Mismanagement and neglect is root of the NHS crisis, UK health secretary says

Natalie Olofsson

In the depths of winter — often most deadly for vulnerable adults, who contract extreme cases of the common flu — the NHS struggles to maintain a standard of care. Long queues keep those with minor illnesses from receiving treatment: they are less urgent compared to those with life-threatening ailments. Regrettably, many whose maladies were easily treatable experience worsening well being. For those whose conditions are extreme, the situation is also dire: category 1 calls see ambulances arriving far past the NHS goal of 7 minutes for transport. As worker strikes come to a cusp during the deadliest month of the year, union compromises with governmental action yield little headway.

Aside from Britain’s national health care system struggling for decades, 2023 comes with new challenges regarding the largest nursing strike on record, a particular delay in emergency care, and a unparalleled number of excess deaths. These deaths are deemed in excess, most obviously, because they are avoidable. Were the NHS to maintain a higher standard of care and a greater quantity of workers, excess deaths would not be at the highest in two years. Indeed, the UK spends a fifth less than other OECD countries, and has decades of deteriorating hospital equipment without the budget to invest in infrastructure.

But the struggle to keep up with growing demand for healthcare services cannot be fixed by a sole increase in the budget. In response to recent strikes and public outrage over NHS delays, PM Sunak proposed an emergency bill to hospitals and councils. Such a bill aids those in crisis right now, but does little to fix an institution which struggles long term. Nursing leaders described the NHS as ”dangerously close to overheating”, a month before excess deaths climaxed in late January. Nursing strikes, which are ongoing from December 2023, are in aim for better pay and a higher standard of work.

Beyond an increase in waiting times, there is a system-wide mismanagement represented from both the emergency care sector and council care homes. The NHS Confederation argue that 1/3 of hospitalised citizens who are fit for discharge remain stuck in hospice due to a lack of local social care. This discrepancy is in part due to the separation between health, or the NHS, and elderly social care, which is run by councils. Patients ready for discharge — often elderly adults with chronic ailments — are kept in hospice for longer than necessary due to a miscommunication between NHS care and local care services. In recent years, UK care homes have struggled to maintain capacity and find themselves with debilitating worker shortages. Living in a care home may then be worse for an elderly citizen’s health than that of semi-permanent hospice.

Lack of government funding is certainly an issue for the NHS and council health services. The NHS has been underfunded for the past three to four decades, so underfunding is not only a problem year-on-year but cumulatively. Capital investment on healthcare technology and hospital capacity is far below required: as demand increases, and previous infrastructure begins to deteriorate, the NHS not only needs to maintain its current equipment but grow. To say that NHS funding has increased year on year is to ignore a growing and ageing population, with increasing needs to health services. The lack of funding which results in crises during Covid-19 and current months raises claims of neglect. President of the Royal College of Emergency Medicine (RCEM), Dr. Adrian Boyle, advocates for tackling the crisis of emergency care.  “Demand management strategies for reducing UEC pressure won’t work,” he says. “[Looking after the elderly] requires adequate inpatient capacity.”

To get to a higher capacity for inpatients requires both discharging available patients and increasing the amount of hospital beds. But to treat more patients, too, requires more than the current shortage of doctors and nurses. And without reliable care homes to discharge elderly patients into, not only will there remain an abundance of NHS spending maintaining the health of those ready to leave, but those in need of service will stay waiting. Sunak’s bid to increase funding temporarily may aid an overwhelmed NHS temporarily; however, there remains an intrinsic neglect which reduces quality and quantity of public care. As Britain’s population ages, increased need for the NHS and council-funded care homes will be noticeable. Private health care, which disproportionately aids the wealthy, is more viable. Recent strikes and public uproar over a public healthcare system in crisis may lead to increased investment in public systems — but it will be years before the NHS is back to a high standard of treatment.