A national treasure, tarnished: Can Britain fix its health service?

“We’re in this situation every day now because the NHS just doesn’t have the capacity to deal with all the patients,” Wood said.

Despite her distress, Patten was sympathetic. Decades ago, she said, the NHS saved her husband’s life when he had a heart attack. “He has to deal with a lot more people,” she said. “You can’t be mad about it.”

Graffiti marking the National Health Service in London, April 17, 2023 (Andrew Testa / The New York Times)

Its stoicism captures the respect Britons have for their cradle-to-grave health system, but also their sorry feeling that it is broken.

Turning 75 this month, the NHS, a proud symbol of Britain’s welfare state, is in the deepest crisis in its history: overwhelmed by the elderly and frail patients; hungry for investment in equipment and facilities; and understaffed by doctors and nurses, many of whom are so exhausted that they either join the strikes or leave to work abroad.

Interviews conducted over three months with doctors, nurses, patients, hospital administrators and medical analysts depict a system so agitated that some experts warn the health service is at risk of collapse.

“Doctors and nurses are faced with an endless stream of patients filling beds,” said Matthew Trainer, chief executive of the NHS Trust which runs Queen’s and another nearby hospital, King George. “For the medical staff, that takes away the feeling of hope — that feeling that what you’re doing matters.”

Michelle Scanlan, left, and Kaushik Bhatt in the emergency unit at Queen’s Hospital in Romford, England, March 20, 2023. (Andrew Testa/The New York Times)

More than 7.4 million people in England await medical procedures, everything from hip replacement to cancer surgery. That’s up from 4.1 million before the coronavirus pandemic began in 2020.

Mortality data, exacerbated by long waiting times, paints a grim picture. In 2022, the number of excess deaths has risen to one of the highest levels in the past 50 years, and those numbers have continued to rise, even as the pandemic subsides.

In the first quarter of 2023, more than half of the excess deaths — that is, deaths greater than the five-year average, before the pandemic — were caused by another cause than Covid-19. And deaths related to cardiovascular disease, which can be linked to delays in treatment, rose particularly sharply.

The spread of labor unrest exacerbated the crisis, turning away hospitals that were already barely coping with a state of paralysis. While Patten waited in bed in Queens, doctors were picketing outside, protesting starting wages similar to those earned by a barista in a hospital lobby.

seeking to solve the problem, Prime Minister Rishi Sunak last month announced the 15-year plan To recruit and train 300,000 nurses and doctors, with a budget of 2.4 billion Egyptian pounds (about 3 billion dollars) for the first five years. But critics point out that the plan does not fund wage increases.

The NHS has always managed to deliver a level of care that justifies its gigantic footprint in British public life, and it is hard to imagine a vibrant Britain if the service had not been stabilized.

Politically, British fiscal austerity exacerbated the system’s failures. Covid has exposed a slew of problems – including poor management and eroding facilities – that have been brooding within the service since Conservative-led governments began curbing budget increases in 2010.

Health care spending increased by an average of less than 2% per year from 2010 to 2019, compared to 5.1% from 1998 to 2008. Britain spent a year less per capita on health care than the EU’s richest countries during the decade of austerity, and now has fewer doctors and hospital beds per capita compared to its European neighbours.

Young doctors sit-in protesting higher starting salaries outside Queen’s Hospital in Romford, England, March 15, 2023. (Andrew Testa/The New York Times)

“Austerity has made things worse,” said Nigel Edwards, chief executive of the Nuffield Trust, a health research organisation. “There’s been a lot of savings in the salami slice over the years, which has made the system even more fragile.”

No major politician is proposing to privatize the NHS. And in some ways, the service remains a marvel, and it’s one of the most comprehensive and taxpayer-funded healthcare providers out there — “free at the point of delivery,” as its quintessential slogan puts it. And it still provides annual physicals, mammograms, immunizations and other services at a level that visiting Americans find impressive.

Indeed, distraught observers say the NHS is in perpetual crisis. But the problems this time around are different, magnified by Britain’s faltering economy and jerky post-Brexit politics. Experts say its universal access model has become unsustainable, and there is no clear blueprint for reinventing it.

Marianne Patten waits in an emergency room bed for a hospital room to open at Queen’s Hospital, where waiting times have improved but more than half of patients with serious illnesses or injuries still wait more than four hours to be treated, in Romford, England, March 20, 2023 ( Andrew Testa/The New York Times)

These problems are compounded by the collapse of primary care, which has made it impossible for many people to get an appointment with their family doctor. With a shortage of general practitioners and nowhere else to turn, the emergency room has become the first stop for millions of sick Britons.

Semi-sacred institution

During the darkest days of the pandemic, people would gather once a week to cheer and bang metal pots for the NHS. Children colored with ‘Thank You NHS’ signs draped in the windows of Number 10 Downing St Boris Johnson, the former prime minister who was treated for COVID in an NHS hospital, were among those turned to applauding.

People applaud during a weekly public appreciation of frontline healthcare workers during the COVID-19 pandemic, outside Chelsea and Westminster Hospital in London, April 7, 2020. (Andrew Testa/The New York Times)

Protecting the health service has become a dogma for British leaders of all parties. Sunak, who has made waiting times shorter one of his government’s five primary goals, regularly reminds Brits that his father was a doctor and his mother a pharmacist.

He said in January: “When I talk about the NHS, I’m not just talking about a precious public service, I’m talking about calling my family to life.”

This dedication was not inevitable. In the first decades of service, Britons were wary of public health care, fearing it might interfere with their relationships with their family physicians. And those doubts culminated in the 1980s with Margaret Thatcher’s free market revolution.

However, rather than being privatized, the NHS survived the Thatcher years. In part because its advocates have shrewdly compared it to health care in the United States, which accounts for America’s skyrocketing costs, deep inequality, and massive uninsured population.

Ambulances in Wrexham, Wales, December 1, 2022 (Andrew Testa / The New York Times)

Experts periodically come up with ideas like privatizing parts of the service or charging for some treatments, which could make people less quick to go to the emergency room for minor health issues. Sajid Javid, the former Conservative health minister, has proposed changing its funding base from tax to an insurance-based system, like that used in Germany.

But Edwards of the Nuffield Trust said there was little evidence that the service’s problems stemmed from how it was funded. Other high-income countries have had problems with their health systems.

“I doubt there will be a desire to change the financing model or to change the ownership of hospitals,” Edwards said. “The danger, then, is that they are trying to play with the train set, which is what future governments love to do.”