Is the NHS fit for purpose?

Buxton Battle of Ideas festival 2023, Saturday 25 November, Devonshire Dome, Buxton


Since the Covid-19 pandemic hit the UK in March 2020, the NHS has been under incredible strain. While staff coped magnificently with the pressures, the diversion of resources, restrictions on capacity due to infection control and staff forced to stay at home due to sickness and self-isolation rules has led to a backlog building up of other untreated patients.

Figures for July 2023, published in September, show that 7.68million people were waiting to start treatment. These delays could lead to people suffering unnecessarily, and many people will die because opportunities to catch health problems early have been missed. The number of people turning to the private sector for treatment has increased dramatically.

Yet problems with the NHS are not new. Almost every year there is a crisis during winter as a variety of pressures combine to stretch healthcare resources. Long waiting lists for treatment seem ever present. While reports for the Commonwealth Fund have frequently suggested the NHS is one of the top health services in the world, when it comes to patient outcomes, the NHS lags behind most other wealthy economies. Moreover, the UK population is ageing, leading to ever-greater demands over time – particularly when it comes to social care.

The NHS has also had to face a variety of scandals over the years – from Bristol to Stafford and beyond – where poor-quality care has led to patient deaths. A recent report into a maternity scandal in the Shrewsbury and Telford NHS trust revealed hundreds of mothers and babies had been harmed over decades of mistreatment – including multiple deaths. Since then, other trusts have been investigated, with many deemed unfit to safely care for women giving birth.

But the biggest story recently has been the conviction of a paediatric nurse, Lucy Letby, for murdering babies in the intensive care unit where she worked. Many have been shocked, not only by the killings themselves, but by the way hospital managers dismissed the concerns of consultants at the hospital.

Is it time to look again at the way we organise healthcare? The UK is relatively unusual among wealthier nations in having a health service that is mostly financed and provided by the state. Is this near-monopoly of provision a strength or a weakness? Moreover, the NHS has been subject to multiple reorganisations over the years, with a panoply of oversight boards, commissioning groups, health authorities and other bodies now overseeing different aspects of the system. For some critics, the pandemic has simply highlighted the diffusion of responsibility between different parts of the NHS, leading to an inability to hold any part of the system accountable for its failings.

How can we solve the problems of the NHS? Is it simply a matter of providing extra resources – for example, giving striking workers the pay increases they demand – or is the way resources are used within the NHS a problem, too? Do we expect too much from the NHS? And with some observers likening it to a national religion, are politicians brave enough to have a proper debate about reform?

Emily Barley
Maternity safety campaigner

Nicky Drury
genetic counsellor, Nottingham Department of Clinical Genetics; former member, United Kingdom Human Genetics Commission

Susie Hawkes
senior lecturer in social work, University of Wolverhampton

Rob Lyons
science and technology director, Academy of Ideas; convenor, AoI Economy Forum

Ella Whelan
co-convenor, Battle of Ideas festival; journalist; author, What Women Want