Reflections on the NHS, and Managing its Resources

Many people are celebrating the 75th anniversary of the founding of the National Health Service (NHS). As someone who has relied on it to keep me alive for the last 75 years, I am not however applauding it.

The NHS was certainly an improvement on health care provision in the UK before 1948 which I recall my parents talking about, but it does not compare well against the systems in most countries now. This was made very clear in a recently published report by the Kings Fund – see

To quote from it: “The UK has less medical equipment and fewer beds. Spending on health care increased substantially in the UK during the Covid-19 pandemic. But despite this, spending per person remains lower than the average [of comparable countries]. This impacts on the patient experience. For example, although there is no objectively ‘ideal’ number of scanners, the UK has fewer CT and MRI scanners than any of the comparator countries, which could be a reason – alongside shortages of imaging staff – for why diagnostic waits in the UK are so high.

The UK also has fewer hospital beds; 2.5 beds per 1,000 people, compared to an average of 3.2 beds per 1,000 in our basket. Again, fewer beds are not necessarily bad – this could reflect shorter hospital stays – but the high occupancy rates of beds in the UK (88 per cent in 2022/23, above recommended levels, and third highest in our basket) implies there is a shortage”.

There are clearly shortages of staff and long waits for non-urgent treatment which is driving people to pay privately for treatment. The Government has recently announced a new “long-term” plan for NHS staffing – see which includes this statement: “For the first time the Plan sets out long term workforce projections. Staffing shortfalls have been an issue since the foundation of the NHS and vacancies now stand at 112,000. The growing and ageing population, coupled with new treatments and therapies, means that without action, the gap could grow up to 360,000 by 2037”. Is it not astonishing that there has been no long-term plan before to match recruitment and training of staff to match likely demand?

As someone who has been a big user of the NHS over the last 75 years I have seen the problems in person. I have had a long history of kidney disease and other problems and a visit this week seems to suggest that the NHS is managing demand in a new way.

I have been on kidney dialysis before and had a transplant 25 years ago. But I either need another transplant or need to go on dialysis again. A meeting with a consultant last week was somewhat disconcerting. He explained how tedious dialysis can be, which I already knew. Without spelling it out, he seemed to be suggesting that at the age of 77, did I really want to stay alive much longer?

Is this another way to manage demand on the NHS? Persuade patients to give up hope? Dialysis is an expensive process for the NHS – more expensive than a kidney transplant but I am allegedly not fit enough for that. I am not keen to give up living just yet but the NHS appears to be managing its resources in a new way.

There is one thing for certain. The NHS is very bad at planning and managing its capacity. Last year I spent two weeks in Farnborough hospital which was an absolute waste of my time and hospital resources when I could have been treated as an out-patient while the ward conditions in a heatwave were very uncomfortable. This is simply not good enough in the modern world.

The NHS needs much more substantial reform to make it fit for the future. More money alone is not the solution. It needs major management reforms.

Roger Lawson (Twitter:  )

You can “follow” this blog by entering your email address in the box below.  You will then receive an email alerting you to new posts as they are added.

Leave a Reply

%d bloggers like this: