Britain’s State-Funded Health System Must ‘Reform or Die,’ Prime Minister Says

LONDON — Britain’s much-loved but overstretched health system is in critical condition and must “reform or die,” Prime Minister Keir Starmer said Thursday, claiming that years of neglect and botched restructuring had made the United Kingdom an increasingly unhealthy nation.

Starmer promised a 10-year plan to fix the state-funded National Health Service, which in recent years had gone from a source of national pride to a symbol of a state and society under growing strain.

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“We are becoming a sicker society,” Starmer said during a speech in London, pinning blame on the Conservative Party that was in power for 14 years until July.

“The last government broke the NHS,” he said.

A national icon on life support

Founded in 1948 in a country determined to build a fairer society out of the ruins of World War II, the NHS provides free health care to citizens and residents, funded through taxation.

So critical to the national identity that its 75th birthday was marked with a thanksgiving service at London’s Westminster Abbey, it has been dubbed Britain’s secular religion — though one in which some people are losing faith.

Even its most ardent supporters acknowledge the NHS is an unwieldy behemoth that has struggled for years to cope with an aging population and rising demand. Since the COVID-19 pandemic, waiting times for treatment have soared and public satisfaction has plummeted.

“Although the NHS does much good, patients repeatedly share their frustrations and confusion about accessing care,” said William Pett of patients’ group Healthwatch England. He added that “these challenges are not experienced equally, with poorer communities hit hardest.”

A critical diagnosis

Soon after Starmer’s center-left Labour Party won a landslide victory in the July 4 election, the government ordered a review of the NHS led by surgeon and former health minister Ara Darzi. In a report published Thursday, Darzi said he was “shocked by what I have found.”

He blamed more than a decade of “almost constant reorganization” along with “austerity and capital starvation” under Conservative governments for a deterioration “not just in the health service but in the state of the nation’s health.”

The NHS “has faced rising demand for health care from a society in distress,” Darzi said.

U.K. health spending grew by 2.4% a year between 2019 and 2024, according to the Institute for Fiscal Studies, down from an average of 3.6% over the longer term. Demand is growing much faster, as the British population grows larger and older. And the coronavirus pandemic piled on more pressure — sucking up resources, draining staff physically and emotionally, and creating a huge backlog of delayed tests and treatments.

The result, Darzi said, is that Britain has “appreciably higher cancer mortality rates than other countries,” while improvements in heart disease mortality rates have stalled since 2010. The British Heart Foundation said the number of people dying from cardiovascular disease is at the highest level in 14 years.

The Conservatives pointed out that Darzi, now a member of the House of Lords, was a health minister in a previous Labour government. Victoria Atkins, the Conservative Party’s spokeswoman on health issues, said Darzi’s report was a “cover for the Labour Party to raise our taxes in the budget in October.”

“We need to have a grown-up conversation about the NHS, but this is not the way to go about it,” Atkins told Sky News.

Prescription for recovery

Darzi said that fixing the health system will require spending more on health than on illness.

“Too many people end up in hospital, because too little is spent in the community,” he said.

Starmer, who claims the previous government left a 22 billion pound ($29 billion) “black hole” in the public finances, agreed with the need to move “from sickness to prevention.” But he said the answer does not lie simply in spending more money.

“We have to fix the plumbing before turning on the taps,” he said, proposing more local services and digital consultations, more treatment at home and reforms to improve productivity.

“The NHS may be in a critical condition, but its vital signs are strong,” Starmer said. But he said the choice was between hiking taxes to meet “ever-higher costs” and reforming the system.

“We know working people can’t afford to pay more, so it’s reform or die,” he said.

One option that is not being considered is a shift to a U.S.-style system of privately funded care. Even free-market Conservatives say — at least in public — that they support a free-to-use system funded by taxation.

“Nothing that I have found draws into question the principles of a health service that is taxpayer funded, free at the point of use, and based on need not ability to pay,” Darzi said.

“With the prominent exception of the United States, every advanced country has universal health coverage — and the rest of the world are striving towards it.”