The NHS has much to be proud of, but it was stymied by lack of funding and a staffing crisis that other health systems avoided
Looking at how health services in different countries have responded to Covid, we can see some common ground. Many countries are increasing funding for health services, expanding the number of frontline clinical staff, providing separate areas to care for patients with confirmed or suspected Covid-19, and using digital technology to deliver virtual rather than face-to-face appointments.
But there are some distinctions: peer a bit closer and it is clear that we have something to teach and something to learn from every healthcare system. The UK has its achievements to share, from a nationalised (and devolved) system that can pool surgical resources in local areas and support mass trials to test new treatments, to a historically strong primary care model that played a key role in delivering the largest vaccination programme in British history while continuing to deliver daily care to patients.
There is also much we can learn from other nations. Some of the countries affected by Sars, such as Singapore, developed new types of facilities with more single and isolation rooms, better ventilation, and versatile designs that could be rapidly adapted for surges in demand. The government’s new hospital building programme must ensure that NHS facilities are better suited to cope with future pandemics.
We can also learn from the way in which other countries increase their health and care workforce during surges of demand like pandemics. Even before Covid-19, some states such as France had established permanent reserve lists of workers who can be rapidly expanded and mobilised to support health services. Other countries that mandate community service often offer placements in hospitals, ambulance services and nursing homes. During Covid-19 the NHS workforce was boosted by a dedicated corps of volunteers, retired clinicians, and clinical students, but exploring other approaches to rapidly expanding our health and care workforce would be prudent with future pandemics in mind.
Although virtual GP and outpatient appointments ballooned here, other countries with more advanced health-data systems have gone further and faster in using digital technology to support health services. In countries such as Singapore and Denmark, self-driving disinfection robots helped clean clinical environments and “command centres” were developed to coordinate health service responses based on real-time data. The NHS worked hard to collect and use data in a more sophisticated way during Covid-19, but a more sustained commitment to digital technology will be needed to give the UK the modern tools it needs to face future pandemics.
The final international lesson is the simplest: give your health and care system the resources it needs to be resilient. The NHS went into the pandemic with rising waiting lists for care, hospitals full to bursting and fewer doctors, nurses and intensive care beds than comparable countries. And successive governments have ducked the issue of social care reform while countries like Japan and Germany acted decades ago to shore up their social care systems. According to the Care Quality Commission, this inaction has left the UK’s health care and social care systems facing a “tsunami of unmet need” and hospitals full of stranded patients who could be discharged if they had the support they needed when out of hospital.
Our health and care system was agile enough to create emergency field hospitals, transform general hospital wards into intensive care areas and use available private sector capacity during the pandemic. But it is hard to shake the impression that the NHS was having to press the accelerator harder because it was starting near the back of the queue. The promises of social care funding reform and a new funding deal for the NHS are welcome, but these come with much ground to make up after a decade where funding failed to keep pace with rising demand and a health and care staffing crisis was allowed to develop.
Recently published data show the UK is still towards the middle of the pack of industrialised nations when it comes to funding our health service, lagging behind countries like France and Germany. Although the government has promised a new funding deal for the NHS, it is unlikely that this will send us to the top of the international leaderboard on health funding. And the new investment – while clearly substantial – is unlikely to be enough to meet the medium-term pressures on a service that will be fighting fires on multiple fronts, as it continues to battle Covid-19 and tackle the burgeoning waiting lists for care that grew during the pandemic.
Siva Anandaciva is chief analyst of policy at the King’s Fund, an independent charitable organisation working to improve health and care in England