Intended for healthcare professionals

Editor's Choice

Sunak fiddles while the NHS burns

BMJ 2023; 380 doi: (Published 12 January 2023) Cite this as: BMJ 2023;380:p68
  1. Kamran Abbasi, editor in chief
  1. The BMJ
  1. kabbasi{at}
    Follow Kamran on Twitter @KamranAbbasi

In the early days of the covid-19 pandemic hope was high that services would “build back better.” It was a hope that sustained health professionals as they pushed themselves further to keep a stretched service from collapsing. Now, hope in the UK has all but evaporated.

Many countries are struggling in these in-between days of the pandemic, which, as we await its end, is still troubling us, especially given the added concerns of the looming threat of China’s mishandled response (doi:10.1136/bmj.p2 doi:10.1136/bmj.p10 doi:10.1136/bmj.o3043).123 Each country faces its own challenges in reviving health services and stabilising population health, although some themes are common, and the UK’s collapse is possibly the most spectacular.

The collapse is undeniable—except that is if you are Prime Minister Rishi Sunak, one of his ministers, or someone senior in the health service whose denial of the collapse is an unedifying daily ritual (doi:10.1136/bmj.p28).4 If your genuine concern is the health and wellbeing of the population, then you don’t waste time contesting plausible data on excess deaths or refusing to hold meaningful talks with unhappy staff (doi:10.1136/bmj.p40 doi:10.1136/bmj.p33).56

The assumption here is that the people in charge do support the principles of universal health coverage funded by taxation. It may be a false assumption. Unfortunately, each health crisis brings with it unsubstantiated hobbyhorse riding for private healthcare, insurance based care, and health service reform. These are false trails (doi:10.1136/bmj.p54 doi:10.1136/bmj.p44 doi:10.1136/bmj.o2987).789

The problem with the NHS isn’t its founding principle or its funding mechanism. The problem is an unwillingness to tackle glaring failings (doi:10.1136/bmj.p12).10 It doesn’t take much common sense or empathy to understand that pensions and pay for junior doctors are driving the retention crisis (doi:10.1136/bmj.p4).11 When people, even health professionals, aren’t being heard, can’t provide the level of service they believe they should be delivering, and can barely make ends meet, it is understandable that they see no option but to strike (doi:10.1136/bmj.p59 doi:10.1136/bmj.p27).1213

It’s clear that unless you deliver and then implement your long promised plans for social care you won’t fix the “flow” problems in acute care. People will continue to die waiting for care that they should receive more urgently because they can’t get into a hospital bed. Or that, without prioritising primary care, public health, the wider determinants of health, and ending austerity, you won’t ease the pressure on hospital services or improve baseline population health and narrow inequalities. None of this is new or revelatory, yet none seems a priority for today’s politicians (doi:10.1136/bmj.p46).14

Other solutions are available (doi:10.1136/bmj.p1).15 To begin with, investing in the workforce and a workable plan, as was the case with the waiting list initiatives of the first decade of this century, can seed optimism, catalyse change, and improve outcomes (doi:10.1136/bmj.p20).16 Investing in early child health delivers longer term health and economic benefits; instead the health of children is worsening, and more and more families rely on food banks as the cost of living crisis deepens (doi:10.1136/bmj.o3064 doi:10.1136/bmj.p5).1718 Innovations such as moving patients to “care hotels” while they await social care may improve access to acute hospital services (doi:10.1136/bmj.p31).19 Any solution, however, must not be underfunded and ill thought out “political symbolism.” (doi:10.1136/bmj.p53).20

The NHS is not in crisis; it is in collapse. Excess deaths are running at alarming levels and can’t be explained away by the pandemic. The indicators for the health service are on red alert. Yet the political response is one of denial, disengagement, and delay. Workable solutions are absent. A healthy workforce is a prerequisite for a healthy economy (doi:10.1136/bmj.p22).21 By that logic the NHS has never been more important, but the tragedy is that the UK’s greatest asset is being burnt on the pyre of political ideology.