An NHS under pressure

We provide an overview of the main pressure points in the English NHS before and due to COVID-19 and what the BMA is doing to address them. 

NHS pressures waiting list

The NHS is experiencing some of the most severe pressures in its 70-year history. The COVID-19 pandemic is just the tip of the iceberg - the health service has been facing years of inadequate planning and chronic under-resourcing.

This page is an overview of the main pressure points in the NHS.

 

Years of mounting pressures on the NHS

Chronic understaffing

Staff shortages have been growing in the NHS for years. This has been driven by inadequate workforce planning and lack of government accountability - including insufficient funding and infrastructure to train enough new doctors.

Poor retention

Chronic understaffing, increasing workload and bureaucracy have made the NHS a ‘leaky bucket’. Additional issues - like years of demoralising pay erosion and punitive pension taxation rules - have made it even harder to retain the doctors we have.

BMA members are telling us these pressures are becoming unsustainable, with 43% of respondents to a BMA survey in September 2021 agreeing with the statement 'I plan to retire early'. 50% agreed with the statement 'I plan to work fewer hours after the pandemic'.

Declining wellbeing

Delivering care amid persistent shortages creates an environment of chronic stress. Excessive workloads are normalised by continuously requiring overstretched staff to fill gaps that should not exist.

The physical and emotional toll includes rising prevalence of stress, fatigue, burnout and moral injury as well as suffering mental health and wellbeing.

Growing pressure on general practice

General practice is at the forefront of managing the needs of our ageing and growing population.

Stagnation in the growth of the GP workforce has meant the average number of patients per FTE (full-time equivalent) GP has increased by 15% since 2015. This puts increasing clinical and administrative burden on them and other practice staff.

Insufficient funding

Recent funding injections announced as part of the autumn budget and spending review come on the back of below-average growth in the health budget in recent years.

The additional funding received to deal with COVID-19 does not fully address the needs of the NHS in managing the pandemic whilst dealing with the backlog of care and upgrading facilities to ensure they are capable of handling future challenges.

Inadequate space and deteriorating estates

After years of insufficient capital spending, parts of the NHS estate are increasingly unfit for purpose. The cost of bringing deteriorating assets back to suitable working order (known as the maintenance backlog) rises each year.

But more fundamental problems - like sites being too small or without sufficient space for training new doctors - are preventing staff from delivering the care they would like to.

Outdated IT

Outdated and insufficient IT provision across the NHS causes delays and eats into valuable staff time.

Meanwhile, issues around lack of interoperability to share patient records are creating blockages and duplication of work between parts of the system.

Falling NHS bed numbers

The number of general and acute beds available in English hospitals has been rapidly falling since 2010.

The UK now has one of the lowest number of beds per head in Europe, an insufficient critical care capacity that has been exposed by the pandemic.

Long waits and waiting lists for patients

Demand for hospital treatment was outstripping capacity even before the pandemic. In recent years, patients have been waiting longer for emergency, routine and cancer treatment. The NHS has been increasingly struggling to treat patients within safe operational standards.

 

COVID-19 has made the crisis worse

Unsustainable strain on general practice

GP practices have been at the forefront of the response to the COVID-19 outbreak, delivering vaccinations whilst maintaining non-COVID care throughout. Stress and workload is mounting, caused by lack of growth in the GP workforce.

Redeployment and cancelled operations

The pandemic called for a reallocation of resources so that critical care for COVID-19 patients was available. Not only has this contributed to the large backlog that the NHS must now work through, but it has also impacted junior doctors, many of whom have experienced significant disruption to their training as a result.  

Infection control measures

Mandatory infection control measures placed limits on the number of patients that could be seen physically. This limited patient numbers and highlighted the need for investment in NHS capital funding - it was more difficult to reconfigure old estates and equipment to accommodate social distancing and infection control measures.

Delayed patient presentation

Hidden unmet need has been ramping up in those who require care but have not yet sought medical help.

The full extent of this remains an unknown for the NHS. It is likely to result in larger numbers of patients presenting down the line, possibly with worsened conditions requiring greater and higher-cost care.

Diagnostics capacity

There has been unprecedented levels of investment in diagnostics in the past year, including an additional 100 community diagnostic centres across England. However, workforce is the limiting factor in elective recovery.

Sustainable staffing solutions are needed if diagnostic capacity is to be truly expanded.

Private hospital care

The use of private sector capacity is one of the measures the Government has taken to address the elective care backlog. However, the extent to which the NHS can purchase private routine activity going forward remains unclear - growing numbers of patients are choosing to self-fund treatments due to restricted NHS access.

 

What the BMA is calling for