Skip Navigation

Cracking Under Pressure: The Uphill Battle Toward Improving the NHS

Image via Tolga Akmen/Shutterstock

Almost three years after the pandemic, providing quality healthcare continues to be an issue in many developed nations. In the United Kingdom, things are no different, and Covid-19 only exacerbated issues already facing the National Health Service (NHS). To address existing shortcomings, the UK has slowly been privatizing the NHS, a process that began in 1980 but was recently accelerated by the Health and Care Act of 2022. Even as privatization is being discussed as a solution to the NHS’s long-standing problems, there are significant concerns over creating a fragmented, two-tier healthcare system. 

In the aftermath of loosening pandemic restrictions, the NHS is facing a backlog of seven million people. From November to December 2022, there was roughly a 44 percent increase in the number of patients waiting over 12 hours to be admitted to a hospital. Former Prime Minister Boris Johnson had already tried to combat the issues facing the NHS when he passed the Health and Care Act in April 2022. The act aimed to reform the NHS and social care systems through measures such as giving the health secretary more power over NHS England and merging NHS England and NHS Improvement. Before the merger, NHS Improvement was responsible for the relationship between independent providers and the NHS, as well as overseeing the NHS’ foundation trusts and NHS trusts. NHS England is responsible for coordinating primary care with general practitioners, pharmacists, and dentists. The merger triggered concerns over increased bureaucracy and a lack of transparency and accountability. But almost a year later, the UK still has fewer hospital beds than any other developed state, and ambulances still wait in lines outside hospitals. 

Simultaneously, workers are demanding pay that keeps up with inflation as the gap between public and private sector wages widens across all industries. In the five months since October 2022, pay in the private sector was up 6.9 percent compared to only 2.7 percent in the public sector. As a result, public sector jobs are suffering from a shortage of labor. The NHS is no exception, as it faces dwindling levels of doctors, nurses, and support staff. Notoriously, nurse strikes are the largest they have been in decades. 

Now, as UK Prime Minister Rishi Sunak, the third person to hold the position in the past year, tries to combat the economic turmoil, he must tread lightly—lest he share the same fate as his predecessor, Liz Truss. Former Prime Minister Truss’ economic policy, known as Trussonomics, abandoned traditional orthodoxy for ‘big bang’ measures. This shift backfired, and she resigned after only 45 days in office. The plan was implemented to address a range of economic challenges facing the UK at the time, including the budget deficit, low productivity growth, economic inequality, and Brexit. Even before becoming prime minister, Truss supported deep cuts to the NHS in 2009, when she was a member of Parliament, and planned to divert critical funds during her time as prime minister. The failure of Trussonomics can be attributed to continued uncertainty trailing Brexit, austerity, weak economic performance, and political instability—issues that followed Sunak into his tenure. 

Unlike Prime Minister Truss, Sunak’s stance on the NHS echoes the general stance of the Conservative Party, of which he is a member. In his January 2023 speech, he pledged to make the NHS a top priority of his administration. Faced with turmoil in the healthcare sector and the risk of striking nurses, Sunak promised to make the health sector one of his top five priorities, even dedicating a £1 billion fund to provide thousands more hospital beds, 800 new ambulances, and an expansion of community care. Despite the ambitious plan, the pledge is incomplete, lacking information on who will staff the new ambulances and hospital beds. Even with this infusion of funds, workforce shortages, exhaustion, and burnout offer additional obstacles toward improving the NHS. Thus, a simultaneous initiative to Sunak’s pledge is privatization as a possible solution to the NHS’ longstanding problems. However, the controversial policy may only be available to higher income brackets. 

Other developed nations have already adopted the public-private healthcare modality. Germany, for example, implemented it in 2007. Privatization in the German healthcare system provides a balance between universal coverage and private sector competition, resulting in high-quality care, choice for patients, and efficient use of resources. But a main concern regarding privatization is the possibility of creating a two-tier system, where those who can afford private healthcare receive better treatment, leading to increased inequality in access to healthcare. In Germany, about 85 percent of the population takes out insurance with one of the country’s 124 public insurers. Still, there is an option for those who make more than €4,350 a month to take out insurance with a private company, which, compared to the average monthly gross salary for a full-time employee of €4,100, is reasonably accessible to middle and upper-class tiers of the population. This system, however, still seems to have created the divide that critics of privatization warn against. Researchers have found that low-income individuals in Germany have a higher prevalence of chronic diseases including diabetes, hypertension, and depression, compared to high-income individuals.

Privatization also risks creating a fragmented healthcare system, making it difficult for patients to receive coordinated care. The cost of private healthcare services may also be higher than those offered by the NHS, leading to increased healthcare costs for patients and the government. Another point of concern is the question of regulation, as private companies may not be as answerable to the NHS, and their priority is pleasing private investors. Finally, privatization could also lead to a loss of expertise within the NHS as experienced staff may leave, resulting in a loss of institutional knowledge. 

Although Sunak’s plan solves the lack of resources, it fails to address staff shortages—an issue that the government has already attempted to resolve in the past. In 2019, prior to the pandemic, the UK government launched several initiatives to recruit more doctors. They offered financial incentives to medical students who committed to working in underserved areas after graduation, increased the number of medical school places available, and recruited doctors from overseas. The government also attempted to improve working conditions for doctors in the NHS by increasing salaries and reducing working hours. But the post-pandemic world looks very different from when the policy was first implemented. As a result, the NHS is still faced with workforce shortage issues due to difficulties, including acquiring visas for foreign healthcare workers.

With the NHS facing a range of challenges, its future remains uncertain. Despite Prime Minister Rishi Sunak’s pledge to make it a top priority, workforce shortages, exhaustion, and burnout pose significant obstacles to improvement. Privatization could be a possible solution to the NHS’s long-standing problems. While a two-tier healthcare system could provide more choices for patients and increase surgical capacity, it could also lead to increased inequality in access to care—a threat perhaps even greater than the shortages themselves. Urgent action is needed to ensure that the NHS can continue to provide quality healthcare to all British citizens.