The NHS—Jewel in our crown or thorn in our side?

Has the National Health Service died quietly without any of us noticing? In 2023, does the UK have access to a fair, safe and accessible healthcare system? Have we lost trust in the ‘NHS Trust’? In 2020, His Majesty’s Government ordered us all to ‘protect the NHS’; in 2023, we ask, is the Government protecting the NHS, protecting NHS staff, protecting patients? With staff leaving the NHS in their droves and over 100,000 vacancies, is it time to rethink the model? Should we ditch the National Health Service model in favour of local health services?

The National Health Service is the jewel in Britain’s crown and a system that is considered a national treasure by the British public, envied around the world—or is it? Gone are the days of doctors in white coats, nurses in starched uniforms and pristine wards filled with flowers, bowls of fruit and open windows. Does the NHS have a future? Nursing correspondent Debi Evans is joined by two previous UK Column interviewees, Roy Lilley and Dr Duncan White, for a frank conversation.

Roy Lilley, health policy advisor, is the former chairman of Homewood NHS Trust in Surry and a former mayor. Roy has written for the Guardian, the Sunday Times and the Daily Telegraph, amongst others. As a policy advisor and visiting fellow at Imperial College, London, he helped start the Health Services Management School at Nottingham University and was founder of the Federation of NHS Trusts, which has become today’s NHS Confederation.

Dr Duncan White, nursing and care systems consultant, challenges concepts about privatisation of the NHS. Starting his career as a Registered Nurse, he worked his way up to executive level in acute medicine and psychiatry. He has worked in healthcare at home and abroad, so has a wide range of experience and knowledge in global healthcare systems. In the British public sector, Dr White has also worked with the Department of Health and Social Care; the Department for Business, Innovation and Skills; the Care Quality Commission; and Skills for Care.

Currently, the NHS is one of the world’s biggest employers, employing 1.26 million full-time-equivalent staff. In financial year 2021/22, the Department of Health and Social Care spent £190 billion on healthcare, which includes ambulance services, hospital services, mental health and community care. A single British ambulance call-out will cost £367 with admission to hospital or £276 with no admission. A nine-minute GP (family doctor) appointment will set the NHS back £42, while an appendectomy will cost £3,409. Fractures of the hip will, depending on complications, cost £2,092 to £6,797.

As of March 2022, there were approximately 140,000 doctors, 40,000 managers and 350,000 nurses working across 215 NHS Trusts and ten Ambulance Trusts. There are 141,960 consultant-led beds (spaces for inpatients). However, it should be noted that the number of hospital beds in England, the largest of the four NHS systems in the UK, has halved in the past three decades.

In Britain on an average day in 2022:

  • 1.2 million attend a GP appointment
  • 260,000 attend outpatient appointments
  • 37,000 call the emergency number, 999, for health reasons
  • 44,000 attend an Accident & Emergency department, with 25% of those presenting admitted to hospital
  • 675 patients are admitted to critical care

(Source: The King's Fund, NHS-aligned think tank)

The NHS is in a state of collapse. What next? How do we rebuild it? Do we invest more money in an already broken system or do we bite the bullet and start again from scratch, perhaps with a new model? What is the Buurtzorg Model (Dutch for 'neighbourhood care', implemented in the USA)? Would it work in the United Kingdom?

The National Health system is unique to the United Kingdom, which currently holds one of the biggest databases in the world. One may as why, if the NHS truly is a gold-standard model, why has no other country adopted it. Addictions are hard to break. Has the British population become hooked on a national treasure that has evolved into a national monster? Should we be revisiting the 2008 Darzi Review?

The interview also considers how Covid–19 has impacted the NHS, its staff and patients. Why are we seeing a rise in sickness among NHS workers? Could it be Covid–19, long Covid, exhaustion? Or is there another culprit that no one wants to talk about: injury from Covid–19 vaccinations? Difficult conversations from different perspectives need to be had. UK Column is grateful to both Dr Duncan White and Roy Lilley for their honesty, their openness, their willingness to discuss and their enthusiasm to listen to a different perspective. With far more to discuss, we look forward to welcoming them back for Part 2.