THE British National Health Service (NHS) was established on July 5, 1948, making Britain the first Western nation to offer free healthcare at the point of use to its entire population.
Seventy-nine years later, despite being a cornerstone of the British welfare state, the NHS is teetering on the edge of collapse. It has become a ‘sacred cow’ for all political parties, and many in Britain still believe they have the best healthcare system in the world.
In every election, political parties promise to ‘fix’ the NHS, but these promises ring hollow, as they know the system is too far gone to be saved. The British media and politicians have convinced voters that the NHS remains one of the world’s best health services, yet none of the parties have the courage to admit the truth: the NHS is crumbling, and acknowledging this could cost them votes.
In a recent World Health Organisation ranking, the UK was placed 18th, well behind Oman at 8th, with France and Italy taking the top spots. Once admired as one of the best health systems globally, the NHS is now one of the worst in Europe.
Successive governments bear responsibility for this decline due to poor planning and a lack of commitment to sustainable healthcare funding. In 2022, health care expenditure of GDP per capita in Germany was 16 per cent higher than in the UK, and in the Netherlands it was 29 per cent higher. This funding shortfall has severely impacted the NHS, which now struggles with increasing patient demand, staff shortages, and outdated infrastructure.
Key issues like workforce retention and hospital capacity have been ignored, while bureaucratic inefficiencies and weak leadership have deepened the crisis.
However, funding is not the only problem driving the NHS toward collapse.
Many NHS hospitals are led by Directors with little or no clinical experience, which undermines effective management. A study in America showed that hospitals run by doctors or those with clinical expertise perform better, which is common sense.
In any field, organisations are more likely to succeed when led by individuals with relevant expertise - schools by qualified headmasters, supermarkets by seasoned retail managers, and car companies by those with industry experience.
Unfortunately even those hospital Directors with medical backgrounds are governed by their political masters who are focused on targets and budgets, often at the expense of patient care.
While the NHS has some of the world’s best doctors, their complaints about poor practices or negligence are frequently ignored, and those who speak out risk their careers. The Lucy Letby case is a recent example of this mismanagement.
Letby, the worst child serial killer in UK history, murdered seven babies and attempted to kill seven more. Doctors raised their concerns with the Directors of the Countess of Chester Hospital, but in spite of this she was allowed to continue working and murdering for another year.
The hospital’s Directors appeared to have protected the hospital’s reputation over the safety of newborns, even forcing doctors who had raised their concerns to apologise to Letby. The police were only called in when the situation became impossible to ignore.
The Mid Staffordshire Trust scandal is another glaring example of NHS mismanagement. Between 2005 and 2008, patients at the Trust suffered from neglect, poor hygiene, understaffing, and long waits, with many dying from preventable conditions.
Hospital managers focused on meeting financial targets and achieving ‘Foundation Trust’ status rather than patient care. Using the Hospital Standardised Mortality Ratio, Professor Sir Brian Jarman’s statistical analysis revealed that Mid Staffordshire had alarmingly high mortality rates, far above the national average, which helped to validate the complaints from patients and their families.
Following the Mid Staffordshire scandal the 2013 Francis Report recommended reforms such as increasing staffing levels, improving accountability and prioritising patient safety.
Although the government initially pledged to adopt these changes, its follow-through has been weak at best. Key recommendations, like ensuring safe nurse-to-patient ratios and fostering a culture of transparency, remain unfulfilled. Underfunding, staffing shortages, and mismanagement continue to plague the NHS, and several investigations have revealed that patient care in some areas remains dangerously inadequate, undermining the government’s commitment to real reform.
Sir Keir Starmer, the newly elected Prime Minister, has made raising NHS standards a priority, promising to deliver many of the reforms outlined in the Francis Report. However, these promises sound all too familiar, and I remain unconvinced.
The NHS is fundamentally broken. It should be dismantled and replaced with one of the many successful healthcare models, such as those in France or Germany.
Karim Easterbrook
The writer is a Former School Principal Cambridge UK
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