Dysfunctional Healthcare. Is it time to let go?

The NHS and Universal social healthcare have long been a defining feature of the United Kingdom and wider Europe, a legacy shaped by the sociopolitical aftermath of the continent’s two most devastating wars. These historical ruptures embedded a collective commitment to healthcare systems that prioritise public welfare over profit. Yet today, the United Kingdom, particularly England, faces some of the most severe challenges to its healthcare infrastructure in living memory.

In the post, COVID healthcare landscape, NHS England reports that the volume of general practitioner appointments in 2025 has returned to levels comparable to those in 2020. However, face-to-face consultations remain critically low, hovering at just under 20% of their 2019 figures. Meanwhile, Accident and Emergency departments are under mounting strain: daily waits exceeding four hours have more than doubled, rising from approximately 2,000 patients to over 5,000. The number of individuals waiting more than 52 weeks for hospital treatment stands at 200,000, more than double the pre-pandemic figure of under 100,000 (Baker, 2024). All this while the NHS England budget has allocated only £151 billion in funding to local NHS systems in 2024/25 (NHS England, 2025), compared to £124 billion in 2019/20, which was used to commission healthcare services for the people of England (NHS England, 2021) a modest increase of just £27 billion, or 21.77%. 

In comparison, countries such as France, Germany and Norway offer similar models of universal healthcare to their citizens, each with distinct approaches to funding and with varying, yet ultimately, more effective outcomes. Germany’s healthcare system ranks among the best in Europe, offering robust state, and employer-backed insurance (Gesetzliche Krankenversicherung) through private providers. Its universal framework ensures that unemployment or student status does not hinder access to medical care. The system’s strengths are reflected in survey data from 5,618 citizens, showing an average wait time of just four days to see a general practitioner under public coverage, and an even shorter 3.3 day wait for privately insured patients (Luque Ramos, Hoffmann, and Spreckelsen, 2018).

The success of universal healthcare is also evident in southern Europe, where access is traditionally more constrained. In Italy, only 1.8% of the population reported experiencing unmet medical needs, such as delays or extended waiting times (OECD, 2023). The prevailing model is one of supplementation: Italy’s healthcare system is fundamentally universal and publicly funded, with private spending serving a supplementary, not primary, role. This underscores the effectiveness of a well funded and well managed public health system.

NHS England and the wider NHS across the UK can be seen as a focal point for government spending and management challenges. It is also a historical amalgamation that may have outlived its original purpose, though not its usefulness. When considering the question of relevance, it becomes clear that a publicly funded and publicly owned healthcare system remains essential to maintaining the quality of life that people in the United Kingdom have come to expect. 

That being said, while the existence of a public healthcare system is essential, its operation should evolve from a 1940s post-war project into a functioning service fit for the twenty-first century. This would involve a shift towards a more corporatist and individually focused model, without moving towards privatisation. Such a shift would not directly increase profits for healthcare providers through increased claims. Instead, it would redirect the cultural and societal burden of healthcare away from a centralised and collective structure towards a more binary, responsibility-driven model. Healthcare would become more personal, more responsive and offer deeper, higher-quality services. In this framework, both employees and employers would benefit directly from access to effective care, while also sharing collective accountability. This move is, and will likely continue to be, seen as contradictory to social welfare in the United Kingdom. 

However, the opposite is true. Germany, which operates a healthcare system that this article is modelling itself on, maintains a welfare budget equivalent to 31.2 per cent of the country’s GDP, totalling €1.35 trillion (Storbeck, Anne-Sylvaine Chassany and Murray, 2025). In contrast, the UK spends just £313.0 billion on welfare in 2024/25 (Jones, 2025). At first glance this disparity appears to weaken the overall perspective presented in this article. As Germany sustains this level of investment in a country with an older, more rapidly ageing and significantly larger population (World Bank Group, 2025), and therefore the current greater spending might indicate future problems for the maintenance of the German welfare budget. However, it could be argued that Germany has built a system where employers and employees share the cost of public healthcare and thus guaranteeing a budget in the first place, is much more sustainable.  

Alongside this, such a shift would reduce pressure on the NHS UK and other publicly owned institutions. A state-mandated, employee-and-employer-supported healthcare model, could, as shown in the example of Germany, ease reliance on government-led systems, paving the way for better primary and secondary care for those who need it most. Ensuring that health care inequality does not become part of the increasing inequality statistics in the United Kingdom. 

Economically, in the long term, this may help reduce the risks of youth and adult unemployment impacting other public services through the current increased ill health of citizens, such as the police and fire services. It would do this by freeing up and expanding avenues for the utilisation and extraction of taxes more effectively. More significantly, it could influence the way in which the government procures housing, while also addressing broader economic inactivity among these two groups in the UK today. This, in turn, has the potential to redirect more capital, both human and financial, back into the public domain, enabling increased and enhanced service capability by reducing cuts to facilities, equipment, staffing, and other essential services such as specialisations.

This could also signal a shift away from the current, on track, privatised facility management model that NHS UK has adopted, including the sale of car parking and facility management contracts to companies such as Mitie, while continuing to charge and tax the public and NHS staff to cover these outsourced services. See Euro Parking Services (2025) and Mitie (2025) for more information.

If the United Kingdom is to preserve the principles of universal healthcare while meeting the demands of a changing society, it must move beyond sentimentality and legacy. The NHS remains a cornerstone of public life, but its structure must evolve to reflect the realities of twenty-first century governance, economics, and demographics. A corporatist, responsibility-based model one that empowers individuals and workplaces without abandoning public ownership offers a viable path forward. The challenge now is not whether the UK can afford to change, but whether it can afford not to.

References

Baker, C. (2024). NHS Key Statistics: England. [online] Parliament.uk. Available at: https://researchbriefings.files.parliament.uk/documents/CBP-7281/CBP-7281.pdf. [Accessed 10 Nov. 2025].

Euro Parking Services (2025). Euro Parking Services Healthcare Sector. [online] Europarkingservices.com. Available at: https://europarkingservices.com/healthcare/ [Accessed 10 Nov. 2025].

Jones, I. (2025). What does the UK spend on welfare – and how much will it rise? [online] The Standard. Available at: https://www.standard.co.uk/business/money/office-for-budget-responsibility-universal-credit-gdp-government-social-care-b1235215.html [Accessed 10 Nov. 2025].

Luque Ramos, A., Hoffmann, F. and Spreckelsen, O. (2018). Waiting times in primary care depending on insurance scheme in Germany. BMC Health Services Research, 18(1). doi:https://doi.org/10.1186/s12913-018-3000-6.

Mitie (2025). Healthcare facilities management for Hospitals | Mitie. [online] Mitie. Available at: https://www.mitie.com/all-sectors/healthcare/ [Accessed 10 Nov. 2025].

NHS England (2021). NHS England Annual Report 2019/20. [online] NHS England. Available at: https://www.england.nhs.uk/wp-content/uploads/2021/01/nhs-england-annual-report-2019-20-full.pdf [Accessed 10 Nov. 2025].

NHS England (2025). Annual Report and Accounts 2024/25. For the year ended 31 March 2025. [online] NHS England. Available at: https://assets.publishing.service.gov.uk/media/69036ef05c84b1206832a86f/nhs-england-annual-report-and-accounts-2024-to-2025.pdf [Accessed 10 Nov. 2025].

OECD (2023). Italy: Country Health Profile 2023. [online] OECD. Available at: https://www.oecd.org/en/publications/italy-country-health-profile-2023_633496ec-en.html [Accessed 10 Nov. 2025].

Storbeck, O., Anne-Sylvaine Chassany and Murray, C. (2025). In charts: Can Germany afford its €1.35tn welfare state? [online] FinancialTimes. Available at: https://www.ft.com/content/efe286dc-9f97-4ad8-96d4-8b97be87fb8c [Accessed 10 Nov. 2025].

World Bank Group (2025a). Population ages 65 and above (% of total population) - Germany | Data. [online] data.worldbank.org. Available at: https://data.worldbank.org/indicator/SP.POP.65UP.TO.ZS?locations=DE [Accessed 10 Nov. 2025].

World Bank Group (2025b). Population, total - Germany | Data. [online] data.worldbank.org. Available at: https://data.worldbank.org/indicator/SP.POP.TOTL?locations=DE [Accessed 10 Nov. 2025].