An NHS in crisis?


Austerity has meant that poor people have suffered the most since 2010. They not only die, if they are men, 10 years sooner than the rich, but they can expect to become disabled two decades earlier. The geographer Frances Darlington-Pollock, in her book Disease, released last November to mark the 80th anniversary of Sir William Beveridge’s radical blueprint for the welfare state, writes that by 2021, life expectancy had fallen for the first time in 40 years, by an average of 1.3 years for men and 0.9 years for women; and those living in the poorest areas had suffered the greatest loss. It is a political choice, she says, to not properly fund the health and social care system.

The Guardian View on Prime Ministers NHS Problem: Editorial, 3rd January 2023

This is not the first winter we have seen headlines aghast at wait times or worrying over respiratory conditions, but the cumulative impact of year-on-year of questionable politicking and mismanaged or misguided reform is taking its toll. 

A global pandemic teetering, it seems, on the edge of resurfacing has not been enough to force political action on a crisis-ridden health service. Headlines abound with cries of soaring demand, rising flu and COVID, a collapsing workforce, and unfathomable wait times whether for an ambulance or an operation. 

This may not be the first winter we have seen headlines aghast at wait times or worrying over respiratory conditions, but the cumulative impact of year-on-year of questionable politicking, of mismanaged or misguided reform, and of disinvestment in training, is taking its toll. Add into the mix austerity, COVID, and a cost of living scandal and the consequences may well be catastrophic. 

Yet too much of public outrage is directed at the Doctor, the Nurse, or the Paramedic balloting to strike. Too little is unleashed on the political machinery that is letting this happen. It is a political choice to not properly fund our NHS. More importantly, it is a political choice not to properly fund our social care system

We do not value those who care for us, whether the porter, the care worker, or the paramedic. The consequences of underfunding health and social care, while also undervaluing key occupations within it, are severe. Not only does it limit individual ability to provide high-quality care, it undermines public confidence and trust in a system where people who are at the limits of their capacity to cope become the focal point for public anger. 

We misdirect frustration and demands for action when we only condemn a failing NHS hospital or struggling care home. Yes, urgently address failings in any care provider, but this is a symptom of the root problem: chronic underfunding, mismanagement and politicking seeking to jettison responsibility for health and social care. 

In 1942, Sir William Beveridge outlined a system of social security for the British population, introducing the National Health Service we now see in crisis. The basic tenet of his vision was premised on a biomedical model of health favouring the silver bullet of medical and, increasingly, pharmaceutical intervention. 

The goal? To return a body in the deviant state of ‘ill-health’ or ‘dis-ease’ to wellness, to ensure that all men are able to continue contributing to a prosperous and growing economy. This did not leave space for the wider provision of social care needed to maintain health and wellbeing. Today, those care needs are more complex than ever and yet there still seems no space for a uniting of the provision of health and social care. 

We live in a society where our health and our life expectancy are shaped by where we are born, where we live, where we work, play or school. For those who may live a life of relative disadvantage,  the cumulative affect in older age can be significant. We do not, however, account for that in our system of care.

Pushing responsibility for care into the realms of our private lives feeds inequality. The health of people with caring responsibilities suffers, and the degree of care for people in need varies according to their and their family members’ time, resources and flexibility to manage  are provision alongside their own lives. We can fix an NHS in crisis, but not just by analysing wait times and worrying about flu or COVID (all of which are needed). Integrate and properly fund our health and social care system, building outwards from the individual and the social networks that sustain them. View individuals as more than a vehicle for economic output, and see populations and resources as more than components on a budget sheet.


Arguments extracted from my new book, Disease.

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