Learning lessons from the austerity period and the COVID-19 crisis in England to help build a more resilient health system

The National Health Service (NHS) in England has been placed under considerable and sustained financial pressure since 2010, due to a decade long programme of austerity. This contributed to the health service entering the COVID-19 pandemic with a shortage of health workers, a relatively low number of hospital beds, bed occupancy rates that frequently exceeded safe levels and an insufficient stock of equipment such as ventilators, MRI machines and CT scanners. Despite this potentially precarious starting point, the NHS did not become overwhelmed during the crisis. However, policy actions were taken as a result that were enormously expensive and have contributed to foregone or delayed care that has exacerbated waiting lists and will likely be detrimental to patient outcomes in the long term. Moreover, extraordinary pressures have been placed on the health workforce that have taken a toll on mental health and may worsen recruitment and retention challenges. This chapter assesses the state of the NHS prior to the pandemic relative to comparable countries and considers how this starting point informed pandemic responses in the health sector. I suggest that cost-savings made under the guise of austerity were likely a false economy, with substantial emergency funding needed during COVID-19 to scale-up critical public health functions and ensure the NHS could adequately respond. It is important that lessons are learnt from the last decade, and from experiences during the pandemic itself, to enhance the resilience of the health system going forward. Even as public spending faces significant challenges in the face of many external economic shocks, increased funding for health and social care is crucial to increase capacity, strengthen the health workforce, modernize infrastructure and scale-up the use of technology to help accelerate progress towards recovery.