What’s Going On With Our NHS? Pt 1. Stakes In The Ground.

What’s going on with our NHS? Pt 1. Stakes in the ground.

What’s going on with our NHS? is a short series of posts about the current state of the NHS.

The NHS is in crisis. It has always seemed to be in trouble, but never more so than now. What’s the problem? If that question was easy, and the solution obvious, then we would not be where we are now. But surely, as a start we can be clear about some things, to put some agreed stakes in the ground?

1. The British love it:

Polls show this over and over again. The public holds its NHS in higher regard than any other element of British society.

2. It has impeccable principles:

The NHS is founded on a fine set of principles that befit a humane, mature society. The best known are that services are free at the point of delivery, and available to all. But, to me, another is crucial as well, that the service treats everyone according to their relative need. It is the lifeboat principle; those in most need get into the lifeboat before those of greater strength and ability. A heart attack trumps (sorry) tonsillitis, no matter who has the tonsillitis.

3. It’s in trouble:

Overall, the service is not delivering in the way we want. Every day the media carries stories of delay, of bed-blocking, of shortages and rationing, and of low morale amongst stressed and overworked staff. Worse still, international comparisons show clearly that in some key clinical areas, such as the treatment of some cancers, we are not performing as well as other countries. There is inefficiency and wasted money; its advocates should not deny this.

I know the media love a juicy story, particularly one containing bad news, but we seldom hear good news about the NHS.

4. Other comparable countries spend more on their health services:

Though some may prefer a Trumpish denial of facts, we should accept the clear evidence that we are not spending as much on our health services as most other comparable countries.

According to the NHS Confederation, UK health expenditure in 2013 was 8.46% of gross domestic product (USA 16.43%, Netherlands 11.12%, Germany 10.98%, France 10.95%, Italy 8.77%).

The UK had 2.8 physicians per 1000 people in 2013 (Germany 4.1, Italy 3.9, Spain 3.8, Australia 3.4, France 3.3, New Zealand 2.8, Canada 2.6) and 2.8 hospital beds per 1000 people in 2013 (Germany 8.3, France 6.3, Denmark 3.1, Spain 3.0, New Zealand 2.8).


Conclusions: Stakes in the ground.

Firstly, we love the NHS. Secondly, for a variety of reasons, it is not performing as well as we would want. But third, we are not spending as much on it as the countries with which it is compared. We have the budget for a hatchback but expect to drive a luxury saloon like the Germans, Dutch and French.

And finally, while adequate funding is essential, a solution needs more than just that.



In my next few posts, I am going to cast the most dispassionate eye I can upon the situation. Although a GP in the past, I retired a decade ago. I am still as devoted to the NHS as ever, but I am now a patient, a user of the service.

I’m going to sketch an outline of the problem as I see it, the background to why we are where we are, and then consider some ways we could move forward, to an NHS which is more satisfactory than it is a moment, one that at least attempts to marry its scope to the funds governments are prepared to pay for it, yet one that still adheres to the principles the public find so attractive.

One thing is for sure. The NHS should be above party politics and dogma. It is too important for that. It is a national institution that the public cherishes. If any government doubts that then, by all means, let them follow the practice of the moment and hold a referendum. I guarantee a result that knocks into a cocked hat those of the EU referendum and US election.

Better still. Don’t waste money on the referendum. Take the result as a given, a mandate to develop and deliver an NHS we can all be proud of.

Next: What do we want? Go to Part 2: What do we want from the NHS? >