IIt was a bright, warm day in August and the heaters were on full blast. A nurse in the acute medical unit beeped my pager. The heart of a patient I had seen that morning started beating. Soon my heart started racing too, not out of solidarity but I had to sprint up from the seven flights of stairs. One half of our department was seven floors away from the other after asbestos flakes started falling from the ceiling.
As I looked at a trace of the patient’s heart rhythm, I suspected the culprit was potassium—that salt of which we need just the right amount, like Goldilocks, to keep beating. If it’s too high or too low, you have a real problem. A simple blood test would provide the information I needed. I walked across the building to one of only two blood gas analysis machines in the hospital and waited impatiently in line, only to find that the potassium measuring function was not working.
I called back to the seventh floor, half thinking that someone might need to check my potassium levels if I started running any more. A nursing colleague was kind enough to take more blood from the patient with palpitations, this time to send to the laboratory, and only asked me to print the appropriate forms. The first printer I tried jammed. Log out, kick someone off another computer, log in, press print again. Finally, the blood sample and paperwork were ready to be shot through the hospital’s pneumatic tube system. Just as I was preparing to record, the department manager reminded me that the system had not been working for the past two days. They suggested that the fastest way to get the blood to the laboratory was to flow it there themselves. I left again.
It took almost two hours to complete a task that should have taken ten minutes. This is the ultimate NHS experience. When policymakers talk about “productivity” and a lack of “capital investment” in healthcare, this is what they are talking about. There are 16% more doctors in training and 11% more nurses and health visitors working in the NHS than before the pandemic, yet we are treating approximately the same number of patients. That’s because the tools that NHS staff work with are centuries old. Our hospital machines and equipment have fallen so sharply in value that this was also the case in 2019 worth five times less per health worker than the tools used by doctors in Austria or Denmark, and less than those used in Slovakia and the Czech Republic. There is little point in training more doctors if they all have to fight to use a computer running Windows XP that is incessantly rebooted to install updates.
These types of bottlenecks are present everywhere in healthcare. The daily struggle to find a bed for a patient who urgently needs a bed; the week it may take before an MRI scan is performed; the hernia operation was canceled because a trauma call took over the valuable operating room. These are the consequences of years of very low investment and shooting in the foot of policymaking. Britain has now done that fewer scanners and hospital beds per person than almost any other comparable country.
When the basic tools you need to practice medicine in the 21st century are lacking, politicians’ talk of a “revolution” in science and technology can seem misdirected and deliberately optimistic. But they have a point. It’s hard to think of a sector where better information and new technologies can have such a rapid and immediate impact on people’s lives. Medicine is the science of gathering information and the art of interpreting it. It is, in theory, ripe for the AI revolution. The reality is very different. It is a world of pagers, pneumatic tubes and paternoster lifts. You can’t build AI on top of that.
Vintage kit isn’t even the worst problem: 42% of NHS hospitals in England, departments and key services have been forced to close since 2020 due to structural or repair issues. Rats and cockroaches have taken over in some hospitals. Electricity outages, overflowing sewage and rodent infestations have a domino effect in healthcare. Spreading patients from the now closed respiratory unit throughout the hospital unintentionally (but predictably) spreads hospital-acquired pneumonia to other admitted patients. Closing an outpatient care service to make more room for an emergency department that no longer has any corridors only means more people in the emergency room. These short-term solutions create disaster for the future.
This goes to the heart of the problem: the NHS is stuck in a cycle of ‘avoidant coping’, the psychological term describing the tendency to avoid or downplay the reality of stressful demands. The total maintenance bill to keep England’s NHS buildings and equipment upright and safe for use has risen to almost £12 billion. This figure has grown reliably year on year, almost tripled in the past decade. It can be argued that we are already seeing what it looks like when the physical infrastructure of the NHS – the buildings, equipment and machines on which our healthcare system depends – collapses. Almost 8 million people in England wait for treatment in hospital, around four in ten cancer patients wait more than two months to start treatment, and waiting times of twelve hours are common in A&E.
If Britain had matched the average Western European country’s healthcare investment as a percentage of GDP in the decade after 2010, it would have invested £33 billion more. This chronic lack of investment is a conundrum for almost every part of Britain’s public infrastructure, from sewers to schools and railways. Isn’t it time to put an end to the self-torture and spend some time on ourselves? The NHS – the country’s closest thing to a national religion – needs a church that won’t collapse.