The Author

Richard Mason

Richard is a local coordinator for European Students for Liberty. He is an active writer on current affairs from a pro-liberty standpoint, and is assistant editor for the ESFL blog SpeakFreely.

In the United Kingdom, the National Health Service (NHS) is viewed by many to be far more than just our humble health system; to millions it is the pride of Britain and envy of the world. Any indication that a government intends to restrict or reform the NHS is usually met with harsh criticism, and to criticise it seems to be akin to burning the Union Flag, plotting to destroy parliament, or talking on the tube.




Yet every year the NHS seems to face another crisis. Every year we see headlines cry about understaffed hospitals, underpaid doctors, and overstocked waiting rooms. Usually, these cries are answered with calls for more funding, more taxes, and ultimately more state.

No-one, however, ever seems to address the elephant in the operating room; underfunding isn’t the problem. The NHS itself suffers from inherent flaws, which no amount of money is likely to fix. The NHS just isn’t working, but no-one seems to want to admit it.

Same Old Story

Back in September 2017, NHS Providers released a ‘Winter Warning’ document, in which the struggles that were certain to arrive with winter are anticipated and given solutions. The document acknowledges that “NHS performance last winter showed unacceptable levels of patient risk as growing demand outstripped NHS capacity” – the seemingly ever present issue of too many patients, not enough doctors/nurses.

Their website further discusses the grievances of 2016/17 winter: more people were left waiting in Accident & Emergency (A&E) for hours while less people saw ambulances arrive quickly enough. Evidently, the NHS needed reforms if it was going to avoid repeating these issues in 2018.

So, of course, the state did the only thing it knows how: increased spending. In response to calls for reforms to better deal with this winter’s crisis, the government decided on the ‘Better Care Fund’ as a solution. Thus, health and social care funding is brought together, coupled with a “major injection of social care money”.

As a result of the Better Care Fund, the NHS received £5.128 billion for the 2017/18 period, and will receive £5.617 billion for 2018/19.

But will this actually make much of a difference this winter? Does increased funding really help ease the strain that comes with winter? Obviously, it’s too early to tell how exactly the fund has affected statistics this year, but NHS firms don’t seem too optimistic.

A survey from NHS Providers found that most NHS firms are either not confident or on the fence about the funding’s merit in helping raise standards. Very few were ‘Very Confident’ that the funding would help ease the winter struggle.

More likely than not, more money simply isn’t the solution to the NHS’s woes. Instead, we should consider some of the more structural issues that holds British healthcare back from performing satisfactorily.

A Broken System?

The vast majority of the NHS is funded directly by taxation , at around 98%. The rest comes from small payments such as parking or prescription charges. As every taxpayers chips in, every UK citizen is entitled to ‘free’ treatment at any NHS hospital or clinic. While this may seem wonderful, it does come with some pretty heavy baggage.

The main issue comes with the sheer number of patients using the NHS – 64.6 million people all entitled to treatment by a single institution. While a wealthy minority may decide to go private, the state system remains the first point of contact for the vast majority of Brits.

It’s no surprise, then, that NHS institutions have to deal with a million people every 36 hours in England alone.




Processing that many people naturally leads to congestion. As a result of the massive patient base, waiting times in A&E continue to get longer and longer. 11% of people attending A&E required no treatment last year, while 39% only received advice.

Thus, 50% of patients who visited A&E, a section dedicated for serious emergencies and injuries, could have received the same treatment from a Google search or visit to a GP.

Ultimately, it all comes down to the funding. From the patient’s perspective, they have already paid for their treatment with their taxes. There’s no reason not to go to a hospital or doctor with a minor cough or flu, because they’ve already signed the cheque. While many praise the NHS for providing accessible healthcare to all, few acknowledge the moral hazard this creates.

One thing is for certain, however: the NHS is in dire need of serious reform. The negative trends discussed in this article are unlikely to go away without real changes, and simply throwing more money at it does nothing to address the underlying, structural issues with a single-payer system.

The British government needs to rethink its strategy on healthcare. If we want patients to receive timely treatment at a high standard, the NHS is going to need restructuring, not a pay rise.

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