Contemporary Social Science

The NHS at 80: Resilient health care systems for a changing world

The National Health Service (NHS) was established on July 5^th 1948, in the aftermath of World War II, as a revolutionary step towards providing free universal healthcare to all UK residents, funded through taxation.  As the NHS celebrates its 80-year anniversary (in 2028) it stands uniquely as an enduring symbol of British society. The NHS has influenced health systems worldwide, with its commitment to providing free healthcare at the point of consumption as a basic human right the founding principle. However, the modern-day NHS faces many challenges with concerns around funding, accessibility and quality of care being particularly prevalent.

The UK’s older population (aged 65 and over) is rapidly rising. In 2022, there were around 12.7 million older people in the UK, making up 19% of the population. By 2072 Office of National Statistics population projections indicate that 22.1 million people, or 27% of the population will be older. This situation is mirrored in many other countries internationally. The ageing of the UK population means a shrinking tax base from which to fund the NHS with the age dependency ratio [the proportion of the population of working age (16-64 years) relative to the older population (aged 65 and above)] reducing drastically. Without significant policy change, the Office for Budget Responsibility forecasts indicate that the UK's age dependency ratio will increase from 31 per cent to 47 per cent of the population over the next 50 years. This situation is not unique to the UK, many other countries internationally including Australia, Canada, Singapore and China are reporting rapid reductions in their age dependency ratios now and into the future (OBR, 2022). 

In addition to funding, expanding populations in many countries and rapidly ageing populations have implications for health and social care system accessibility and demand. Many people are living longer with common conditions of older age including physical limitations, frailty, cognitive impairment and dementia requiring an increasing intensity of care and support from hospital, primary care and aged related social care services. Older people frequently access health systems with more than  60% of all current NHS inpatient admissions and 70% of all NHS inpatient bed days being accounted for by older people. Similar statistics are evident in other countries including Australia where statistics from the Australian Institute of Health and Welfare indicate that older people currently account for 16% of Australia’s population but 42% of all hospitalisations and 49% of the total days spent in hospital. Aside from ageing populations, budgetary constraints and resource limitations are placing increasing pressures on health systems globally.

Moreover, the cost of acquiring and diffusing new health care technologies, treatments and pharmaceuticals is rapidly rising. Capacity and system constraints are common with rising ambulance wait times, ambulance ramping (whilst waiting to access a hospital bed) and bed blocking (e.g. whilst waiting to return home with support from social care services or waiting to access residential care), resulting in poor quality care and compromising patient health and wellbeing.  Increasing ambulance response times have recently been described by a senior health system commentator as the “NHS’s falling house of cards”. Moreover, low pay for nursing and ancillary staff are intensifying workforce shortages, with the NHS heavily dependent upon migrant workers.   

In response, there have been calls for greater privatisation of healthcare systems, amid perceived limitations of publicly funded provision. Advocates argue that expanding the role of private providers can increase efficiency, stimulate innovation, reduce waiting times, and offer patients greater choice by introducing competitive pressures into healthcare delivery, while alleviating fiscal pressures and accelerating the adoption of new technologies and service models. Yet, increased privatisation may exacerbate inequalities in access to care and prioritise profitability over patient outcomes, undermining the principles of universal healthcare. Consequently, debates over healthcare privatisation continue to focus on how to balance efficiency, quality, and patient choice with equity and public accountability.

Another response to the mounting pressures on the NHS has been to focus on prevention. Successive governments have promised to pursue a preventative agenda to relieve pressure on health care services and to address interrelated societal challenges. However, funding arrangements and organisational structures have largely failed to support shifts to prevention, resulting in limited and short-lived impacts. There are a growing number of advocates for a more wide-ranging prevention agenda to secure the long-term future of the NHS. They draw together concerns with the wider determinants of health, the commercial determinants of health, health inequalities, neighbourhood health, service integration and decentralised delivery. What this looks like in terms of practical policy change remains less clear.

This special collection seeks to explore how the NHS and other healthcare systems have adapted and are continuing to adapt to a changing world with associated budgetary and financial pressures, increased privatisation, the introduction of new health care technologies, treatments and pharmaceuticals and the implications of expanding populations and ageing.

Submissions are invited to this special collection of Contemporary Social Science that will be published in 2028 to coincide with the 80^th anniversary of the NHS. Submissions should link their particular area of focus with wider debates about the future of the NHS and/or other health care systems internationally.

We encourage the submissions of original articles, both theoretical and empirical, as well as shorter Comment pieces, which investigate and analyse from either single disciplinary and/or multi-disciplinary perspectives on the following, but not exhaustive, topics relating to health and social care systems:

• The current and future state of the NHS and/or healthcare systems elsewhere
• Health and Social Care system integration
• Decentralisation and regionalisation of healthcare systems
• Prevention and the wider determinants of health
• Health inequalities
• The role and impact of privatisation in the NHS and/or other publicly provided healthcare systems
• Health and social care policy reform in the UK and/or other countries
• Health care financing, efficiency and budgetary constraints
• Impact of population expansion and/or ageing on health care system sustainability
• Quality of health care and quality assessment
• Healthcare system resilience and reform