Why is the NHS in crisis? Here are some of the key reasons

Across the UK, the four nations’ health services are battling to stay afloat amid a “perfect storm” of issues applying huge pressure to staff and capacity. Westminster is the common denominator.

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Here are some of the complex and interlinked issues facing the NHS across the UK right now.

Workforce

“Workforce is probably, where we are now, the biggest single challenge in social care and health care,” SNP MP Dr Philippa Whitford (above) told The National. Brexit has played no small part in that.

The year after the UK voted to leave the EU, the number of nurses being recruited from Europe fell by 87%.

And Brexit’s impacts on staffing in the social care sector have been severe. In 2022, England saw a net fall in the social care workforce of some 50,000 people – the first time the number had dropped in a decade.

But there is also a key Tory government policy “hampering all four health services across the UK”.

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A surreal quirk in the UK pension and tax system – raised by both Whitford and EveryDoctor chief executive Dr Julia Patterson – means that medics may end up having to pay out in order to work.

“They count the growth in your pension pot as if it was earnings, although you may not live long enough to collect it,” Whitford says. This means that doctors who take on extra work may inadvertently cross a Tory-defined threshold and be left with tax bills of far above their income.

“We’ve been calling since 2015 for the Treasury to sort it. Of course it hampers all four health services across the UK. You’re talking about senior people with the greatest experience either retiring early, going part-time, or not wanting to take on extra duties.

“To have this specific Westminster disincentive is just bizarre and self-defeating.”

Delayed discharge

Delayed discharge – sometimes called “bed blocking” – describes when a patient is ready to leave hospital but they are unable to because there is no capacity in the care service to take them on. The issue is a key reason for the rising waiting times at A&E services.

Earlier in January, Health Secretary Humza Yousaf said that every Scottish health board would be tasked with identifying patients who are ready to leave hospital – to go home or to a social care setting – with the goal of driving down waiting lists.

The Scottish Government said the review would build on an “£8 million commitment to provide an extra 300 interim care home beds to get patients discharged quicker”.

Brexit

It is not only through the workforce that Brexit has impacted on the NHS. As well as adding to inflationary pressures, which in turn squeezes the health service budget, Brexit has had a serious impact on medicine supply.

Increased bureaucracy and barriers at borders drove up costs of basic medicines, which were also driven up domestically due to the impact of Brexit on the value of the pound. As soon as a Leave vote was declared in 2016, sterling slumped to a three-decade low from which it has never ­recovered.

The NHS has had to pay more for the same medicines as a result, according to experts at the Nuffield Trust, and pressures on its budget have been compounded.

Austerity

The NHS Confederation said last summer: “Since its creation, NHS spending has increased by an average of 3.7% per year in real terms. But from 2010/11 to 2018/19, NHS funding growth slowed to 1.4 per cent per year.”

This persistent underfunding of the NHS and other public services has led to widening inequality and increased poverty, which in turn adds to the pressure on the strained health service.

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In October 2022, academics at the University of Glasgow found that “a great many more deaths are likely to have been caused by UK Government economic policy [austerity] than by the Covid-19 pandemic”.

“Poverty is the biggest single driver of ill health,” Whitford says. “We’ve seen child poverty go up since 2012, we’ve seen it go up in pensioners and disabled.

“All of the actual illness that came out of austerity … people will be experiencing that, and all of it contributes to this perfect storm that the NHS has been facing.”

Covid and the flu

The particularly acute pressures on the NHS in the winter of 2022/2023 were compounded by a further confluence of respiratory illnesses. While people had spent the previous Christmases in lockdown or wearing masks, 2022 saw everything open up fully once again.

Whitford says: “We had a surge in Covid leading up to Christmas, we had influenza, we had RSV [respiratory syncytial virus], and we had streptococcus. We literally had four significant respiratory infections that were all going at the same time and landing people in hospital.”