NHS70: What troubles have hit the NHS?
The NHS - praised as one of the best healthcare services in the world and often singled out as one of Britain’s most cherished institutions - has not been without its trials and tribulations over the past 70 years.
Waiting times, reform, hospital-acquired infections, funding and overspending, hospital closures, staffing levels and a rapidly rising and ageing population are some of the many issues that have affected - and continue to affect - the NHS, which has come under increasing levels of scrutiny as the years have gone on.
As far back as 1967, huge failings in the care of the elderly and elderly people with mental illness were identified at seven hospitals across the country, with claims of a Government whitewash following in their wake.
Treatment of those with mental health conditions also came to the fore during the 1960s and 1970s, with several scathing reports published on the lack of dignity afforded to patients, who were commonly housed in overcrowded mental hospitals where little treatment was given to them.
Several medical scandals shook the system to its core as it entered the 21st century.
In 2001 the official Redfern Report was published, two years after it emerged that Liverpool’s Alder Hey Children’s Hospital had stripped hundreds of dead babies of their organs without the permission of relatives.
Body parts, some of which were also obtained by other hospitals, were then secretly held for medical research.
Notably, Mid Staffordshire NHS Foundation Trust found itself at the centre of a major public inquiry after it was found that up to 1,200 people may have died unnecessarily as a result of maltreatment and neglect between 2005 and 2009.
It was revealed that many patients were left lying in their own urine and excrement for days, forced to drink water from vases or given the wrong medication.
Sir Robert Francis, who chaired the public inquiry, called for a “zero-tolerance” approach to poor standards of care in his damning report, which made 290 sweeping recommendations for healthcare regulators, providers and the Government.
Health and social care secretary Jeremy Hunt described the Mid Staffs scandal as “probably the worst thing that has happened to the NHS” in its history and it led to ministers pledging a more open and transparent health service.
But just a year after he made those comments, Mr Hunt was forced to apologise to families following the unnecessary deaths of 11 babies and one mother at a maternity unit, which he described as a “second Mid Staffs”.
The inquiry into serious incidents at Furness General Hospital in Barrow, Cumbria, between 2004 and 2013 uncovered a series of failures “at every level”, from the maternity unit to those responsible for regulating and monitoring the trust which ran it.
The “superbug scandal” also saw public confidence in the NHS challenged, after a series of outbreaks of antibiotic-resistant infections such as MRSA and Clostridium difficile (C diff).
Ninety people were found to have died of C diff at Maidstone and Tunbridge Wells NHS Trust following care and hygiene failures in 2005 and 2006, while an outbreak at Stoke Mandeville hospital in Buckinghamshire caused the deaths of 33 patients between 2003 and 2005.
Government reforms to the NHS - most notably the Health and Social Care Act 2012 which brought in the most wide-ranging changes since the health service was founded - have come under sustained attack.
The health secretary at the time, Andrew Lansley, wanted to make the NHS more accountable to patients and to release frontline staff from excessive bureaucracy and top-down control.
But six years on, the changes have been largely slated as being ineffective in improving services, while many have said the focus should be on improving patient care and sorting out the dire financial situation the NHS is in.
Waiting times for treatment have been a huge source of controversy in recent years, with 2017/18 the worst year on record for A&E departments, which are seen as a key measure of how the NHS is performing.
The “NHS winter crisis” saw hospitals come under intense pressure due to particularly cold weather, including heavy snow, along with high rates of flu and norovirus.
It led Mr Hunt to describe the period as the “worst ever” for the NHS, with doctors warning of patients dying prematurely in the corridors of A&E departments or being forced to wait in ambulances for hours as hospitals lacked space for them.
Prime minister Theresa May also apologised to patients after it emerged that it meant tens of thousands of planned operations were likely to be delayed for at least a month as the NHS dealt with the most urgent cases.
In general practice, there are concerns about waiting times for appointments, with figures from the British Medical Association (BMA) showing a fifth (20pc) of patients are waiting more than a week for an appointment, up from 12pc five years ago, while a report earlier this year found the number of GPs who plan to leave the profession in the next five years is at an “all-time high”.
Overall, the NHS in England is around 100,000 workers short of what it needs, including around 36,000 nurses and almost 10,000 doctors.
Other issues that the NHS has to contend with in the present day surround the changing nature of the nation’s health itself.
The health service was created in the middle of the 20th century when the biggest threats were infectious diseases such as TB and polio, but today it is having to deal with obesity, diabetes, coronary heart disease, cancers and dementia, which are driven more by lifestyle choices.
For the first time people are living longer, but not necessarily healthier lives, and the country also faces caring for an ageing population - by 2040, nearly one in seven people in the UK is projected to be aged over 75.
The growing population and number of people with long-term health conditions is also piling the pressure on services, with data on A&E attendances showing they increased by 1.9 million in total between 2011/12 and 2016/17 - the equivalent of an extra 5,100 more attendances each day.
The financial situation of the NHS is also a source of major contention, with 44pc of trusts in deficit in 2017/18 compared to a high of 66pc in 2015/16. They ended the financial year with a deficit of £960m - nearly twice the amount planned.
The suggestion that patients should directly pay for treatment, which would end the principle of an NHS free at the point of delivery, has long been mooted.
While it remains to be seen whether this will become a reality in the future, the government has announced the NHS is to receive an extra £20bn a year by 2023/24 as a “birthday present” to mark its 70 years.