Cautionary tale for SA’s NHI - UK’s broken NHS sucking in more money, delivering less

Key topics:NHS funding boost falls short of fixing its aging infrastructure crisisUK needs a national care service to ease pressure on hospitalsPolitical delays stall long-promised social care reform for the elderly.Sign up for your early morning brew of the BizNews Insider to keep you up to speed with the content that matters. The newsletter will land in your inbox at 5:30am weekdays. Register here.Support South Africa’s bastion of independent journalism, offering balanced insights on investments, business, and the political economy, by joining BizNews Premium. Register here.If you prefer WhatsApp for updates, sign up to the BizNews channel here.The auditorium doors will open for BNIC#2 on 10 September 2025 in Hermanus. For more information and tickets, click here..By Rosa Prince.In pure numbers, the biggest winner of last week’s spending review from Chancellor of the Exchequer Rachel Reeves, which allocated departmental budgets for the next few years, was the nation’s beloved but creaking National Health Service. Yet almost before Reeves had finished delivering her House of Commons statement, experts were warning the £29 billion ($39 billion) uplift will prove insufficient to maintain the service in its current form.If Reeves really wants to solve the problems facing the NHS — and halt the seemingly inexorable cycle of spending more and more money for less and less reward — her government must get a grip on the thorny question of how best to care for elderly citizens who aren’t sick enough to require hospitalization but can’t fully look after themselves at home.What the UK needs — and what politicians have been promising for a generation — is a comprehensive service providing elderly people with help at home, in communities and in residential facilities. Its funding could come from a levy similar to how pension savings are accumulated. This would both be fairer for individuals and ease the relentless pressure on the NHS to provide services it was never designed to cope with. The problem is, politicians can’t agree on how to deliver this. The 3% bump awarded to the NHS is below the 3.5% annual average increase it received during the last two decades, and way lower than the largess shown by the Labour governments of the 1990s and 2000s, the last time truly transformative cash, amounting to annual increases averaging 6%, was poured into the health service. Despite years of above-inflation awards, the NHS is struggling with crumbling infrastructure, waiting lists that remain stubbornly high three years after the end of the pandemic and chaotic emergency and maternity departments.That’s because any extra funding is immediately absorbed by the demands of servicing an aging population. It’s a topic political parties of all stripes have long promised to tackle; successive failures pose an almost existential threat to health care. But instead of confronting what has become a dual crisis in health and care services, the Telegraph reported Monday that a review into social care ordered by Health Secretary Wes Streeting in January had paused on holding cross-party talks, which are imperative to stop politicians torpedoing any future agreement on a national care service for electoral gain..Read more:. NHS under Tory rule: A system in crisis.The review, conducted by “Whitehall fixer” Louise Casey, is the 13th major study or government proposal on reforming social care since Tony Blair declared in one of his first speeches on coming to power in 1997 that he didn’t want a country “where the only way pensioners can get long-term care is by selling their home.”Rather than fixing the social care problem, the government risks making matters worse by restricting overseas care staff in a bid to lower migration figures. At its peak two years ago, in response to looser visa rules introduced by the Conservatives, 19% of care staff were from overseas; this has fallen by two-thirds since the regime was tightened, with a corresponding increase in vacancies. The government says it will boost wages to attract more homegrown workers to the industry, but hasn’t pledged extra money to local authorities to pay for it.It shouldn’t be like this. The greatest Labour government in history came to power 80 years ago next month — coincidentally the first anniversary of Keir Starmer’s victory — on July 4, 1945. Three years later to the day, the NHS was officially launched, the central pillar of the postwar settlement that envisaged a new, fairer future for the generation that won the war and its descendants.It was a towering achievement, providing cradle-to-grave care to every man, woman and child, and has been Brits’ most popular institution ever since. Even in its overstretched state, with only 21% happy with the way the service is run compared to 59% dissatisfied, a majority say they are content with the quality of NHS care and most believe it should receive more money.These days, one of the biggest drains on the service is the cost of so-called bed blockers, elderly people who can’t be moved on from hospitals once their treatment is finished because they’re unable to look after themselves in their own homes. As well as being bad for the individual, bed blocking is estimated by the King’s Fund think tank to cost the NHS more than £2 billion a year.Social care is currently funded by local authorities and means-tested at a low rate; anyone with assets of more than £23,250 is ineligible, so most homeowners are automatically disqualified. This means pensioners and their families often lose their life savings, including any property, to fund their care. Life becomes a lottery; someone unlucky enough to develop a long term condition such as Alzheimer’s may pay hundreds of thousands of pounds over the remainder of their life, while another whose condition falls under the purview of hospital care, including cancer, has their costs met by the state.Care could be paid for by implementing a cap on costs coupled with a far higher threshold for means testing, with the remainder picked up by the state; a levy on older workers; or payments deferred until the recipient’s estate is wound up. The most sensible, fair and affordable option would be a savings option similar to the state pension, — but any of these mooted plans would be better than the current system. And there should be an increased sense of urgency. The first part of Casey’s review isn’t due for two years, while the full plan for a future care service will arrive just in time for the next general election in 2028 or 2029 — the very moment when any proposals in this sensitive area will be most vulnerable to partisan bickering. Aneira Thomas, the first baby born under the NHS, came into the world at a minute past midnight on July 5, 1948, and was named for Aneurin Bevan, the man who spearheaded the founding of the NHS as health secretary in the Attlee government. At the time, life expectancy was 63 years for men and 68 years for women; today, it’s 79 and 83, respectively. The NHS can’t bear the demographic strain; a transformation in the way we tend to the elderly is needed now. Starmer was lucky enough to win office on a landslide, giving him the time and space to think radically. That makes it all the more regretful that, instead of being bold, he often proves lacking in vision. It’s not too late. Labour should mark Attlee’s 1945 election by announcing a new National Care Service paid for by a national savings program. It would provide dignity in old age instead of forcing the elderly to spend their final years shuttling in and out of hospital emergency departments, rescuing an NHS that Britons are — perhaps rightly, perhaps nostalgically — so proud of..© 2025 Bloomberg L.P.

Cautionary tale for SA’s NHI - UK’s broken NHS sucking in more money, delivering less

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