Is the NHS about to collapse?

Once described as the envy of the world, the UK's National Health Service is in dire straits. As with any public health service, it's a juggernaut. It's expensive, sprawling, and employs over 1.2 million full-time staff. But this winter, after the pressures of Covid-19, rising costs of living and Brexit, there's a very real possibility that the NHS is on the verge of collapse.

Let's be clear: the NHS is not going to disappear in some apocalyptic disaster. We aren't going to wake up one day and find the hospitals crumbled and abandoned. However, we are rapidly approaching a point where Britain has no functioning public healthcare service. In fact, we may already be there.

Not all areas of the NHS are equal. The news reports we see are often of packed Accident & Emergency (A&E) departments. They're the front line of emergency care and usually the point where delays are most apparent. You can see queues of ambulances outside, patients waiting in the car parks and they're generally very visible presences in towns and cities. For those reasons, they're effective locations for news stories. They're operational – barely – but with extreme delays in some areas. In fact, those delays are so extreme that some areas are considering deploying "field hospitals" to cope with demand.

The government knows that disproportionate attention is given to A&E departments for the reasons given above. We look at the current situation unfolding at A&Es up and down the country with horror, but if that is the situation at the most prominent, public-facing part of the NHS, how bad are the other areas?

The truth is that they're even worse. Over one million people are currently on the waiting list for mental health services in England alone, and six million on the overall NHS waiting list in England (over 10% of the population). GPs are unable to offer appointments to anywhere near the number of people requesting them, and those people are then pushed to the 111 non-emergency phone line. As good as that service can be, you can often end up in a "redirect loop", with 111 passing you to the pharmacy who in turn pass you back to the GP, where you can't get an appointment. Likewise, because hospitals are overloaded, they are rejecting referrals and sending them back to General Practice, further adding to delays.

We somehow live in a situation – in 2023 in one of the supposedly richest countries in the world – where the only way to book a GP appointment is to telephone the surgery at precisely 8.30am along with everyone else. Getting through to a receptionist can take hours – and literally hundreds of phone calls – to be told there's no appointments left, please try again tomorrow.

And if your condition deteriorates, you go to Urgent Care or A&E. This was an approach that sometimes was more efficient than even attempting to navigate the GP system, but the delays and pressures on these centres are at unprecedented levels. I'd heartily recommend listening to The News Agents' most recent podcast, "The collapse of the NHS", for first-hand accounts of how bad it's really got.

To be absolutely clear, this is not the fault of NHS staff. These are generally extremely hard-working, dedicated people who sacrifice so much for our benefit. The system itself, and those in charge of it, are what has fundamentally broken.

In 2021, there were 311 million non-COVID vaccination GP appointments delivered in England. That's approximately 5 and a half appointments per person per year. I find that incredibly difficult to believe. As someone who hasn't seen their GP for over ten years (I've been lucky to be very healthy) and someone who doesn't know anyone who's even been able to get through to their GP in England in recent months, I'd genuinely love to know who's getting in to see their GP.

It's not just GPs struggling to deliver. As I wrote this article, pharmacy bosses issued a warning that some pharmacists were struggling to obtain "the very basic" supplies. The Chief Executive of the Association of Independent Multiple Pharmacies stated, "This isn't just the branded medicines, it is also simple things like throat lozenges, cough mixtures or pain killers - particularly the ones that are soluble."

On top of all of this, for the first time in history, the Royal College of Nursing has taken strike action and is set to continue to do so. And who can blame them? Typical salaries for nurses have fallen by 5.9% since 2010 and are set to drop by over 10% below 2010 levels against a backdrop of rising inflation. There are over 17,000 unfilled nursing vacancies in the NHS, and over 10% of nurses left the service between 2021 and 2022. That's a ticking time bomb.

It's got to the point where, for the first time in my life, going private for medical care is not a luxury – it might be essential for my health. I know a few people now who have been unable to progress through the NHS system for issues as serious as suspected cancer, and have been forced to go private to ensure it doesn't spread. By that metric, the NHS in England has already collapsed.  If it cannot be relied upon to deliver life-saving care, then it cannot be relied upon at all.

How on earth did we get here?

As usual, it's a combination of factors, but the four major contributing factors are:

1. The Conservative Government
2. Brexit
3. Covid-19
4. Declining living standards

The Conservatives have underinvested in the NHS. Despite repeated attempts to announce "record money" being put into the NHS, they were warned repeatedly that their increase in spending would not be sufficient. The problems that this chronic underinvestment has caused are well documented here. The scale of the change in investment can be seen below.

It's not just a case of pumping money into the service and it magically gets better, of course. But Labour also managed the money well, leading to demonstrable improvements.

When Labour left government in 2010 they had succeeded in vastly improving the NHS. The waiting list had steadily decreased, down to 2.3 million in 2009. It even tightened targets for treatment times on GP referrals – something unimaginable today. In simple terms, Labour ran the NHS far better than the Conservatives have.

Brexit is also a huge factor. Since 2016 there has been a significant slowdown in EU citizens coming to work in the NHS, which is unsurprising given the toxic "hostile environment" and anti-European rhetoric spewed out during the Brexit campaign. At the same time there has been a rise in non-British NHS workers reporting ethnicity or race as a ground for discrimination. This correlates with wider trends in the UK.

Those who still wanted to come have been faced with increased costs and bureaucracy for visas. We've wilfully made it more difficult to staff our health service.

Thirdly, Covid-19 has had a huge impact in terms of burnout and long-term sickness within the NHS. Britain's somewhat cavalier attitude towards Covid-19 meant we were willing to accept quite a high burden on our health service, compounding existing problems.

A Parliamentary report in 2021 found that an NHS Providers survey found that 9 out of 10 trust leaders were concerned about staff wellbeing, stress and burnout following the pandemic. A Macmillan GP stated that even the most resilient of colleagues were “cracking” under the pressure. During the pandemic itself, capacity was further stretched as the percentage of days lost to sickness almost tripled from 3% to 8% from March to July 2020 compared to usual levels.

Finally, in a society where the poor are evermore stretched, the need for healthcare services increases. As energy prices have soared through the roof and people are choosing between eating and heating, we find people becoming malnourished or ill as a result of living in unfit habitation. The tragic death of Awaab Ishak who died following "chronic exposure" to mould in Rochdale in 2022 is a national scandal.

All in all, the question of whether the NHS might collapse is probably redundant. It already has collapsed as a functioning service for millions, much as the country itself is collapsing around it. It is a damning indictment of a decade of Conservative mismanagement and the inevitable consequence of ideologically driven policies of international isolationism and national austerity. Things will get worse, particularly if – as a country – we continue to vote Conservative charlatans into power.

The staff of the NHS deserve better. We as a people deserve better. At the next election, make sure we all get better.