The National Health Service (NHS) has long been considered one of the UK’s greatest achievements. Founded in 1948, it was built on the principles of universal healthcare, free at the point of use. However, in recent years, the NHS has faced mounting pressures, with declining performance, longer waiting times, underfunded infrastructure, and growing staff shortages. While domestic policies play a significant role in shaping the healthcare system, the broader context of global politics and economics cannot be ignored.
Since around 2010, the NHS has experienced what many analysts describe as a steady decline, largely attributed to underinvestment and misallocation of resources. But what caused this shift? To understand this, we need to examine the global events that shaped economic policy decisions in the UK, the government’s response to financial pressures, and how international factors—ranging from the 2008 financial crisis to Brexit and the COVID-19 pandemic—created a perfect storm that left the NHS in a vulnerable position.
This article explores the ripple effects of global politics on the NHS, analysing the financial, political, and demographic factors that contributed to its challenges over the past decade and a half.
To understand the roots of the NHS’s struggles in the 2010s, we must first look at the 2008 global financial crisis. The crisis, which originated in the United States due to subprime mortgage lending and the collapse of major financial institutions, triggered a worldwide economic recession. Banks that had engaged in risky financial practices found themselves unable to cover their losses, leading to the bankruptcy of major firms like Lehman Brothers and the need for massive government bailouts.
The UK was particularly vulnerable to this crisis due to the size of its financial sector. London had long been a global banking hub, and when the financial system collapsed, the UK government was forced to intervene. The Labour government under Prime Minister Gordon Brown bailed out major banks, including RBS and Lloyds, to prevent total economic collapse. However, this intervention came at a cost. Government debt soared, and public spending had to be reassessed to stabilise the economy.
As the UK emerged from the immediate effects of the crisis, the political conversation turned toward deficit reduction. In the 2010 general election, the Conservative Party, led by David Cameron, campaigned on a platform of economic responsibility and cutting public spending. When the Conservatives formed a coalition government with the Liberal Democrats, they implemented austerity measures—a policy that would have long-term consequences for public services, including the NHS.
From 2010 onwards, the UK government pursued one of the most aggressive austerity programs in its modern history. Chancellor George Osborne justified these cuts by arguing that reducing government debt was necessary to ensure economic stability. However, austerity policies disproportionately affected public services, leading to real-term funding squeezes in the NHS, local councils, and social care.
The NHS budget did continue to increase year-on-year, but at a much slower rate than in previous decades. Between 2010 and 2019, NHS spending grew by around 1.5% per year on average—far below the historical average of 3.7% since the NHS’s founding. This lower level of funding was insufficient to keep up with rising demand, inflation, and the costs of an aging population.
The effects of austerity on the NHS were significant:
Staff shortages became an increasing problem, as public sector pay caps led to lower wages for healthcare workers. Recruitment and retention suffered, with many nurses and doctors leaving the profession or moving abroad for better pay and working conditions.
Hospital infrastructure deteriorated due to a lack of investment in buildings, equipment, and technology. Maintenance backlogs grew, leading to aging hospitals struggling to keep up with patient needs.
Social care cuts meant that hospitals became overwhelmed with patients who could not be discharged due to a lack of community care options. This increased waiting times and pressure on hospital beds.
The government defended these policies by arguing that they were necessary for long-term economic recovery. However, critics pointed out that underfunding public services would only create greater costs down the line, as crises in healthcare and social services worsened.
While austerity was the UK government’s chosen response to the financial crisis, broader global economic instability also played a role in shaping public policy. The Eurozone crisis (2010–2012) saw several European countries, including Greece, Spain, and Italy, facing severe debt crises that threatened the stability of the entire European economy.
As one of the EU’s largest economies, the UK was affected by this turmoil, even though it was not part of the Eurozone. The crisis led to economic uncertainty, affecting trade and investment. The government’s cautious approach to public spending was reinforced by fears that the UK could face a similar fate if it did not control its deficit.
The Eurozone crisis also influenced immigration policies. EU migration had played a crucial role in staffing the NHS, with thousands of European nurses, doctors, and care workers filling gaps in the workforce. However, the political climate following the crisis saw increased anti-immigration sentiment in the UK, which would later culminate in Brexit—a decision that would have profound consequences for NHS staffing levels.
The 2016 Brexit referendum marked a turning point in British politics, with widespread implications for the NHS. One of the key arguments made by the Leave campaign was that Brexit would free up £350 million per week for the NHS—an infamous claim emblazoned on the side of a campaign bus. In reality, Brexit introduced new challenges for the healthcare system, particularly in terms of workforce shortages and supply chain disruptions.
Prior to Brexit, the NHS and social care system relied heavily on EU workers. Freedom of movement allowed thousands of healthcare professionals from Europe to work in the UK, filling critical gaps in staffing. However, following the referendum, many EU nationals faced uncertainty about their immigration status, leading to a sharp decline in applications from European healthcare workers.
In the years following Brexit, NHS staffing shortages worsened. The introduction of a points-based immigration system made it harder for lower-paid healthcare workers to enter the UK, exacerbating recruitment difficulties. Hospitals and care homes struggled to fill vacancies, leading to increased workloads for existing staff and a decline in patient care quality.
Brexit also affected the NHS’s ability to procure medical supplies. New trade barriers and customs checks disrupted the supply of essential drugs and medical equipment, increasing costs and leading to concerns about stock shortages.
By the time the COVID-19 pandemic struck in early 2020, the NHS was already in a weakened state. Years of underfunding, staff shortages, and infrastructure neglect left it ill-prepared for a public health crisis of this scale.
The pandemic exposed the fragility of the NHS. Intensive care units were overwhelmed, hospitals ran out of critical supplies, and exhausted healthcare workers struggled to cope with the surge in patients. The government was forced to inject emergency funding into the NHS, but much of the damage had already been done.
In the aftermath of the pandemic, the NHS has continued to struggle with record waiting lists, a burnt-out workforce, and financial pressures. While the government has announced additional funding in response, many healthcare professionals argue that the system remains underfunded relative to demand.
The decline of the NHS over the past decade cannot be attributed to a single cause. Instead, it is the result of a combination of global economic crises, political decisions, and demographic pressures. The 2008 financial crash led to austerity policies that squeezed NHS funding, the Eurozone crisis contributed to economic instability and immigration restrictions, Brexit worsened staffing shortages, and the COVID-19 pandemic pushed the system to its limits.
As the UK moves forward, the question remains: can the NHS recover from over a decade of underinvestment and political turbulence? The answer will depend on whether future governments choose to prioritise healthcare funding and workforce sustainability over short-term political gains. If the past fifteen years have taught us anything, it is that global events have far-reaching consequences—and the NHS, as a cornerstone of British society, is at the mercy of those ripple effects.