Why is it So Hard to Fix the NHS?

Why is it so hard to fix the NHS?

Short answer: because the NHS isn’t one problem — it’s a tightly tangled system where every fix pulls three other threads.

Longer, clearer version 👇

1. It’s doing two opposite jobs at once

The NHS is expected to be:

• Universal and free at point of use (morally popular, politically untouchable)
• Cost-controlled and efficient (financially constrained)

Demand always rises (aging population, chronic illness, new treatments), but funding never quite keeps up. That tension never goes away — it just shifts pressure around.

2. Demand keeps growing faster than capacity

People live longer, but with more long-term conditions (diabetes, dementia, heart disease).
Medicine can do more, so expectations rise.

Social care hasn’t kept pace, so hospitals end up caring for patients who shouldn’t be there but have nowhere else to go.

Hospitals clog → waiting lists grow → staff burn out → people leave → capacity drops further.

3. Huge cultural issues – the senior doctors won’t modernise their work practices

There are many examples of this issue. Here are three:

The NHS works 5 days a week

Hospitals work 4.5 days. Their operating and procedure rooms, and outpatient clinics, are largely empty on Friday afternoons, and through the weekend and Bank Holidays.

• This is a choice by the senior doctors
• The last time NHS England – led by Sir Bruce Keogh, in 2013 – tried to make it a 7 day service (7DS), the project failed after huge resistance from the BMA which encouraged a junior doctor strike
• The Royal Colleges (those eminent bodies) were just as culpable, by pretending to support the government and DHSC whilst actually sitting on their hands; so they didn’t upset the senior doctors that fund their august institutions. Why does it matter?
  • First of all it’s a huge waste of 30% of productive capacity
  • Secondly, as few patients are sent home at weekends, most A&Es are in chaos by Monday morning and it takes all week to get them going again, and clear their corridors

Note 1. GPs are no better. They also largely provide a 5 day service. At least they work on Friday pms. And, as we all know, they are making it harder and harder to get to see them. Again, that is their choice. The patients just give up trying to get seen.

Note 2. Individual hospitals could choose to run a 7 day service. They (through their boards) could do what NHS England and DHSC is failing to do above them. There is nothing to stop them coming up with a local 7DS, using rotas etc.

Consultants (senior hospital doctors) – retain the right to do their NHS work and private practice as well

• It is like the police or teachers being allowed to do private security work or teaching whilst at work
• It means they are never 100% focused on their NHS work, and lack loyalty to the hospital (and NHS) that employs them

Resident (previously called junior) doctors – go on strike regularly

• Why? Its partly as they have terrible role models ‘above them’. So do not feel guilty when they strike
• They are never happy, and blame everyone but themselves for their woes, like their bosses.

Their union (the BMA, British Medical Association) is very strong and resists all modernisation. It is really only interested in the pay and working conditions of doctors.

4. Social care is the NHS’s missing puzzle piece

This is huge and often overlooked.

25% of beds in hospitals are filled by the frail elderly (someone’s Mum) who are ‘fit for discharge’. But when elderly or vulnerable patients can’t get home care or care-home places:

• They stay in hospital beds unnecessarily
• A&E backs up
• Ambulances queue
• Everything slows down
• Operations get cancelled

But social care is means-tested, fragmented, underfunded, and politically ignored — so the NHS absorbs the fallout.

Note 1. The public share some of the blame for this issue. Most Brits are not willing to have their frail elderly parents living in their home, in their later stages of their parents’ lives.

Note 2. The solution is not ‘more beds’. Interestingly Sweden (see below) have significantly less beds per million population than us. How? They have a social care system that works.

5. Workforce problems are slow to fix

You can’t train a doctor or nurse quickly.

• Training takes years
• Retention is poor (stress, pay, workload)
• International recruitment is politically sensitive and logistically fragile

Even if you ‘fix funding’ today, staff shortages lag for years.

6. It’s massive and politically radioactive

The NHS is:

• One of the largest employers in the world, the biggest in Europe (1.6 million employees)
• Deeply loved by the public (well, used to be)
• Used as a political weapon by all sides – with all parties calling it ‘our NHS’

That means:

• Big reforms are risky
• Governments prefer short-term patch ups
• Long-term structural change gets delayed or watered down

No one wants to be ‘the government that broke the NHS,’ even if reform is necessary.

7. Productivity is hard to unlock

Unlike factories or tech:

• Healthcare is labour-intensive
• Many efficiency gains mean staff doing more emotional, complex work
• Digital reforms are slow, expensive, and disruptive

You can’t automate empathy, diagnosis, or end-of-life care.

The brutal truth

Blah blah blah. The public are now sick of all these excuses .. when 11% ish of their hard earnt taxes fund an NHS that fails to deliver on a daily basis.

The NHS isn’t ‘failing’ because its staff don’t care, or don’t try — it’s struggling because it’s trying to meet 21st-century healthcare needs with a mid 20th-century structure, and 21st-century constraints.

Fixing it would require 5 things:

1. Long-term funding commitments – tax rises may be needed, especially to fund social care
2. Serious social care reform
3. Workforce planning beyond election cycles
4. Political courage to address the ‘cultural issues’ and upset someone, especially doctors and the BMA
5. A new model for health and social care

And those are exactly the hardest things to deliver.

The Solution

MyHSN feels the time has come to abandon the current (1948) model of how the NHS works. Isn’t it strange that no other country has copied our system, and runs their socialised healthcare system in ‘our way’?

Other developed European countries – e.g. Netherlands, Scandanavia, Switzerland, France – put a similar proportion of GDP into healthcare, and have systems that work. So why not copy one of theirs?

Hence MyHSN favours full reform and a change to the Dutch system of socialised health and social care – based on a social insurance model. Interestingly, the Dutch system has financial incentives for their public to keep fitter. We have none.

We think only 3 laws (described here) would have to pass through parliament to make such changes possible. Yes, it might take 3-5 years to bring about all the changes.

Unfortunately, our governments (red and blue) lack the courage or longterm vision to make such a call. The public will pay the price. And we will have to wait decades until we have a government with a real ambition to address these (fixable) issues.