Introduction

In its 75th year, despite the hallowed role that the NHS plays in the UK national psyche, the NHS found itself in a parlous position. Across a range of measures, the NHS was facing unprecedented pressures in 2023. First, public satisfaction with the NHS had fallen to its lowest recorded level – 29 per cent, falling 7 percentage points from 2021. Equally significant was the level of dissatisfaction with the NHS, at 51 per cent (Morris et al, 2023). Second, waiting lists were at an all-time high of 7.2 million (as of December 2022). Much of this can be explained by delayed care due to COVID-19 (a rise of 2 million since the start of the pandemic). This was despite the ‘elective recovery plan’ published in 2022 (NHS England, 2022). Third, there were 133,000 (full-time equivalent) vacancies in the NHS in September 2022, a vacancy rate of 9.7 per cent (Health Foundation, 2022). Vacancies in social care stood at 165,000, a vacancy rate of 10.7 per cent (King’s Fund, 2023). Fourth, there was a wave of strikes among NHS staff. Members of the Royal College of Nursing went on strike for the first time in their history. They were joined by ambulance staff and junior doctors. NHS consultants had also voted for strike action. Fifth, while pay can explain some of the causes of these strikes, it is likely that high levels of stress and burnout were also significant factors. The 2022 NHS Staff Survey (published in March 2023) indicated that 45 per cent of staff were unwell due to work-related stress and 57 per cent had come to work despite feeling unwell. Overall, 34 per cent of staff felt burnout, with ambulance staff being especially prone (49 per cent) (Nuffield Trust, 2023).

The conditions prevailing in 2023 were the confluence of factors in the previous several years – financial austerity from 2010, the Brexit referendum vote in 2016 (and the consequent impact upon recruitment and retention of staff and pharmaceuticals) and COVID-19 pandemic (from March 2020). Arguably, the conditions were also the result of the NHS’ politics, policies and organisational structure over the previous 75 years. So it is timely to reassess the contribution and state of the NHS in the past, in the present and in the future.