3 Graphs that show the NHS is under threat

May 20, 2021  

The NHS as we know it is increasingly unsustainable. These graphs show why – and how we need to change the way the NHS works if we want to protect its future.

Over the last year, the extent to which we, as a country, rely on our NHS has been revealed. 

In a time of unprecedented crisis, we have rallied around our most beloved national institution, and it has in turn been there for us when we need it.  

As we emerge from the Covid-19 pandemic, we now need to turn our attentions to thinking about how we can strengthen the NHS, and ensure that it can still be there for us, free at the point of use and available to all, going forward.  

Unfortunately, however, as the following three graphs will illustrate, the NHS faces an array of challenges. Meeting and defeating them is a necessity for policymaking in the 2020s.  

Demand for emergency care is rising

As the graph above shows, even if you adjust for changes in the population, demand for frontline NHS services (in this case A&E) has been rising steadily throughout the 21st century.

The drivers for this are complex. However, demographic factors play a big role, and as our population continues to age, we should expect to see this dynamic become ever more acute over time.

There is declining optimism about the state of the NHS 

This graph shows that the challenges facing the NHS are starting to be picked up by the people who use the health service – the general public.

Over the last ten years or so, people have gone from feeling that the NHS was basically improving, to thinking that standards are deteriorating.

Health services are taking up an ever-growing share of the public sector budget 

The rise in demand illustrated by the first graph has knock on effects on the entire public sector budget. As demand for NHS services grows, the share of total public sector spending that goes to the health service increases. 

It is not sustainable for this trend to continue indefinitely.

At some stage, the squeeze on available spend for other parts of the public sector – like education, economic development, and transport – will lead to a decline in quality, beyond what has already arisen from austerity.

Alternatively, political pressure will grow for some combination of service rationing or outright charges for NHS care.

At present, the service is operating on the brink of viability, with winter crises long a feature before the pandemic hit.

To avoid this future, we need to prevent demand from continuing to creep up, and we need to create a health service that plays an active role in supporting good health in the community.


Quite clearly, the NHS faces serious challenges – and challenges that are likely to become more acute in the coming years.

We need policy solutions to these, and fast.

At New Local, we believe in working towards a more sustainable system, in which health services are more preventative, more outward facing and more embedded in the communities they serve.

In the words of the GP Mark Spencer, we believe in a system that creates good health and stops “sending people back to the conditions that made them ill in the first place”. We call this community power.

If you are interested in these ideas, or have views on how they might be made a reality, we want to hear from you. We are running a call for evidence on this topic – and you can find out more here.

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