Logos of the National Health Service

Logo of the NHS in England^[a][1]

Logo of HSC in Northern Ireland

Logo of NHS Scotland

Logo of NHS Wales

The National Health Service (NHS) is the umbrella term for the publicly funded healthcare systems of the United Kingdom, comprising the NHS in England, NHS Scotland and NHS Wales. Health and Social Care in Northern Ireland was created separately and is often locally referred to as "the NHS".^[2] The original three systems were established in 1948 (NHS Wales/GIG Cymru was founded in 1969) as part of major social reforms following the Second World War. The founding principles were that services should be comprehensive, universal and free at the point of delivery—a health service based on clinical need, not ability to pay.^[3] Each service provides a comprehensive range of health services, provided without charge for people ordinarily resident in the United Kingdom apart from dental treatment and optical care.^[4] In England, NHS patients have to pay prescription charges; some, such as those aged over 60, or those on certain state benefits, are exempt.^[5]

Taken together, the four services in 2015–16 employed around 1.6 million people with a combined budget of £136.7 billion.^[6] In 2014, the total health sector workforce across the United Kingdom was 2,165,043 making it the fifth largest employer and largest non-military public organisation in the world.^[7][8][9]

When purchasing consumables such as medications, the four healthcare services have significant market power that influences the global price, typically keeping prices lower.^[10] A small number of products are procured jointly through contracts shared between services.^[11] Several other countries either copy the United Kingdom's model or directly rely on Britain's assessments for their own decisions on state-financed drug reimbursements.^[12]

History

Calls for a "unified medical service" can be dated back to the Minority Report of the Royal Commission on the Poor Law in 1909.^[14]

Somerville Hastings, President of the Socialist Medical Association, successfully proposed a resolution at the 1934 Labour Party Conference that the party should be committed to the establishment of a State Health Service.^[15]

Following the 1942 Beveridge Report's recommendation to create "comprehensive health and rehabilitation services for prevention and cure of disease", cross-party consensus emerged on introducing a National Health Service of some description.^[16] Conservative MP and Health Minister, Henry Willink later advanced this notion of a National Health Service in 1944 with his consultative White Paper "A National Health Service" which was circulated in full and short versions to colleagues, as well as in newsreel.^[17]

When Clement Attlee's Labour Party won the 1945 election he appointed Aneurin Bevan as Health Minister. Bevan then embarked upon what the official historian of the NHS, Charles Webster, called an "audacious campaign" to take charge of the form the NHS finally took.^[18] Bevan's National Health Service was proposed in Westminster legislation for England and Wales from 1946 and Scotland from 1947, and the Northern Ireland Parliament's Public Health Services Act 1947.^[19] NHS Wales was split from NHS (England) in 1969 when control was passed to the Secretary of State for Wales.^[20] According to one history of the NHS, "In some respects the war had made things easier. In anticipation of massive air raid casualties, the Emergency Medical Service had brought the country's municipal and voluntary hospitals into one umbrella organisation, showing that a national hospital service was possible."^[21] Webster wrote in 2002 that "the Luftwaffe achieved in months what had defeated politicians and planners for at least two decades."^[22]

The NHS was born out of the ideal that healthcare should be available to all, regardless of wealth. Although being freely accessible regardless of wealth maintained Henry Willink's principle of free healthcare for all, Conservative MPs were in favour of maintaining local administration of the NHS through existing arrangements with local authorities fearing that an NHS which owned hospitals on a national scale would lose the personal relationship between doctor and patient.^[23]

Conservative MPs voted in favour of their amendment to Bevan's Bill to maintain local control and ownership of hospitals and against Bevan's plan for national ownership of all hospitals. The Labour government defeated Conservative amendments and went ahead with the NHS as it remains today; a single large national organisation (with devolved equivalents) which forced the transfer of ownership of hospitals from local authorities and charities to the new NHS. Bevan's principle of ownership with no private sector involvement has since been diluted, with later Labour governments implementing large scale financing arrangements with private builders in private finance initiatives and joint ventures.^[24]

At its launch by Bevan on 5 July 1948 it had at its heart three core principles: That it meet the needs of everyone, that it be free at the point of delivery, and that it be based on clinical need, not ability to pay.^[25]

Three years after the founding of the NHS, Bevan resigned from the Labour government in opposition to the introduction of charges for the provision of dentures, dentists,^[26] and glasses; resigning in support was fellow minister and future Prime Minister Harold Wilson.^[27] The following year, Winston Churchill's Conservative government introduced prescription fees. However, Wilson's government abolished them in 1965; they were later re-introduced but with exemptions for those on low income.^[28] These charges were the first of many controversies over changes to the NHS throughout its history.^[29]

From its earliest days, the cultural history of the NHS has shown its place in British society reflected and debated in film, TV, cartoons and literature. The NHS had a prominent slot during the 2012 London Summer Olympics opening ceremony directed by Danny Boyle, being described as "the institution which more than any other unites our nation".^[30]

Eligibility for treatment

Everyone living in the UK can use the NHS without being asked to pay the full cost of the service, though NHS dentistry and optometry do have standard charges in each of the four national health services in the UK.^[31] In addition, most patients in England have to pay charges for prescriptions though some patients are exempted.^[5]

Aneurin Bevan, in considering the provision of NHS services to overseas visitors wrote, in 1952, that it would be "unwise as well as mean to withhold the free service from the visitor to Britain. How do we distinguish a visitor from anybody else? Are British citizens to carry means of identification everywhere to prove that they are not visitors? For if the sheep are to be separated from the goats both must be classified. What began as an attempt to keep the Health Service for ourselves would end by being a nuisance to everybody."^[32]

The provision of free treatment to non-UK-residents, formerly interpreted liberally, has been increasingly restricted, with new overseas visitor hospital charging regulations introduced in 2015.^[33]

Citizens of the EU holding a valid European Health Insurance Card and persons from certain other countries with which the UK has reciprocal arrangements concerning health care can get emergency treatment without charge.^[34]

The NHS is free at the point of use, for general practitioner (GP) and emergency treatment not including admission to hospital, to non-residents.^[35] People with the right to medical care in European Economic Area (EEA) nations are also entitled to free treatment by using the European Health Insurance Card. Those from other countries with which the UK has reciprocal arrangements also qualify for free treatment.^[36][37] Since 6 April 2015, non-EEA nationals who are subject to immigration control must have the immigration status of indefinite leave to remain at the time of treatment and be properly settled, to be considered ordinarily resident. People not ordinarily resident in the UK are in general not entitled to free hospital treatment, with some exceptions such as refugees.^[4][38]

People not ordinarily resident may be subject to an interview to establish their eligibility, which must be resolved before non-emergency treatment can commence. Patients who do not qualify for free treatment are asked to pay in advance or to sign a written undertaking to pay, except for emergency treatment.^{[citation needed]}

People from outside the EEA coming to the UK for a temporary stay of more than six months are required to pay an immigration health surcharge at the time of visa application, and will then be entitled to NHS treatment on the same basis as a resident. This includes overseas students with a visa to study at a recognised institution for six months or more, but not visitors on a tourist visa.^[39] In 2016 the surcharge was £200 per year, with exemptions and reductions in some cases.^[40] This was increased to £400 in 2018. The discounted rate for students and those on the Youth Mobility Scheme will increase from £150 to £300.^[41]

From 15 January 2007, anyone who is working outside the UK as a missionary for an organisation with its principal place of business in the UK is fully exempt from NHS charges for services that would normally be provided free of charge to those resident in the UK. This is regardless of whether they derive a salary or wage from the organisation, or receive any type of funding or assistance from the organisation for the purposes of working overseas.^[42] This is in recognition of the fact that most missionaries would be unable to afford private health care and those working in developing countries should not effectively be penalised for their contribution to development and other work.^{[citation needed]}

Those who are not ordinarily resident (including British citizens who may have paid National Insurance contributions in the past) are liable to charges for services.

There are some other categories of people who are exempt from the residence requirements such as specific government workers and those in the armed forces stationed overseas.

Historical issues

Funding

2016

In 2016, the systems were 98.8% funded from general taxation and National Insurance contributions, plus small amounts from patient charges for some services.^[44][45] As of 2016, about 10% of GDP was spent on health and was the most spent in the public sector.^[46] In 2019, the UK spent roughly 10.2% of GDP on healthcare compared to 11.7% in Germany and 11.1% in France.^[47] The money to pay for the NHS comes directly from taxation. The 2008/09 budget roughly equated to a contribution of £1,980 per person in the UK.^{[48][needs update]} Some 60% of the NHS budget is used to pay staff. A further 20% pays for pharmaceuticals and other supplies, with the remaining 20% split between buildings, equipment, training costs, medical equipment, catering and cleaning. Nearly 80% of the total budget is distributed by local trusts in line with the particular health priorities in their areas.^{[49][needs update]}

When the NHS was launched in 1948 it had a budget of £437 million^[50] (equivalent to £16.91 billion in 2021). In 2016–2017, the budget was £122.5 billion.^[51] In 1955/56 health spending was 11.2% of the public services budget. In 2015/16 it was 29.7%.^[52] This equates to an average rise in spending over the full 60-year period of about 4% a year once inflation has been taken into account. Under the Blair government spending levels increased by around 6% a year on average. Between 2010 and 2017 spending growth was constrained to just over 1% a year.^[52] A 2019 report said that a study by the 'Centre for Health Economics' at the University of York found that between 2004/05 and 2016/17 the productivity of the NHS has increased nearly two and a half times as quickly as the larger economy.^[53]

2017

Between 2010 and 2017, there was a cap of 1% on pay rises for staff continuing in the same role. Unions representing doctors, dentists, nurses and other health professionals have called on the government to end the cap on health service pay, claiming the cap is damaging the health service and damaging patient care.^[54] In 2017, the pay rise was likely to be below the level of inflation and to mean a real-terms pay cut.^[55] In 2017, the House of Commons Library research predicted that that real-terms NHS funding per head was to fall in 2018–19, and stay the same for two years afterwards.^{[56][needs update]}

2018

In January 2018, The Guardian reported that GPs faced excessive workloads throughout Britain and that this put the GP's health and that of their patients at risk.^[57] The Royal College of Physicians surveyed doctors across the UK, with two-thirds maintaining patient safety had deteriorated during the year to 2018: 80% feared they would be unable to provide safe patient care in the coming year while 84% felt increased pressure on the NHS was demoralising the workforce.^[58] In June 2018, at a time when the NHS was short of doctors, foreign doctors were forced to leave the UK due to visa restrictions.^[59] A study reported in November 2018 found that a fifth of doctors had faced bullying from seniors in the previous year due to pressure at work.^[60]

In May 2018 it was reported that the NHS was under-resourced compared to health provisions in other developed nations. A King's Fund study of OECD data from 21 nations, revealed that the NHS has among the lowest numbers of doctors, nurses and hospital beds per capita in the western world.^[61] In May 2018, it was said that nurses within the NHS said that patient care was compromised by the shortage of nurses and the lack of experienced nurses with the necessary qualifications.^[62] In June 2018 it was reported that the NHS performed below average in preventing deaths from cancer, strokes and heart disease.^[63]

In September 2018 it was reported that staff shortages at histology departments were delaying diagnosis and start of treatment for cancer patients.^[64] In England and Scotland cancer wards and children's wards have to close because the hospital cannot attract sufficient qualified doctors and nurses to run the wards safely. In November 2018 it was reported that cancer patients and child patients were having to travel very long distances to get treatment and their relatives had to travel far to visit the patients. In wards which had not closed staff sometimes worked under stress due to staff shortages. It was also predicted then, that Brexit was likely to aggravate those problems.^[65] In November 2019, it was reported that due to the shortage of nurses the NHS was then relying on less qualified staff like healthcare assistants and nursing associates.^[66]

For the period between 2010 and 2018 the Health Foundation funded research by Birmingham University said there was insufficient and falling NHS capital spending that put patient care and put staff productivity at risk. The Health Foundation said that £3.5 billion more a year would be required to get capital spending to the OECD average. Spending limits were effecting service efficiency, and patient care. Shortages of equipment and equipment failures had an impact as did relying on ageing diagnostic equipment.^[67]

In 2018, British Prime Minister Theresa May announced that NHS in England would receive a 3.4% increase in funding every year to 2024, which would allow it to receive an extra £20bn a year in real terms funding.^[68] [dead link] There is concern that a high proportion of this money will go to service NHS debts rather than for improved patient care. In June 2018, it was reported that there were calls for the government to write off the NHS debt. Saffron Cordery of NHS Providers said that hospitals needed help to do their work without being up in deficit, as two-thirds were in the year to 2018.^[69] It was also said that some expressed doubt over whether May could carry out this proposed increase in funding.^[70] The next day, Health Secretary Jeremy Hunt backed the extra £20bn annual increase in NHS funding and responded to criticism by stating that taxation would be used to carry out the funding and that details would be revealed at the next budget.^[68][71]

In June 2018 it was reported that the Institute for Fiscal Studies had stated a 5% real-terms increase was needed for real change. Paul Johnson of the IFS said the 3.4% was greater than recent increases, but less than the long-term average.^[72] In July 2016, health experts^[who?] said the money would "help stem further decline in the health service, but it's simply not enough to address the fundamental challenges facing the NHS, or fund essential improvements to services that are flagging."^[73] In November 2018, it was thought that inflation may erode the real value of this funding increase.^[74]

As part of the 2018 funding increase the UK Government asked the NHS in England to produce a 10-year plan as to how this funding would be used.

2019

In September 2019, it was reported that cancer survival rates in the UK had been rising fast but probably still lagged behind the best results internationally, mainly because of late diagnosis.^[75] In March 2019 it was reported that death rates from breast cancer were falling faster in Britain than in any other of the six largest countries in Europe, and were estimated then to have improved beyond the European average.^[76][77] In October 2018, according to Breast Cancer Care, 72% of NHS trusts across the UK did not provide dedicated specialist nurses for patients with incurable breast cancer."^[78][75]

In September 2019 it was reported that Cancer Research UK maintained that more NHS cancer personnel were needed to enable the UK to catch up The NHS in England was expanding early diagnosis services with the goal of increasing the proportion of cancers diagnosed early (at stages 1 and 2) from 53% to 75% in the decade to 2028.^[79] In September 2018, it was reported that the NHS was the first health service in Europe to negotiate coverage for novel CAR-T cancer therapy, with agreement reached within 10 days of its European marketing authorisation.^[80]

On 7 January 2019, the NHS England published the NHS Long Term Plan.

2020s

The Guardian reported that data for 2020 suggests a change, and that the doctors' trade union and professional association, the BMA, say this was largely due to raised spending during the pandemic and the effect of Covid on the whole economy, since the GDP of the UK dropped more than that of all other G7 nations.^[47] The BMA also said in December 2022 that the NHS experienced "historical underfunding and under-resourcing" during the ten years before COVID.^[47][81][82] The King's Fund maintains The investment in services started in 2021 was badly needed, but despite it restoring key services and performance standards will require years. Shortages of workers and growing staff numbers experiencing burnout and thinking of leaving the NHS may stop progress. If the new funding is to be efficiently used the NHS will need a comprehensive and fully funded workforce strategy to ensure future supply of staff.^[83]

In March 2022, Rishi Sunak doubled the annual efficiency target for the NHS in England. The 2.2 per cent target would deliver annual savings of saving of £4.75 billion. At the same time the additional Covid funding is being removed in 2022–23.^[84] At the same time Sir Charles Bean, recently leader of the Office for Budget Responsibility said that "the rising trend in health and social care spending and pensions will be adding something like another £75 billion spending over the next five years, £150 billion, potentially over the next decade" as if treatments are available to keep people alive longer, then people will want them.^[85]

In July 2022, The Telegraph reported that the think tank Civitas found that health spending was costing about £10,000 per household in the UK. This, they said, reflected the third highest share of GDP of any nation in Europe. This was said to show that the UK "has one of the most costly health systems – and some of the worst outcomes". The findings were made before the government increased health spending significantly, with a 1.25% increase in National Insurance, in April 2022. Civitas said this showed evidence "runaway" spending as health spending in the UK had increased by more than any country despite the significant drop in national income due to the COVID pandemic.^[86]

Staffing

The NHS is the largest employer in Europe, with one in every 25 adults in England working for the NHS.^[87] As of February 2023, NHS England employed 1.4 million staff.^[88] Nursing staff accounted for the largest cohort at more than 330,000 employees, followed by clinical support staff at 290,000, scientific and technical staff at 163,000 and doctors at 133,000.^[89]

In June 2018, the Royal College of Physicians calculated that medical training places need to be increased from 7,500 to 15,000 by 2030 to take account of part-time working among other factors. At that time there were 47,800 consultants working in the UK of which 15,700 were physicians. About 20% of consultants work less than full-time.^[91]

2020s

Brexit, in 2020, was predicted to affect medical practitioners from EU countries who worked in the NHS, accounting for more than 1-in-10 doctors at the time.^[92] A 2017 survey suggested 60% of these doctors were considering leaving, with a record 17,197 EU staff leaving the NHS in 2016.^[93] The figures led to calls to reassure European workers over their future in the UK.^[94]

A study by the Centre for Progressive Policy called for NHS trusts to become "exemplar employers" by improving social mobility and pay especially for those "trusts in poorer places where they can play a particularly large role in determining the economic wellbeing of the local population." They found the NHS to be " a middle ranking employer in comparison to other large organisations and falls short on social mobility and the real Living Wage", and ranked trusts using a 'good employer index'. Ambulance trusts were ranked worst.^[95]

On 6 June 2022, The Guardian said that a survey of more than 20,000 frontline staff by the nursing trade union and professional body, the Royal College of Nursing, found that only a quarter of shifts had the planned number of registered nurses on duty.^[96]

The NHS is facing a shortage of general practitioners. From 2015 to 2022, the number of GPs has fallen by 1,622. Some family doctors have 2,500 patients each, forcing patients to attend A&E instead. Certain regions have fewer than 50 GPs per 100,000 people, while other regions have more than 70, presenting a challenge to the NHS's founding principle of equal treatment. A growing number of family doctors are reporting unsustainable workloads, and many have chosen to work part-time. A Health and Social Care spokesperson said that the department is making 4,000 training positions available for GPs every year, which help create an extra 50 million appointments annually.^[97]

In 2023, a report revealed that NHS staff had faced over 20,000 sexual misconduct from patients from 2017 to 2022 across 212 NHS Trusts. Some of the claims included rape, sexual harassment, stalking, and sexualised remarks at staff from patients. In the report, female staff members were told by hospitals to continue caring for patients even after there were issues regarding abuse or harassment without further safeguards in place. Other parts of the report showed that staff were pressured into not reporting grievances.

In June 2023, the delayed NHS Long term Workforce Plan was announced, set up to train more doctors and nurses and create new roles within the health service.^[98]

Brexit

There was a concern that a disorderly Brexit might have compromised patients' access to vital medicines. In February 2018, many medical organisations planned for a worst-case Brexit scenario because "time is running out" for a transition deal to follow the UK's formal exit that occurred in March 2019.^[99] Pharmaceutical organisations working with the Civil Service to keep medicine supplies available in the case of a no-deal Brexit had to sign 26 Non-Disclosure Agreements (NDAs) to prevent them from giving the public information. The figures were given on 21 December 2018 after Rushanara Ali asked a parliamentary question.^[100]

Rising social care costs

Social care will cost more in future according to research by Liverpool University, University College London, and others. Professor Helen Stokes-Lampard of the Royal College of GPs said: ^[when?] "It's a great testament to medical research, and the NHS, that we are living longer – but we need to ensure that our patients are living longer with a good quality of life. For this to happen we need a properly funded, properly staffed health and social care sector with general practice, hospitals and social care all working together – and all communicating well with each other, in the best interests of delivering safe care to all our patients."^[101]

Mental health

Some patients have to wait excessively long for mental health care. The Royal College of Psychiatrists found^[when?] that some patients must wait up to thirteen months for the right care. Wendy Burn of the Royal College of Psychiatrists said, "It is a scandal that patients are waiting so long for treatment. The failure to give people with mental illnesses the prompt help they need is ruining their lives." Even patients who are suicidal or who have attempted suicide are sometimes denied treatment; patients are told they are not ill enough or waiting lists are too long. During very long waits for treatment, one in three patients deteriorate, and they may become unemployed or get divorced. One in four patients throughout the UK wait over three months to see an NHS mental health professional, with 6% waiting at least a year.^[102]

The National Audit Office found mental health provisions for children and young people will not meet growing demand, despite promises of increased funding. Even if promises to provide £1.4bn more for the sector are kept, there will be "significant unmet need" due to staff shortages, inadequate data and failure to control spending by NHS clinical commissioning groups. Currently one-quarter of young people needing mental health services can get NHS help. The Department of Health and Social Care hopes to raise the ratio to 35%. Efforts to improve mental health provisions could reveal previously unmet demand.^[103]

Meg Hillier of the select committee on public accounts said: "The government currently estimates that less than a third of children and young people with a diagnosable mental health condition are receiving treatment. But the government doesn't understand how many children and young people are in need of treatment or how funding is being spent locally. The government urgently needs to set out how departments, and national and local bodies, are going to work together to achieve its long-term ambition." Amyas Morse said, "Current targets to improve care are modest and even if met would still mean two-thirds of those who need help are not seen. Rising estimates of demand may indicate that the government is even further away than it thought."^[103]

In response, NHS England has embarked on a major programme to expand mental health services, whose budgets are now growing faster than the NHS overall.^[104] MIND the mental health charity responded saying: "We are pleased that the plan includes a commitment of £2.3bn a year towards mental health, to help redress the balance. The plan promises that this money will see around two million more people with anxiety, depression and other mental health problems receive help, including new parents, and 24 hour access to crisis care. The plan also includes a guarantee that investment in primary, community and mental health care will grow faster than the growing overall NHS budget so that different parts of the NHS come together to provide better, joined-up care in partnership with local government. Since the funding announcement in the summer, Mind has been working with the NHS, Government and voluntary sector to help shape the long term plan. This longer-term strategy was developed in consultation with people with mental health problems to ensure their views are reflected."^[104]

Performance

Performance of the NHS is generally assessed separately at the level of England, Wales, Scotland and Northern Ireland. Since 2004 the Commonwealth Fund has produced surveys, "Mirror, Mirror on the Wall", comparing the performance of health systems in 11 wealthy countries in which the UK generally ranks highly. In the 2021 survey the NHS dropped from first overall to fourth as it had fallen in key areas, including 'access to care and equity.'^[105] The Euro Health Consumer Index attempted to rank the NHS against other European health systems from 2014 to 2018. The right-leaning^[106] think tank Civitas produced an International Health Care Outcomes Index in 2022 ranking the performance of the UK health care system against 18 similar, wealthy countries since 2000. It excluded the impact of the COVID-19 pandemic as data stopped in 2019. The UK was near the bottom of most tables except households who faced catastrophic health spending.^[107]

A comparative analysis of health care systems in 2010, by The Commonwealth Fund, a left-leaning US health charity, put the NHS second in a study of seven rich countries.^[108][109] The report put the United Kingdom health systems above those of Germany, Canada and the United States; the NHS was deemed the most efficient among those health systems studied.

A 2018 study by the King's Fund, Health Foundation, Nuffield Trust, and the Institute for Fiscal Studies to mark the NHS 70th anniversary concluded that the main weakness of the NHS was healthcare outcomes. Mortality for cancer, heart attacks and stroke, was higher than average among comparable countries. The NHS was doing well at protecting people from heavy financial costs when ill. Waiting times were about the same, and the management of longterm illness was better than in other comparable countries. Efficiency was good, with low administrative costs and high use of cheaper generic medicines.^[110] Twenty-nine hospital trusts and boards out of 157 had not met any waiting-time target in the year 2017–2018.^[111] The Office for National Statistics reported in January 2019 that productivity in the English NHS had been growing at 3%, considerably faster than across the rest of the UK economy.^[112]

In 2019, The Times, commenting on a study in the British Medical Journal, reported that "Britain spent the least on health, £3,000 per person, compared with an average of £4,400, and had the highest number of deaths that might have been prevented with prompt treatment". The BMJ study compared "the healthcare systems of other developed countries in spending, staff numbers and avoidable deaths".^[113]

Over 130,000 deaths since 2012 in the UK could have been prevented if progress in public health policy had not stopped due to austerity, analysis by the Institute for Public Policy Research found. Dean Hochlaf of the IPPR said: "We have seen progress in reducing preventable disease flatline since 2012."".^[114] The key NHS performance indicators (18 weeks (RTT), 4 hours (A&E) and cancer (2 week wait) have not been achieved since February 2016, July 2015 and December 2015 respectively.^[115]

A ranking of individual hospitals around the world, published by Newsweek in March 2022, no NHS hospital was listed within the top 40. St Thomas' Hospital was ranked at 41, followed by University College Hospital at 54, and Addenbrooke's Hospital at 79.^[116]

Overall satisfaction with the NHS in 2021 fell, more sharply in Scotland than in England, 17 points to 36% – the lowest level since 1997 according to the British Social Attitudes Survey. Dissatisfaction with hospital and GP waiting times were the biggest cause of the fall.^[117]

The NHS Confederation polled 182 health leaders and 9 in 10 warned that inadequate capital funding harmed their "ability to meet safety requirements for patients" in health settings including hospitals, ambulance, community and mental health services and GP practices.^[118]

Public perception of the NHS

In 2016 it was reported that there appeared to be support for higher taxation to pay for extra spending on the NHS as an opinion poll in 2016 showed that 70% of people were willing to pay an extra penny in the pound in income tax if the money were ringfenced and guaranteed for the NHS.^[119] Two thirds of respondents to a King's Fund poll, reported in September 2017, favoured increased taxation to help finance the NHS.^[120]

A YouGov poll reported in May 2018 showed that 74% of the UK public believed there were too few nurses.^[121]

The trade union, Unite, said in March 2019 that the NHS had been under pressure as a result of economic austerity.^[122]

A 2018 public survey reported that public satisfaction with the NHS had fallen from 70% in 2010 to 53% in 2018.^[123] The NHS is consistently ranked as the institution that makes people proudest to be British, beating the royal family, Armed Forces and the BBC.^[124] One 2019 survey ranked nurses and doctors – not necessarily NHS staff – amongst the most trustworthy professions in the UK.^[125]

In November 2022 a survey by Ipsos and the Health Foundation found just a third of respondents agreed the NHS gave a good service nationally, and 82% thought the NHS needed more funding. 62% expected care standards to fall during the following 12 months. Sorting out pressure and workload on staff and increasing staff numbers were the chief priorities the poll found. Improving A&E waiting times and routine services were also concerns.^[126] Just 10% of UK respondents felt their government had the correct plans for the NHS. The Health Foundation stated in spite of these concerns, the public is committed to the founding principles of the NHS and 90% of respondents believe the NHS should be free, 89% believe NHS should provide a comprehensive service for everyone, and 84% believe the NHS should be funded mainly through taxation.^[127]

Role in combating coronavirus pandemic

In 2020, the NHS issued medical advice in combating COVID-19 and partnered with tech companies to create computer dashboards to help combat the nation's coronavirus pandemic.^[128][129] During the pandemic, the NHS also established integrated COVID into its 1-1-1 service line as well.^[130] Following his discharge from the St. Thomas' Hospital in London on 13 April 2020 after being diagnosed with COVID-19, British Prime Minister Boris Johnson described NHS medical care as "astonishing" and said that the "NHS saved my life. No question."^[131][132] In this time, the NHS underwent major re-organisation to prepare for the COVID-19 pandemic.^[133]

On 5 July 2021, Queen Elizabeth II awarded the NHS the George Cross.^[134] The George Cross, the highest award for gallantry available to civilians and is slightly lower in stature to the Victoria Cross, is bestowed for acts of the greatest heroism or most conspicuous courage. In a handwritten note the Queen said the award was being made to all NHS staff past and present for their "courage, compassion and dedication" throughout the pandemic.^[135]

Hospital beds

In 2015, the UK had 2.6 hospital beds per 1,000 people.^[136] In September 2017, the King's Fund documented the number of NHS hospital beds in England as 142,000, describing this as less than 50% of the number 30 years previously.^[137] In 2019 one tenth of the beds in the UK were occupied by a patient who was alcohol-dependent.^[138]

NHS music releases

NHS charity songs under various choir names have become a tradition (usually at Christmas time but not necessarily) and various formation carrying the name of NHS have released singles including:

• 2015: National Health Singers - "Yours"
• 2015: NHS Choir - "A Bridge Over You" (being a mashup of "Bridge Over Troubled Water" and "Fix You")
• 2018: NHS Voices - "With a Little Help from My Friends"
• 2018: National Health Singers - "NHS 70: Won't Let Go"
• 2020: NHS and keyworkers - "You'll Never Walk Alone"