Written by Dr. Andrew Stein MD, Consultant Physician. Last updated: June 2026
The NHS is currently facing an unprecedented ‘flow crisis.’ In mid 2026, with waiting lists exceeding 7.2 million and A&E departments frequently operating under ‘black alerts,’ the system is effectively jammed.
The current government – led by Keir Starmer and previous Health Secretary Wes Streeting – seem to think that ‘shaking the broken radio’ will sort it out. After 2 years in government, their ‘reforms’ have had little or no effect.
Why? It is simple. They are not facing, let alone addressing, the following five core problems. Other countries have faced all five issues and their systems work (Netherlands, Switzerland etc), using a similar proportion of GDP.
Hence this artricle explores the five structural ‘logjams’ within the NHS and the radical solutions—ranging from organisational reform to a total funding overhaul—required to fix them.
Their current NHS 10 Year Health Plan (July, 2025) makes almost no mention of any these 5 issues.
Most of this article focuses on secondary care. This is because MyHSN believes that Primary Care (GP) is working reasonably. Though the public may have a different view.
In the UK do the patients help themselves?
Not hugely. They expect the NHS to look after them. And when it doesn’t they blame the system, not themselves. This is really the sixth hidden (by silence) problem that we are all reluctant to admit.
From the patient perspective, they feel that they cannot easily get F2F appointments with GPs and then cannot get continuity after being seen. At that same time, they don’t think “why do I need to see a doctor? Could I have done something to prevent this issue?.” They also may not go to a doctor early in a disease process.
From the GP’s (and the nation’s) point of view, in the NHS, there is no incentive for the patient to address their own health, i.e. the patient (not the doctor) prevents disease by looking after their body. And if they had gone to a doctor at an earlier stage, it may have been easier for the problem to be sorted out.
We need as a country to start a discussion on these issues, which are debated more later.
As of 2026, the data remains sobering:
The Waiting List: Over 10% of the UK population is waiting for a first clinic appointment, operation, procedure – many 6-12 months. This is totally inappropriate for the 6th strongest economy on Earth.
The ‘Trolley Crisis’: Currently about 50,000 patients per month (and over 70,000 in winter months) spend over 12 hours on a hospital trolley in A&E corridor, after a decision to admit has been made.
Ambulance Handover Delays: Around 20% to 25% of all handovers experience delays exceeding 30 minutes, peaking higher during winter pressures. Ambulances then remain parked outside hospitals, unable to respond to new 999 calls.
Currently, the NHS mixes Emergency (Hot) and Elective (Cold) care in the same buildings. When a winter flu surge or a spike in pneumonia cases hits, ‘cold’ surgery—like hip replacements or cataract removals—are the first to be cancelled to free up beds for emergency admissions.
The Solution: Total Separation
We must legally and physically separate elective hubs from acute hospitals.
Surgical Hubs: Dedicated ‘cold’ sites that never take emergency admissions. This ensures that even during a crisis, cancer surgeries and joint replacements continue uninterrupted.
Integrated Care Boards (ICBs): These regional bodies must use their power to designate specific ‘clean’ sites within their geography solely for planned procedures. There is little evidence ICBs are using their power to change the way hospitals work.
Note. There are currently 42 ICBs (which are about ‘county-sized’). The government is merging them into 26 ‘ICB Clusters’. This is slow, expensive, illogical (as will be too big, and have no local connection) and take years. It is an unhelpful distraction.
Disease does not recognise weekends – or bank holidays. Yet the NHS still largely operates on a ‘Monday to Friday, 9-to-5’ rhythm for non-emergency services.
The Weekend Effect: Mortality rates rise 11% for patients admitted on weekends because consultant presence, diagnostic scanning, and pharmacy services are significantly reduced.
The Monday Chaos: Because discharges drop by 60% on Saturdays and 40% on Sundays, hospitals become ‘gridlocked’ by Monday morning.
The Solution: A True 7-Day NHS
The NHS must modernise its rotas to provide an identical level of service 365 days a year.
Consultant-Led 7DS: Senior doctors must be present in normal numbers on Saturdays and Sundays to authorise discharges and lead clinical decisions.
The ‘Tesco, Uber and Booking.com Models’: If retail services can run 24/7 through smart rotas, so can non-elective (emergency) and elective healthcare. This requires a cultural shift in medical contracts to prioritise patient flow over traditional working patterns.
Roughly 25% of hospital beds are occupied by patients who are “Medically Fit for Discharge” but have nowhere to go. This is known as Delayed Transfer of Care (DTOC).
The Funding Gap: Social care is currently run by local councils, whose budgets are not linked to population growth or healthcare demand.
The Weekend Stride: Nursing homes often refuse to take patients back on weekends because they believe (rightly) that the NHS support isn’t there. They are right. They copy the NHS’s poor performance.
Solution: Merge Health and Social Care – Properly, not With a Title (DHSC)
The government must bring Social Care under the NHS umbrella with a unified budget.
Universal Care: Move toward a system where the state pays for social care, preventing families from having to sell homes to fund end-of-life care. This will require increased funding (via taxation). But we must be bold and do that.
7-Day Discharge: Social care managers must work weekends to ‘green-light’ transfers, ensuring the ‘exit door’ of the hospital remains open 24/7.
Note. There is an irony regarding social care. The beds and staff at nursing and residential homes are still there at the weekend. They are just not asked to do their job. Crazy!
The NHS still struggles with fragmented IT systems. A GP often cannot see what a hospital consultant has prescribed, and A&E doctors frequently have no access to a patient’s primary care history.
The Solution: Unified Single Patient Record (EPR)
We need subregional, ICB-based EPRs that merge with each other (and GP) all of which link directly to the NHS App.
Some progress has been made towards such a system (to be completed in 2028). And that is only for England. What abiut the rest of the UK?
And the pace of change lacks ambition and focus. For example, these areas should be part of such an SPR:
One-Click Discharge: Use AI to automate discharge summaries (TTOs), sending prescriptions directly to the patient’s local pharmacy before they even leave the ward.
Interoperability with other hospitals: Systems like Epic and Cerner must be mandated to ‘talk’ to each other across all 42 ICBs in England.
The NHS is currently a mishmash of barely connected ‘silos’ – partly for historical reasons. Hospital and ambulance trusts, NHS regions and ICBs, and local councils often have different geographic boundaries and priorities.
Solution: Regional Streamlining
We must align all NHS organisations (Ambulance, Public Health, Council) into 7 consistent regions built around the current NHS England structure.
Empowered ICBs: Give Integrated Care Boards the legal authority to override individual hospital ‘traditions’ and enforce standardised pathways.
The current tax-funded model, established in 1948, is unable to cope with PACE (Population growth, Ageing, Complexity, and Expectation).
The Dutch Model (Social Insurance): Many experts (and MyHSN) believe the UK should transition to a Social Insurance system, similar to the Netherlands. In this model:
Healthcare remains free for the vulnerable.
Competition between non-profit insurers drives efficiency.
Waiting lists are virtually non-existent because the funding follows the patient immediately.
How the Dutch Model Solves the ‘Big Five’ Problems
1. It Ends the “Postcode Lottery”
In the Netherlands, insurance companies are non-profit but competitive. If one insurer has long waits for hip surgery, patients move to another. This forces hospitals to be efficient. If they don’t see patients quickly, they don’t get paid.
2. It Fixes the Social Care Logjam
The Dutch system includes long-term care insurance. Because the same system pays for both the hospital bed and the home care, there is a massive financial incentive to get patients out of the hospital and back home as soon as they are medically fit.
3. It Mandates 7-Day Productivity
In a social insurance model, ‘the money follows the patient.’ If a hospital closes its theaters on Friday afternoon or weekends, it loses revenue to a clinic that stays open. This naturally ends the ‘5-day working week’ culture without needing a government mandate.
Note. It is generous to state the NHS works 5 days a week – 4 and half is more the mark. Little happens on a Friday afternoon.
4. It Protects the Vulnerable
A common myth is that insurance models hurt the poor. In reality, the Dutch government pays the premiums for low-income citizens through ‘healthcare allowances.’ No one is denied care based on their ability to pay.
5. General Practice is part of the Social Insurance Model
Many of the UKs current problems in GP could be addressed by their incorporation into the Social Insurance model. Then GP will stop being ‘outside the NHS’ in a system whereby they are quasi-independent of the NHS working as small independent companies. It would also depower the BMA (doctors’ union), which resists all modernisation of the NHS.
6. National Drug Formulary
The formation of a National Drug Formulary (similar to the Lothian Formulary in Scotland), could be part of a change to a social insurance model. It is estimated this could save 10% of NHS costs (£20 billion per year), freeing up funding for radical reform as suggested in this article.
The table below compares the current NHS (Tax-Funded) system with the Netherlands (Social Insurance) model to show how it could solve the ‘jammed’ hospital crisis.
| Feature | UK NHS (Current) | Netherlands (Proposed Model) |
| Funding Source | General taxation and National Insurance. | Mandatory private insurance premiums + tax subsidies. |
| Provider Choice | Limited by your local ICB/GP area. | High; patients choose their insurer and providers. |
| Waiting Lists | High (7.2m+); rationed by time. | Virtually non-existent; rationed by capacity. |
| Hospital Flow | Jammed; ‘Hot’ and ‘Cold’ care mixed. | Efficient; ‘Money follows the patient’ immediately. |
| Social Care | Separated (run by local Councils). | Integrated into the mandatory insurance package. |
| Patient Responsibility and Patient-Led Preventative Care | Reactive; heavily reliant on overstretched GP access for basic screenings and lifestyle interventions. Does not matter if DNA appointment, or go to doctor earlier. | Proactive; insurers financially incentivise wellness programs, wearable tech tracking, and routine check-ups. Incentives exist to turn up, and go at early stage in disease process. |
| Primary Care | GP as ‘gatekeeper’ (hard to access hospitals, try to block referrals). | GP as coordinator (incentivised to guide patients efficiently through a competitive network). |
Note: In the Dutch model, insurers actively compete on preventative care packages (like gym discounts or free health coaching) because keeping patients healthy directly lowers their long-term clinical costs.
Whilst the results (shorter waits, better cancer outcomes) are tempting, it is true that the transition would be difficult:
Higher Costs: The Dutch spend a slightly higher percentage of GDP on health than the UK.
Administrative Shift: We would need to move from 42 ICBs to a regulated insurance market.
Cultural Resistance: Many in the UK view ‘insurance’ as ‘Americanization,’ even though the European model is entirely different from the US system.
Key Takeaway: The Dutch model unjams hospitals by replacing ‘block funding’ (where hospitals get a set budget regardless of how many people they see) with ‘activity-based funding,’ where efficiency is rewarded and social care is fully integrated.
To unjam our hospitals, we must stop blaming ‘the system’ and start reforming it. We need to split elective care, implement a 7-day service, and unify health and social care.
Whether through significant tax rises or a ‘Dutch-style’ insurance system (our preferred model), the status quo is no longer an option.
The NHS
A new NHS for a new age: let’s go Dutch
How to convert the NHS into a (Dutch-style) National Health and Social Service
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