Aditya Tiwary

How can the NHS be improved?

Not so long ago, the NHS was the pride of the UK. Once regarded as one of the fairest and most effective
healthcare systems in the world, it is now in a state of ruin. Millions of people in the UK rely on the NHS
for their health and well-being, thus placing the NHS in a position of utmost responsibility. Consequently,
the importance of improving the quality of service the NHS provides cannot be underestimated.
Problems with the NHS
Chronic understaffing is a fundamental issue within the NHS, that has been consistently rising in the last
few years. As of September 2022, the total number of vacancies was 133,466, a vacancy rate of 9.7%,
which is a significant increase from 2021, when the vacancy rate was 7.9% (Waitzman, 2022). This issue
appears to have several causes, for example, insufficient funding and infrastructure to train enough
doctors. Alongside the increased workload and low pay for healthcare workers, this has led to higher
stress among healthcare workers. Unsurprisingly, this has led to a poorer quality of service in the NHS
and poor retention – it is becoming increasingly difficult to retain doctors and nurses (BMA, 2022).
Recent strikes over pay disputes are another example of the rising dissatisfaction among NHS workers.
For example, ambulance workers who are members of Unite are striking on the 6 th, 17th and 20th of
February and the 20th of March (NHS, 2023). A survey conducted by the BMA indicates that one in three
junior doctors plan to leave the NHS to work abroad, with 83% of them citing pay as their primary reason
(Waters, 2022).
Another key issue with the NHS is
outdated technology, which has led to
increased inefficiency in the NHS.
According to the BMA, 13.5 million
working hours are lost annually in the
NHS due to inadequate IT systems (UK
Parliament, 2022). Increased waiting
times and a lack of ability to share patient
records (meaning duplication of work)
are key examples of the detrimental
impact outdated technology has on the
NHS. The inefficiency of the NHS has
also led to worsening public opinions
regarding the NHS, and many people
now prefer healthcare systems in other
Figure 1: Public opinion of the NHS (Statista, 2023)
countries over the NHS.

Looking ahead, the current cost-of-living crisis will likely exacerbate poverty levels and health issues,
further escalating the pressure on the already exhausted NHS.
Potential improvements
 Aditya Tiwary

Government expenditure
on the NHS has been
consistently rising in the
past decade. Despite this,
there are still claims that
the NHS is underfunded,
although other countries
whose healthcare systems
outperform our own, such
as South Korea, contribute a
similar proportion of their
GDP towards healthcare as
the UK. Therefore, the
fundamental issue is not Figure 2: Government healthcare budget (BMA, 2023)
how much money should be spent on the NHS but rather where the money should be spent.
In the short run, salaries for NHS staff must increase. Not only would this improve the satisfaction of
NHS staff and increase their productivity, but this would also make the NHS a more attractive place to
work for aspiring doctors, which would deter doctors from leaving the NHS.
Another way to decrease the stress levels of NHS workers would be to bring back the tuition fee grants
that were available before 2016 (Gallagher, 2022). Since then, new nurses have been leaving with a
tuition fee debt, most of whom are understandably struggling to pay off this debt, given the rising cost of
living. Bringing back this bursary would not only make it easier for new nurses to cope with the rising
cost of living, but it would also encourage more students to train to become nurses, which, in the long run,
is a solution to the staff shortages within the NHS.
The NHS is also the world’s single biggest buyer of healthcare products, and the way it spends money is
heavily criticised. In Canada, a system called ‘innovation procurement’ invites firms to participate in
design competitions, which focus on providing the best solution to a problem, for instance designing
better tools for surgeons (Siddique, 2018). Rather than spending money on unrequired products, effective
competition could be used here in the UK to ensure that the NHS is spending its procurement budget
efficiently.
A longer-term solution would be for the government to bolster spending on new technology and capital
equipment for the NHS. Given the current rate at which artificial intelligence is being developed, there is
a possibility that AI could be implemented into the NHS in the future. For example, it could handle calls
from those booking GP appointments, or manage patients’ data. This would make the NHS more efficient
in the long run, as staff would no longer need to spend time completing trivial admin tasks.
Inspiration can also be taken from Israel, where there is a data sharing system that stores the data for
patients across the country, allowing information to be collected regarding patients much faster and
decreasing the duplication of work collecting data from patients, drastically increasing the efficiency of
hospitals (Siddique, 2018).
Naturally, these improvements would come at a high cost to taxpayers. Health Minister Maria Caulfield
recently stated it would cost the government £700m to increase pay for NHS staff by 1% (Gilder, 2022),
and given that the current inflation rate is over 10%, pay rises are likely to cost the government several
billions of pounds. However, these improvements are necessary to restore the NHS to its former glory,
thus raising the question, where will this funding come from?
 Aditya Tiwary

Privatisation is one suggestion that is frequently brought up. Complete privatisation of the health sector in
the UK would almost certainly increase the efficiency of the healthcare system, as it would be in every
firm’s interest to make their service as efficient as possible to cut costs. Other potential benefits of this
increase in competition would be more consumer choice and a better-quality service for those who could
afford it. However, with real household incomes falling, complete privatisation would almost certainly
exclude some people from getting the healthcare they need. Other drawbacks include a lack of continuity
in care and less transparency and oversight from the government.
In the Netherlands, every citizen has private health insurance; the government ensures that everyone has
it. Most citizens pay for it, and the state provides for those who cannot. The government also ensures that
health insurers cannot discriminate, as firms cannot deny any applicant. In almost every measure, the
Dutch system consistently outperforms the NHS: they have a higher survival rate for strokes, heart
attacks, and common forms of cancer, all of which largely depends on the quality of healthcare provided
(Niemietz, 2022). Moreover, the UK and the Netherlands spend just over 10% of their GDP on healthcare
provision. This is no different from
most other countries in the world
with a better healthcare system than
the NHS. South Korea, whose
healthcare system is widely regarded
as the best in the world, spent 8.71%
of its GDP on healthcare (Statista,
2022), again less than what the NHS
receives. Like the Netherlands, South
Korea’s healthcare system is not
free, but citizens only need to pay
20% of their medical bills
(InterNations, 2022).
Complete privatisation of the UK’s
health sector is unreasonable, although the Figure 3: South Korea's national health expenditure as a percent of GDP
NHS will most likely be better off if those (Statista, 2022)
who can afford to pay for NHS services did pay, even if they only cover part of their medical bills. This
would free up much of the government’s budget and make the previously suggested solutions far more
achievable. Given the current crisis, this is not a system that should be put into place immediately, and it
will likely receive severe backlash from households already struggling to pay their bills.
Nevertheless, it is still possible to implement certain charges to resolve certain issues. For instance, fines
could be introduced for missed GP appointments, which currently account for almost 20% of all NHS
appointments (Johnson, 2017). Other minor reforms could also significantly reduce some of the problems
faced by the NHS, such as introducing fees for A&E services, which would deter people from going to
A&E with minor ailments.

An abundance of issues stands against our NHS. If the correct steps are not taken, the pride of the UK
will collapse under the unprecedented pressure it faces today. Change is required, and although this may
be the end of the NHS we grew up with, it must adapt to survive.
 Aditya Tiwary

Works Cited
BMA. (2022, December 6). An NHS under pressure. Retrieved from BMA:
https://www.bma.org.uk/advice-and-support/nhs-delivery-and-workforce/pressures/an-nhs-
under-pressure#:~:text=Poor%20retention,retain%20the%20doctors%20we%20have.

BMA. (2023). Health funding data analysis. Retrieved from BMA: https://www.bma.org.uk/advice-and-
support/nhs-delivery-and-workforce/funding/health-funding-data-analysis

Gallagher, P. (2022, January 8). How to fix the NHS. Retrieved from inews:
https://inews.co.uk/news/health/how-to-fix-the-nhs-recruitment-changes-staff-exodus-
healthcare-doctors-nurse-1389499

Gilder, L. (2022, December 17). Would every 1% rise to Nurses' pay cost £700m? Retrieved from BBC:
https://www.theguardian.com/society/2018/jul/03/five-ideas-from-other-health-systems-that-
could-transform-nhs

InterNations. (2022). South Korea Healthcare. Retrieved from InterNations:

https://www.internations.org/south-korea-expats/guide/healthcare

Johnson, S. (2017, July 7). Nine ways to save NHS healthcare. Retrieved from The Guardian:
https://www.theguardian.com/healthcare-network/2017/jul/07/nine-ways-save-nhs-
healthcare-professionals#:~:text=Break%20down%20barriers%20between%20different,5p
%20plastic%20bag%20charge%20did.

NHS. (2023, February 3). Information for the public on industrial action. Retrieved from NHS:
https://www.england.nhs.uk/long-read/information-for-the-public-on-industrial-action/
 Aditya Tiwary

Niemietz, K. (2022, February 8). Should the NHS be privatised. Retrieved from IEA:
https://iea.org.uk/motion-should-the-nhs-be-privatised/

Siddique, H. (2018, July 3). Five ideas from other health systems that could transform the NHS. Retrieved
from The Guardian: https://www.theguardian.com/society/2018/jul/03/five-ideas-from-other-
health-systems-that-could-transform-nhs

Statista. (2022). Health Spending South Korea. Retrieved from Statista:

https://www.statista.com/statistics/647320/health-spending-south-korea/

Statista. (2023, January 31). Distribution of opinion in the UK on NHS. Retrieved from Statista:
https://www.statista.com/statistics/1359963/opinion-in-the-uk-on-nhs-compared-to-european-
healthcare/

UK Parliament. (2022, November 11). MPs examine replacement of outdated technology. Retrieved from
UK Parliament: https://committees.parliament.uk/committee/81/health-and-social-care-
committee/news/174304/mps-examine-replacement-of-outdated-technology-to-improve-
patient-care/

Waitzman, E. (2022, December 9). Staff shortages in the NHS and social care sectors. Retrieved from
House of Lords Library: https://lordslibrary.parliament.uk/staff-shortages-in-the-nhs-and-social-
care-sectors/

Waters, A. (2022). A third of junior doctors plan to leave NHS. Retrieved from thebmj:
https://www.bmj.com/content/379/bmj.o3066.full