The NHS Isn’t Failing. It’s Been Failed.
The next time you see someone at your GP surgery or hospital, they may not be a doctor. You will probably not be told. In 2022, Emily Chesterton wasn’t. She saw a physician associate (PA), a role that does not require a medical degree, twice about leg pain. She believed she was seeing a doctor. The blood clot was missed. She was 30 when she died.
Chesterton’s case is not an isolated tragedy. It is a consequence of policy choices. Two reviews explain the cause. In 2024, Lord Darzi’s investigation asked why, despite investment, the NHS fails to deliver. His answer: the capital budget has been raided to plug spending gaps, leaving a £37 billion shortfall in buildings, equipment and technology. The 2025 Leng review asked: did patients know who was treating them? It found that many patients did not. Patients often believed they were seeing a doctor “even if the PA clearly says ‘I am not a doctor.’” The review recommended renaming the role “physician assistant” – its title before 2013. Together, Darzi and Leng reveal two consequences of the same political failure: an NHS left without the infrastructure and workforce needed to care for patients.
This year, over 33,000 doctors competed for fewer than 13,000 specialty training posts. Half of those finishing foundation training (the first two years as a doctor) had no job to go to. Not because they are incompetent. Not because they don’t want to work. Not because they have been struck off. But because successive governments have refused to fund enough posts to absorb them. Patients are older and sicker, arriving with conditions left years to worsen. The UK has 3.3 practising doctors per 1000 people, among the lowest ratios in the developed world, against 4 to 5 in comparable countries. We do not lack doctors willing to work; we lack a government willing to fund and employ them. Some days a department runs on three doctors, the bare minimum safe level, and a day off is refused. On others it runs on two. Over two thirds of staff say there are not enough of them to do their job properly. The headcount, even on paper, is not always safe. The reality is worse.
This debate has become trapped between two predictable explanations. Many on the Right call this a culture problem: malingerers, poor productivity, an institution too soft to say no. The evidence tells a different story. More than half of NHS staff went to work last year despite not feeling well enough to do their job, and over 40 per cent end shifts worn out. Not because they are weak, but because they work in a system that has nothing left to give and keeps asking anyway. The Right’s answer is to scrutinise individuals, but individual scrutiny cannot fix what individual behaviour did not cause. These are institutional failures. Politicians, press and the media created them. They should take responsibility for their choices.
The Left’s explanation also falls short. Many argue that the problem is funding: more money, more buildings, more everything. While closer to the truth, it does not explain how resources were mismanaged, or where the underinvestment lies. Part of the explanation comes from how staffing budgets were used. Physician assistants and advanced practitioners (APs) were deployed not as additions to the workforce, but as cheaper substitutes for doctors, without patients being told the difference. It is replacing doctors without transparency that has caused harm – not the professions. Used properly, these roles ease pressure on the system.
But reducing pressure is not the same as improving care. Nobody asks what happens to patients discharged after waiting too long for an appointment or seen by someone unable to diagnose. Emily Chesterton is what happens when you stop asking. The same neglect runs through equipment as it does through staff: a scanner without a doctor is an expensive photograph. A doctor without a functioning hospital is an expensive apology. Both have been withheld. Both are required.
What unites the Right and Left is not solely that they are wrong. It is that they are convenient. One produces a villain with a face and avoids structural reckoning. The other makes a demand without accounting for how money was spent, or how a substitution policy degraded the workforce it claimed to strengthen. Both suggest abandoning the current model, as if the problem were the principle of a publicly funded health service, rather than the political choices made within it. None of this requires either side to change their position. That is not analysis. It is positioning.
The government’s answer is the 10-Year Health Plan, published in 2025, committing £29 billion to shift care from hospitals into communities, digitise services, and prevent illness before it begins. But it has yet to answer the most basic question: who will deliver it? The promised 10-Year Workforce Plan, setting out required staff numbers, is still missing. Six major health bodies, including the British Medical Association, have warned that current plans underestimate staffing needs. A ten-year vision means little without the workforce to deliver it.
The NHS is not failing. It is being failed, by politicians who made choices across decades, and by a press and media that covered the symptoms rather than naming the cause. Correcting this is not impossible. It simply requires a higher standard than we have settled for. And it is time we demanded it.