Austerity bites as almost half of physicians view NHS services negatively

06 November 2018 8 min. read

With the NHS facing a number of mounting crises, including a shortfall in staffing and an ageing population, physicians have noted their concern that without significant changes to the NHS’ management and funding, it will not be able to survive. According to a new survey, more than 90% of NHS professionals believe the institution will not exist in 20 years without much needed alterations.

Originally conceived by Bain & Company, a Net Promoter Score (NPS) is an index ranging from -100 to 100, which measures the willingness of customers to recommend a company's products or services to others. It is used as a proxy for gauging the customer's overall satisfaction with a company's product or service and the customer's loyalty to the brand. According to Bain, the correlation between a company’s growth and its Net Promoter Score accounts for 20% to 60% of a company’s organic growth rate. On average, the leader in an industry has a Net Promoter Score more than double that of its competitors.

While the National Health Service is not a business, and as a public service should be run for the benefit of people over profit, by analysing the institution’s NPS among physicians, the challenges facing the hallowed health service can be brought to light, and addressed. As the NHS faces continuing under-funding from the government, while having to contend with staffing shortages and the growing demands of an ageing population, understanding these issues, and what medical experts believe is the best way to address them, could well prove essential for the NHS’ long-term survival.

The UK has the lowest Net Promoter Score among its European peers, with a nearly 100% increase in detractors from 2016 to 2018

Since the creation of the NHS by the Attlee Labour Government some 70 years ago, healthcare has been available free at the point of access to people across the UK. The institution could not have survived the following seven decades but for its ability to change with the times, as the population grew rapidly from the rubble of post-war Britain. Now, it stands at another seminal cross-roads in its existence, as exemplified by the results of the Bain Europe Front Line of Healthcare Survey.

The poll, which was conducted in 2018 by the physician panel at SERMO, a leading global social network for physicians and healthcare market researcher, canvassed 1,156 physicians and 154 procurement officers from Germany, France, Italy and the UK, including 324 physicians in the UK. The UK portion of the results revealed that physicians are now the least likely to recommend their services among their peers. Almost half of UK physicians now actually provide negative assessments of their practices and organisations as a place to work, when speaking to friends and colleagues.

This reflects a stark contrast with the same survey two years ago, when UK respondents supplied the healthiest net-promoter scores among the four nations, which each host universal health care in some form. According to Bain’s survey, to that end more than nine in every 10 doctors believe that the NHS will not reach its ninetieth ‘birthday’ if things do not change.

91% of doctors believe that the National Health Service will not survive another 20 years without major transformation

Of the 91% of medical practitioners who said they doubted the service could survive to 2038 without major transformation, 38% cited changing demographics and rising costs would doom the NHS, if not addressed, while a further 30% said that flagging resources and funding would see the collapse of the treasured British institution. These combined factors mean that the approach of the baby-boomer generation towards advanced old age has particularly begun to put a strain on the under-resourced NHS in recent years, while it has struggled to obtain enough new talent to adequately meet this spike in demand.

NHS exodus

Startlingly, 14% of doctors indicate they will leave the National Health Service over the next five years. This contingent said they will either leave the profession altogether, or move to another country over the next five years; while only 5% of the same cohort indicated that they would've had similar wishes to exit the NHS if asked the same question five years ago. At the same time, nearly three-quarters of all medical specialties had unfilled training posts, and dozens of specialties must make do with annual recruitment shortfalls.

This critical shortage in staff is undoubtedly being fuelled by stagnant wages, which over the past seven years have amounted to a real-terms pay-cut for many workers in the healthcare sector. Frontline providers have endured controversial wage freezes throughout the duration of the current Government’s tenure, and even after this purportedly came to an end, the salary increases they have seen since were capped at 1%, as part of the a continuing austerity agenda. As these restrictions do not allow salaries to keep pace with the rising cost of living, they have resulted in the front line inching closer to the breaking point.

UK spending on healthcare is lower than comparable European peers

When looking for what sets the UK apart from its continental equivalents, this seems to be one of the largest x-factors behind the NHS’ fall from grace, in the eyes of physicians. The UK’s collective spend on healthcare is lower than all of its comparable European peers. While NHS funding has increased year over year to reach £124.7 billion in 2017–2018, this is actually a historic low.

According to Bain, between 2010–2011 and 2016–2017, health spending grew by an average of 1.2% above inflation – something set to continue in real terms at a similar rate until the end of this Parliament – but this is well beneath the pre-2010 NHS annual inflation-proof growth rate. That era saw funding increases of 4% stretching back to the 1950s. Rather than finding ways to address staffing shortfalls meanwhile, this is leading to management increasingly concentrating on how to spread thinly allocated resources further.

The UK is the only nation noted by Bain to have seen the proportion of its GDP spent on healthcare drop between 2015 and 2016. At the same time, the proportion of trusts with a financial deficit still stands at four times the number from 2012-2013, now flat-lining at 44 compared to 10 back then. With no end in sight for austerity despite the promises of Theresa May during the Conservative Party conference, talent resourcing also faces a crisis with the UK’s withdrawal from the EU, as Home Secretary Sajid Javid has only granted temporary exemptions for migrant labour in the NHS. As such, many physicians are now concerned about a growing skills gap.

A majority of physicians have concerns about the skill gap

46% now report that this gap is having a moderate impact, while a 17% margin now say it is taking a major toll on their team. According to physicians, the most critical gaps are management, leadership and up-to-date clinical practices. At the same time, investment in smart-health technology was also cited as a major opportunity to both improve efficiency and service provision. Without a dramatic turn-around in these areas, the NHS faces a perilous few years.

In a closing statement, Bain’s researchers said, “Regardless of the source of funding, the NHS must transform to become a better receptacle for renewed funding. To do so, it is critical that a sizeable portion of the additional funding be invested in innovations that will deliver long-term efficiencies and support greater productivity. In this sense, the NHS can speak to its investments in modernisation efforts that will enable it to do more with less while improving access to care and the quality of care delivery… By ensuring that physicians feel more valued, the NHS will add more value as it reorients its model for the 21st century. Making this change won’t be easy, but it will go far in positioning the health system for favourable outcomes over the next 70 years.”

Related: The professional services firms that are helping NHS embrace technology.