My understanding after reading this article is that the problem has nothing to do with ambulances or medics. https://www.nytimes.com/2022/12/20/world/europe/uk-ambulance...

First order problem, the hospitals have no beds. This means that ambulances end up waiting for hours and medics twiddling their thumbs at the ER until the staff can finally take the patient. Medics can't just abandon the patient because there legally needs to be a proper handoff. So your emergency can't be responded to quickly because we can't trivially spin up thousands of new medic units to spend all their time waiting in line at the hospital.

Second order problem, the hospitals have no beds because of a lack of long term care services. From the article...

> There is an acute lack of beds in the accident and emergency department, or A&E, as emergency rooms are called in Britain, which are overcrowded because of an inability to find room for patients elsewhere in hospitals. That is because patients ready to be discharged from the hospital often have nowhere to go as a result of dwindling social services — which have been hobbled by a lack of government funding and severe staffing shortages.

Now the question is why aren't there enough non hospital care services? Could be many reasons, but I'd speculate that it's a combination of a) an increasing population of old, sick people who need care in a society whose demographics are beginning to turn upside down, and b) because Brexit means it's drastically harder to import poor, foreign workers willing to do the shitty job of elder care for low wages. If this prognosis is correct, it starts to beg the question of whether Britain's world renowned health care system was only possible because it could extract excess, cheap labor from poor countries to take care of their old people, when Britain's own young people were never going to do that work for the wages offered.

b) is not exclusive to Britain. A very large portion of the US benefits from poorer countries to the south with high birth rates and porous borders. Probably applies to almost all large developed countries.

In the EU it's the east European countries. Without Bulgarian and Romanian workers the Austrian elderly care system might already have collapsed. There were even highly pucliciced exceptions during strict lockdowns

Nurses in the US earn at least 3x their UK counterparts though.

Same for doctors, dentists, etc. too.

Yea, but we are starting to see upcoming issues with nurses in the US where some places just don't have enough. Granted, this is more because hospitals are trying to keep their number of nurses as low as possible. The hospital my wife works at, they suppress the number of nurses when they in fact need more and just hire travel nurses on demand. Then they complain that travel nurses cost too much. I don't think pay is the only factor here. Nurses get paid great by hospitals, but also still get treated like shit. My wife doesn't even get bathroom breaks during her 12 shift and most of the time no lunch break because there is never a nurse available to cover for a 30 minute lunch or a 5 minute bathroom break.

> when Britain's own young people were never going to do that work for the wages offered

Too true. I’m from Canada where we worry nurses will go south of the border, but was recently in London at an NHS hospital and was talking about this with a nurse. Pay for nurses in Canada is on par with a Jr Developer here. (Still low for the hours and effort required!) By comparison, nurses in the UK make about as much as an intern or admin assistant. After all, single payer means there isn’t much pressure to raise wages from other sectors, you’ve a monopoly on nursing so you can set the wages at whatever level keeps staffing adequate, which isn’t the same thing as paying a living wage…

They also do not keep the wages at a level that keeps staffing near adequate.

My understanding is, to a large extent "beds" really means "physical bed and sufficient staff to support the patient in it" and the ingredient most missing is the latter.

Doctors tend to be ridiculously overworked in the UK. This is much worse recently - first doctors were off sick / isolating due to Covid. That means less doctors to do the same jobs having to work harder. That drives more doctors to either leave or take long term sick leave - goto 1.

The care home vaccine mandates were far more impactful than Brexit. There were mass resignations when the government forced care home workers (and only them) to take the COVID shots.

Concerted efforts by the Tories over decades to defund public health so that they can raise a generation of people who sincerely believe that it's best for the country for the government to get out of Healthcare and leave that to the more efficient private sector.

It's a very slow process that requires first the defunding, then some brainwashing via television. The American model.

The UK NHS budget has been steadily increasing. You can't plausibly claim that the Tories have defunded public health over decades. Some might claim that the funding should have increased at a faster rate, but there are limits to what any society can spend on healthcare.

https://www.kingsfund.org.uk/projects/nhs-in-a-nutshell/nhs-...

It's easier for people to believe in a personified evil with a face that can be hated and a body that can be killed than it is for them to accept that many of our biggest problems are intractable hyperobjects which are simultaneously nobody's fault and everybody's fault.

I do not think anyone would have a problem with intractable hyperobjects if the King, Prime Minister, and others also had to wait in the same queue at the emergency room.

What people have a problem with is that the problem seems to be tractable for some, and not for others, and whether or not those “some” are worthy of it.

If the wealthy and connected were forced to access the same services as the rest of us, the services would be better.

Just cause the dollar amount is increasing doesn't mean it isn't being defunded. You have to account for inflation, population size, and population age distribution.

NHS spending has increased by over 6.5% yearly since 2010, with even more massive increases planned for 2024-25.

Want a comparison? France's healthcare spending increased 0.3% yearly in the same timeframe. The UK is outpacing France's spending increases by 2,066%.

The spending argument is made from political propaganda, not from fact.

Tell that to the nurses who have to work ungodly hours to keep the system going.

France is still in the EU and has lots of former colonies to extract healthcare workers from. Their cultural diplomacy is one of the best compared to any former European colonialistic power.

> increased by over 6.5% yearly since 2010

Could you provide a source for that? Such an increase would imply a doubling of the budget over that time period. I can't find anything that suggests the NHS budget has doubled since 2010.

From what I can gather, the NHS spending adjusted for inflation increased modestly over the time period.

Taking into account the fact that costs in the healthcare sector have increased more than CPI globally, that increase could well correspond to a decrease in purchasing power.

That doesn't yet take into account the UK specific issues around Brexit.

You can increase more than others and still be funded less than them. The EU on average still spends dramatically more per capita on health.

The spending argument is nuanced and complex. Declaring that it's "not from fact" just reveals your partisan leanings.

https://www.health.org.uk/news-and-comment/charts-and-infogr...

No it doesn't. When private healthcare is included the UK spends about the same.

What are you saying exactly? How much should spending have increased to account for inflation, population size, and population age distribution? Please give a specific number. Would that be a good use of limited resources?

Not exactly what you ask for, but "the NHS budget has traditionally risen by an average of 4% above inflation each year." (https://www.bbc.co.uk/news/health-64190440)

Obviously NHS funding can't continue growing faster than inflation forever. That is unsustainable. At some point the NHS would consume the entire government budget.

And also, the population distribution can't continue skewing older indefinitely, that's unsustainable. At some point geriatrics would make up the entire population.

And yet, both of these trends can continue for quite some time, and one trend can outweigh the other for quite some time.

That's the rate which causes people to argue it's being "defunded".

"...and population age distribution."

Ay, there's the rub.

You’d be changing the definition of “defunded” then. It means “less money”.

then the term should be "underfunded".

Very interesting. So what's causing the blowout in A&E wait times?

More money doesn't just mean better service.

For example, I spoke to a doctor that has to travel between multiple hospitals during the course of their work.

There used to be an in-house service that the NHS owned for transporting medical staff between locations.

That has been privatised as in a contract has gone out for tender and a company won to do the service.

The service used to be reliable. Now they often have to book Ubers out of pocket to get where they need on time.

The inhouse service is gone. So of course and renewals are going to cost more.

When people talk about the deterioration of the service, a common counterargument is that the money being spent is going up as a way to shut down conversation.

At the same time getting rid of the nurses bursary that helped new nurses get trained.

Salaries not increasing with inflation.

Staff finding it harder to stay in the UK after Brexit.

Closure of many hospitals, a gradual move (including the previous gov) to many more privatised services.

All these things have increased costs without improving the service.