We work in the NHS – this is why it’s broken and how to fix it

Rachel Reeves is expected to hand the Department of Health and Social Care a £30bn boost in her spending review on Wednesday.

The extra money, spread over three years, will amount to a £17bn real-term increase. But will it be enough to meet the Government’s targets?

Sir Keir Starmer has pledged that by the next election, 92 per cent of patients in England waiting for planned treatment will be seen within 18 weeks of being referred. NHS data suggests that about 60 per cent of people are currently seen within this time.

The i Paper spoke to staff working across our health services to hear what people on the front line want announced this week.

The consultant: Boost staff numbers

Dr Tim Cooksley, former president of the Society for Acute Medicine, said the answer to what frontline medics want from the Chancellor is “relatively simple” – “investment in staffing and capacity so that we can deliver an acceptable standard of care to patients.”

He warned that patients are suffering or dying “daily in every hospital in the country” as a result of the NHS staffing crisis.

“The grim reality is well known to everyone who works in acute care and is increasingly personally experienced by large numbers of people by either their own patient journey or that of a loved one.”

Dr Cooksley added: “Degrading corridor care, poor patient experiences, significant delays, low staff morale. This is an appalling situation.”

He believes that as a result, this winter will be worse than last and that addressing the lack of capacity for care in hospitals “should and must be a priority in the spending review”.

“Hospital services require a staffing and capacity plan that spans at least a decade, matched to predictable population needs. Ideally, this needs to be independent from the increasing instability of political manoeuvring,” he said.

The pharmacist: Treat more illnesses at pharmacies

Olivier Picard, chair of the National Pharmacy Association (NPA) and a pharmacist in Berkshire, urged Starmer and Reeves to invest in community healthcare by expanding the illnesses treated under the Pharmacy First scheme.

By aligning England’s Pharmacy First service with the service available in Scotland – where a broader range of conditions are treated by pharmacists – it could mean up to 20 million patients a year are treated, potentially saving about 14 million GP appointments a year, according to the NPA.

“That means quicker access to care for patients and less strain on GPs and A&E departments. To achieve this, pharmacies need to see progress towards closing a funding gap of around £2.5bn,” Picard said.

The most recent community pharmacy funding settlement, which saw the sector secure an extra £481m over the next two years, was “an important step forward… but it’s clear we need to work together to do more to relieve the pressure and end pharmacy closures for good“, he said.

NHS figures show that between January 2021 and the end of November 2024, 752 pharmacies closed in England.

The resident doctor: Stop ignoring the impact of climate change on the NHS

Dr Matthew Lee, head of sustainability at the Doctors’ Association UK (DAUK) and a resident doctor (formerly known as a junior doctor) in Wales, argues that the impact of climate change on the NHS cannot be ignored.

“The 2022 heatwaves claimed more than 3,000 lives in the UK, but little thought was given to the tens of thousands of increased hospital attendances, the sweltering, unsafe working conditions or the infrastructure meltdowns such as at Guy’s and St Thomas’ [where IT systems were knocked out – leading to operations being cancelled],” he said.

“Even in the mild temperature rises in recent weeks, wards have been uncomfortably hot and we’ve yet to hit 30°C, let alone 40°C. Predictions of upwards of 10,000 excess deaths every year due to heat within the next 25 years do not take into account the vast increases in healthcare workload and dangerous working conditions experienced during these periods.”

Dr Lee said pollution, disease migration and biodiversity loss all exacerbate current health crises, such as antimicrobial resistance or the threat of pandemic emergence.

“Just last month, the first strains of the mosquito-borne West Nile virus were detected in the UK, with the likes of dengue fever becoming more common just across the channel in France.

“I’ve not even mentioned the threats to health from our sewage-polluted waterways, air pollution due to road traffic, or the health inequalities forced into existence by rising food prices because of climate change-related crop failures. Investment to tackle climate change will improve health.”

The nurses’ view: Fix social care to move elderly people out of hospitals

“Six months ago, nursing staff in their thousands delivered devastating testimony to the nation, revealing a corridor care disaster unfolding in every hospital,” said Professor Nicola Ranger, general secretary and chief executive of the Royal College of Nursing (RCN).

Ranger said that elderly and vulnerable people are still being treated in hospital corridors in overcrowded A&E departments “with nowhere left to turn“.

“Dedicated nursing staff weren’t just sounding the alarm about collapsing care standards, they were issuing a clarion call for Government to act. Then, they were demanding crucial investment in community services and social care, today, they’re doing it again.”

She added: “Our call for investment this Wednesday comes with a warning: if you fail to rebuild community and social care services, you also threaten your own flagship NHS reforms.”

Ranger warned that nursing numbers in community services have collapsed over the past decade.

• The number of district nurses – those who provide care to patients in their homes and residential care settings – are down by almost half, Ranger said.

• The number of registered nurses working in social care has fallen by 17,000 in the past decade.

• In total, there are more than 26,000 empty nursing posts across all of England’s NHS services.
• Student recruitment “has collapsed” and the number of people leaving the profession early is “skyrocketing”, she added.

The GP: ‘Stop treating general practice as if we were the black sheep of the NHS’

Kamila Hawthorne, chair of the Royal College of General Practitioners and a GP with 34 years of experience, said 367 million appointments were made in general practice last year – 20 million more than the year before.

While GP numbers are rising slowly, the NHS only has about 200 more GPs than it did in 2019, she said.

Her message to the Chancellor? “Address long-standing failures in healthcare workforce planning and provide GPs with the support needed to ensure patients get a quality service.”

Dr Hawthorne said that last year’s Darzi review, which analysed the current performance of the NHS across England and the challenges facing the healthcare system, made clear that the NHS has “major problems that will take long-term reform and investment to fix”.

“Less than 10 per cent of the NHS commissioning spend in England is spent on primary care, and core funding for general practice has fallen as a share of NHS funding. For too long, spending reviews have treated general practice as if we were the black sheep of the NHS rather than its bedrock. This has to change.”

The College is calling for a Primary Care Investment Standard, ensuring that both central government and ICBs [integrated care boards: regional funding and decision-making bodies within the NHS] increase their spending on general practice and primary care each year.

“We also need to see investment in a national GP retention scheme, to help keep GPs at all stages of their careers in the profession longer,” she said.

Dr Hawthorne says additional ringfenced funding of at least £2bn is needed to improve practice buildings after a recent College survey found that over a third (34 per cent) of GPs say that their premises are not fit for purpose.

The patient: Neighbourhood health hubs

Rachel Power, chief executive of the Patients Association, said the Government’s pledge to move care from hospital to community is right, but investment is needed “to create accessible hubs with good connections to public transport so that patients in under-served neighbourhoods can benefit”.

“Prevention is where the Government can make the biggest difference,” she added. “Rather than constantly firefighting, it must provide investment to keep people healthy. This requires cross-government working to tackle the root causes: poor housing, food insecurity, and social isolation, that make us sick in the first place.”

Power says technology offers exciting possibilities and the promised single patient record “could revolutionise how patients move through the system”, but warns that digital transformation cannot leave anyone behind. “Investment must include proper digital skills support and ensure platforms are designed inclusively from the start.”

“This spending review and the upcoming 10-year health plan can either perpetuate a system that treats us all as passive recipients or transform into one of genuine partnership. I know what I would choose.”