# Opinion: The NHS Needs Honesty, Not More Empty Promises > Politicians promise to 'save the NHS' every election, then fail to deliver. It's time to have an honest conversation about what the NHS can actually afford to do. *Section: Opinion — By Naomi Clarke (Opinion Editor) — Published June 14, 2026 — 8 min read* Canonical URL: https://dailyjunction.org/opinion/opinion-nhs-needs-honesty-not-promises Tags: opinion, NHS, healthcare, public services, funding, waiting lists, UK politics, health policy ## Key takeaways - NHS waiting lists reached 7.6 million in 2024, with the average wait for treatment rising from 9 weeks in 2010 to 15 weeks in 2024 - The UK spends 10.3% of GDP on healthcare, below France (11.3%) and Germany (11.7%), and NHS funding per capita has grown by only 1% per year since 2010 - Every government promises to cut waiting times and hire more staff, but none has delivered sustained improvement since the 2000s - The NHS cannot do everything for everyone — rationing already happens through waiting lists, postcode lotteries, and NICE decisions on drug funding - An honest conversation about NHS funding, rationing, and what services should be prioritised is overdue, but politicians fear the electoral consequences Every election, politicians promise to "save the NHS." They pledge to cut waiting times, hire more doctors and nurses, and protect the health service from privatisation. They invoke Aneurin Bevan and the spirit of 1948, and they warn that the other side will destroy the NHS if elected. And then, once in power, they fail to deliver. Waiting lists grow, staff leave, and patients suffer. The cycle repeats. The truth is that **the NHS is not sustainable in its current form**, and no amount of tinkering will fix it. The model — free at the point of use, funded by taxation, and available to everyone for everything — was designed for a different era, when the population was younger, treatments were simpler, and expectations were lower. In 2026, the NHS is trying to provide 21st-century medicine on a mid-20th-century budget, and it is failing. It is time for politicians to stop making promises they cannot keep, and to have an **honest conversation** about what the NHS can actually afford to do, what should be rationed, and how much voters are willing to pay. The alternative is managed decline, where the NHS limps on, underfunded and overstretched, until it collapses under its own weight. ## The Scale of the Crisis The NHS is in the worst state it has ever been in. The numbers are stark: - **Waiting lists**: 7.6 million people in England are waiting for treatment (as of January 2024), up from 4.4 million in 2019. Some patients wait over a year for routine surgery. - **A&E performance**: Only 72% of A&E patients are seen within four hours (the target is 95%). The average wait is over five hours. - **Ambulance response times**: The average response time for a Category 2 call (strokes, heart attacks) is 45 minutes (the target is 18 minutes). - **GP appointments**: The average wait for a GP appointment is two weeks. Many patients cannot get an appointment at all. - **Staff shortages**: There are 100,000 vacancies across the NHS, including 40,000 nurses and 10,000 doctors. These are not just statistics. They are people waiting in pain, people dying because ambulances arrive too late, and people giving up on the NHS and going private (if they can afford it). ## Why the NHS Is Failing ### 1. Underfunding The NHS is not funded adequately. The UK spends **10.3% of GDP on healthcare**, below France (11.3%), Germany (11.7%), and the Netherlands (10.9%). NHS funding per capita has grown by only **1% per year since 2010**, far below the 3.7% average growth rate between 1948 and 2010. This is not enough to keep up with demand. The population is ageing (the number of over-85s has doubled since 2000), and older people need more healthcare. New treatments (cancer drugs, gene therapies) are expensive. And the backlog from COVID-19 (when routine care was paused) has added millions to waiting lists. The government argues that it is spending record amounts on the NHS, which is true in cash terms. But in real terms (adjusted for inflation and population growth), NHS spending per capita has barely increased since 2010. ### 2. Staff shortages The NHS has **100,000 vacancies**, and it cannot recruit or retain enough staff. Doctors and nurses are leaving for better-paid jobs abroad (particularly in Australia, Canada, and the Middle East) or in the private sector. Junior doctors went on strike for a year (2023–2024) over pay, and many are still considering leaving. The reasons are clear: pay has fallen in real terms, workloads are unsustainable, and morale is at rock bottom. The government has promised to train more doctors and nurses, but training takes years, and many newly qualified staff leave within five years. ### 3. Demand is rising faster than capacity The NHS is a victim of its own success. People are living longer, which means they need more healthcare. Obesity, diabetes, and mental health problems are rising. And patients expect more — they want same-day GP appointments, instant test results, and access to the latest treatments. The NHS cannot keep up. Capacity (the number of beds, staff, and appointments) is not growing fast enough to meet demand. The result is longer waiting lists, worse outcomes, and burnt-out staff. ### 4. The NHS tries to do everything The NHS provides **free healthcare for everyone, for everything**. GP appointments, A&E visits, cancer treatment, hip replacements, IVF, gender reassignment surgery — all free at the point of use. This is unique. Most European countries charge for some services (GP appointments, prescriptions, hospital stays) or limit what is covered. The problem is that "free" does not mean "free." It means paid for by taxation, and there is a limit to how much voters are willing to pay. The NHS cannot afford to do everything for everyone, so it rations care through **waiting lists**. If you need a hip replacement, you wait six months. If you need a cancer drug that NICE (the National Institute for Health and Care Excellence) has not approved, you do not get it. This is rationing by stealth. Politicians pretend the NHS can do everything, but in reality, it cannot. ## The Solutions No One Wants to Talk About ### 1. Spend more The obvious solution is to spend more money. If the UK matched France or Germany's healthcare spending (11–12% of GDP), the NHS would have an extra £30–40 billion per year. That would be enough to hire more staff, cut waiting lists, and improve services. But where would the money come from? Taxes would have to rise. National Insurance (which funds the NHS) could be increased, or a new health tax could be introduced. But voters say they want better public services and lower taxes, which is impossible. Labour has promised to increase NHS funding, but it has also promised not to raise income tax, National Insurance, or VAT. That leaves little room for manoeuvre. ### 2. Charge for some services Most European countries charge for GP appointments (€10–30), A&E visits (€50–100), and hospital stays (€10–20 per night), with exemptions for low-income patients and children. This raises revenue and reduces demand (people think twice before going to A&E for minor ailments). In the UK, this is politically toxic. The NHS is a sacred cow, and any suggestion of charging is denounced as "privatisation" or "Americanisation." But charging for some services (with exemptions for the vulnerable) could raise billions and reduce pressure on the system. The counter-argument is that charging deters people from seeking care, worsens health inequalities, and undermines the principle of free healthcare. But the NHS already has inequalities (postcode lotteries, waiting lists), and "free" is a fiction when you are waiting six months for treatment. ### 3. Ration more explicitly The NHS already rations care, but it does so through waiting lists and NICE decisions, which are opaque and unfair. A more honest approach would be to **explicitly prioritise** certain treatments and patients. For example: - Prioritise life-saving treatments (cancer, heart disease) over quality-of-life treatments (hip replacements, cosmetic surgery). - Limit access to expensive treatments with marginal benefits (e.g., cancer drugs that extend life by only a few weeks). - Require patients to take responsibility for their health (e.g., lose weight before getting a hip replacement, stop smoking before getting surgery). This is politically difficult, because it means telling some patients "no." But it is more honest than the current system, where rationing happens by stealth. ### 4. Reform the model The NHS is a centralised, state-run system, which is unusual. Most European countries use **social insurance models**, where healthcare is funded by mandatory insurance contributions and delivered by a mix of public and private providers. Patients have more choice, and providers compete on quality. The UK could move to a similar model, where the NHS becomes a regulator and funder rather than a direct provider. This would increase competition, improve efficiency, and give patients more choice. But it would also be a radical break from the NHS's founding principles, and it would be fiercely opposed by unions, the Labour Party, and much of the public. ## Why Politicians Will Not Be Honest Politicians will not have this conversation because it is electoral suicide. The NHS is the UK's most beloved institution, and voters will not tolerate anyone who suggests it is unsustainable or needs radical reform. So politicians make promises they cannot keep. They pledge to cut waiting times, hire more staff, and protect the NHS, knowing that they will fail. And when they do fail, they blame the other side, or the pandemic, or "efficiency savings," and the cycle continues. The result is **managed decline**. The NHS limps on, underfunded and overstretched, providing worse care to more people. Staff leave, patients suffer, and the system slowly collapses. ## The Bottom Line The NHS is in crisis. Waiting lists have reached 7.6 million, the UK spends less on healthcare than France or Germany, and staff shortages are crippling the system. Every government promises to cut waiting times and hire more staff, but none has delivered sustained improvement since the 2000s. The NHS cannot do everything for everyone — rationing already happens through waiting lists, postcode lotteries, and NICE decisions. An honest conversation about NHS funding, rationing, and what services should be prioritised is overdue, but politicians fear the electoral consequences. The solutions — spend more, charge for some services, ration more explicitly, or reform the model — are all politically toxic. So politicians make promises they cannot keep, and the NHS continues its managed decline. It is time to stop pretending the NHS can be "saved" with a few more billion pounds and a few more promises. The NHS needs radical reform, and voters need to decide how much they are willing to pay, and what they are willing to give up. The alternative is a health service that fails everyone. ## Frequently asked questions ### How much does the NHS cost? The NHS budget for England in 2024–25 is £165 billion, around 40% of total government spending. This covers hospitals, GPs, mental health services, and community care. Scotland, Wales, and Northern Ireland have separate NHS budgets funded by the UK government. ### Why are NHS waiting lists so long? A combination of factors: underfunding (NHS spending per capita has grown by only 1% per year since 2010), staff shortages (100,000 vacancies as of 2024), an ageing population, and the backlog from COVID-19. Demand is rising faster than capacity. ### Should the NHS charge for some services? This is politically toxic, but some argue that charging for GP appointments or A&E visits (with exemptions for low-income patients) could reduce demand and raise revenue. Others say it would deter people from seeking care and worsen health inequalities. The debate is overdue. ## Sources - [NHS England — Statistics and data](https://www.england.nhs.uk/statistics/) - [The King's Fund — NHS funding and performance](https://www.kingsfund.org.uk/) - [House of Commons Library — NHS spending](https://commonslibrary.parliament.uk/) - [Nuffield Trust — Healthcare policy analysis](https://www.nuffieldtrust.org.uk/) --- Daily Junction — https://dailyjunction.org/opinion/opinion-nhs-needs-honesty-not-promises