Intended for healthcare professionals

Opinion Dissecting Health

Scarlett McNally: The UK cannot afford for the NHS to fail

BMJ 2023; 380 doi: (Published 05 January 2023) Cite this as: BMJ 2023;380:p22
  1. Scarlett McNally, professor
  1. Eastbourne
  1. scarlettmcnally{at}
    Follow Scarlett on Twitter @scarlettmcnally

The NHS is facing a crisis: people are waiting hours in emergency departments, waiting in queuing ambulances, or dying on trolleys; staff morale is at an all time low. Yet underpinning the inhumanity is a crisis for the UK economy. The UK cannot afford for the NHS to fail. Having a healthy workforce is key to maintaining a prosperous economy.

The numbers of working age adults claiming disability support has doubled since before the covid-19 pandemic.1 Record numbers of people are taking early retirement, with ill health cited as the most common reason.2 Nine million people—21% of the “working age” population aged 16-64 and 565 000 more than at the start of the pandemic—are now “economically inactive,” with 2.5 million of those giving long term sickness as the reason.2

The NHS is sometimes disparagingly described as a “treatment service” rather than a health service, but when it provides treatment, it does so effectively. We need the NHS to work, primarily so that people can access healthcare when they need it, but also to get the UK workforce back to work.

The emergency departments in NHS hospitals are remarkable and essential. They assess and treat people, preventing long term disability. Swift thrombolysis following a stroke can get someone back to work. A rapid magnetic resonance imaging scan can identify a scaphoid fracture for treatment or rule it out to enable someone to continue working. Early surgery for hip fractures reduces complications and lifelong dependency and helps with a quicker recovery.

An estimated 14% of hospital beds are in use by people who are medically fit for discharge.3 This affects patient flow through hospital,4 resulting in people being treated in corridors in emergency departments and lengthy ambulance handovers. We should acknowledge that the problem isn’t just about physical beds but having fully staffed beds. Safely discharging patients from hospitals relies on strong social and community care. Having somewhere for people to go for non-medical support following discharge would free up doctors, nurses, allied health professionals, and other NHS staff to look after other patients.

Let’s be honest, the situation is now worse than during the worst of the covid pandemic when the Nightingale hospitals were set up. We must consider reintroducing Nightingale hospitals for people who no longer need medical care so that we can free up capacity in hospital wards. Nightingale hospitals were massively underused5 during the pandemic because they competed with demand for NHS staff. But now we could repurpose them to provide social and community care. They could be staffed by people with skills in emotional and social support, physical rehabilitation, and fitness. At present, patients in hospital for both short and long stays decondition and lose function and confidence. A non-medical approach might work better to help patients regain mobility, recover quicker, and return home.6

Already, one in four UK adults live with multiple long term conditions,7 and some 70% of NHS spending is on long term conditions.8 Many people are resistant to simple prevention interventions, such as increasing physical activity, that could massively improve their long term health.9 Ideally, we would free up clinicians’ time to undertake individualised consultations for patients with complex health needs, including prevention and de-prescribing. This kind of personalised care is highly impactful. By transferring patients who are medically fit for discharge to a Nightingale hospital for non-medical interventions, we would reduce some pressure on the NHS.

The UK economy needs acute and emergency care in the NHS to work. Primary care services and routine elective surgery are also cost effective. Ensuring that people can access care in a timely way is not only a basic human right but also makes economic sense, preventing people from needing further long term, expensive future care. Unless we can treat people who present to emergency departments effectively, we will be doomed to endless labour shortages, lack of staff retention, long waiting times, and worsening of the current crisis.

The UK economy will crash if the NHS is allowed to fail. The NHS workforce needs urgent practical support and investment to ensure the whole country’s health and prosperity.


  • Competing interests: None.

  • Provenance and peer review: Commissioned, not externally peer reviewed.