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Almost 60 years old, the NHS is the oldest and largest single-payer healthcare system in the world. Funded by the taxpayer, overseen by the Department of Health, and with most of its services 'free at the point of use', the NHS is a cornerstone of British society ­– but there is growing evidence that today's NHS is in deep crisis.

Inadequate funding is often blamed when failings are found in NHS provision, but medical think-tank the Nuffield Trust is now warning that the problems could run much deeper and be harder to heal.

A growing crisis in workforce morale is potentially a far greater risk to the NHS than financial difficulties, warns the Nuffield Trust's chief executive Nigel Edwards. He said that serious staff shortages, ongoing disputes with the Government, and in some places a perceived culture of bullying, were a "toxic mix" undermining staff morale. 

Results of the most recent NHS staff survey, published earlier this year, clearly signposted the problems. Only 31% of those who took part said there was enough staff for them to do their jobs properly. A separate report from the Public Accounts Committee last month warned the NHS was short of about 50,000 staff out of a frontline workforce of just over 800,000.

Unless action is taken to tackle understaffing, the problem becomes self-perpetuating. People working in understaffed departments often feel they are expected to do too much, to make up the shortfall. Struggling to cope under an increased workload and other pressures, their own stress levels and health begin to suffer. In many cases they reach breaking point and quit, and so the staffing crisis is magnified.

A series of strikes by Junior Doctors, plus protests about plans to scrap study bursaries for nurses and midwives, are obvious symptoms of the growing unrest among NHS staff, warns the Nuffield Trust. If the problems are allowed to persist, the affinity which most NHS staff have traditionally felt for their employer could be irreparably damaged.

Mr Edwards stressed the care and compassion shown by health workers was underpinned by a "psychological contract" with the NHS, but that it was increasingly strained.

"Once the psychological contract with staff is broken, it may be impossible to reverse," warned Mr Edwards.

He urged the Government not to focus solely on addressing financial problems, but to look urgently at deteriorating morale in the NHS, to identify its root causes and take immediate action to rectify them.

• The National Health Service was established as part of the 'cradle to grave' welfare state reforms introduced by the Labour Government of 1948. Prior to the Second World War, healthcare had been a mix of private doctors, supported by charity and municipal schemes for the less well-off.

Many people also relied on commercially available remedies and potions, which made all kinds of (usually untested) claims for their medical benefits in newspaper advertisements. Despite their dubious benefits, these 'pills and potions' were far cheaper than consulting a doctor in private practice.

The new NHS was founded on three core principles; that it should meet the medical needs of every British citizen, that it be free at the point of delivery, and that the treatment given be determined by clinical need and not the ability to pay. These three guiding principles have remained at the heart of the NHS ever since.

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