Thatcher.

Yet rather than being privatized, the NHS survived the Thatcher years. That was partly because its defenders shrewdly contrasted it with health care in the United States, playing up America’s soaring costs, deep inequities and vast number of uninsured.

Experts periodically float ideas like privatizing parts of the service or charging fees for some treatments, which might make people less quick to go to the ER for minor health issues. Sajid Javid, a Conservative former health secretary, has proposed changing its funding base from taxes to an insurance-based system, like that used in Germany.

But Edwards of the Nuffield Trust said there was little evidence that the service’s problems stemmed from how it was funded. Other high-income countries have had woes with their health systems.

“I doubt there will be an appetite for changing the funding model or changing the ownership of the hospitals,” Edwards said. “The risk, then, is they try to play with the train set, which is what incoming governments like to do.”

This article originally appeared in The New York Times.