Crisis Fatigue: What the NHS Can’t Fix with Funding Alone

Everyone talks about the challenges facing the NHS right now — and they’re not wrong. The system is on its knees. Years of austerity, chronic underfunding, and ever-expanding demand have left it fragile. What we’re working in now isn’t the NHS as it was envisioned in 1948. It’s something far more brittle — stretched beyond what any public service should endure.

Let’s be blunt: the NHS was never built for this. It was designed for a post-war Britain by the most enthusiastic Welsman when there was shorter life expectancies, fewer chronic conditions, and a population pyramid with more young people at its base than a crowd swell at Glastonbury main stage on a Sunday night. Today, that pyramid has flipped. We’re treating an ageing, increasingly multimorbid population with a shrinking workforce, dwindling resources, and growing public expectations.

This is why, whenever someone at a dinner table or a social gathering engages me in the topic, I drink heavily and reply "not my place to question the cold water rising, just going to play some lovely violin for the Women and Children getting into the lifeboats instead"...

After too many - it just becomes a garbled "F**k you, Billy Zane..."

I get very ranty, very quickly about this because I've tried and failed so many times to write it because, in all honesty, it's very complicated (read, I don't fully understand it either).

For start though (said the Mum who said "I know you're going to call me racist, but") the whole thing has become very sound-bitey bulls**t Political for those on the frontline. That much-publicised “£60 million” injection? It might sound generous to your average person lamenting a 40p Freddo bar, until you realise that it’s roughly what a large hospital trust needs — for about a week. According to the King’s Fund, capital spending in the NHS remains 20% below the OECD average, and UK health spending per capita trails many Western European countries by over £500 per person.

In primary care, the picture is equally bleak. The number of fully qualified GPs per 100,000 people has fallen every year since 2015, despite rising patient demand. The Nuffield Trust reports that GPs now manage 50% more appointments per month than they did a decade ago — often with fewer staff, longer hours, and mounting abuse from a frustrated public.

General practice accounts for about 90% of patient contacts with the public for around 10% of the funding. Imagine taking part in an Orgy and taking 90% of the custom for 10% of the lubricaton. It's enough to leave anyone in that situation feeling very worn out and sore.

Speaking of a terrible segue pun; Burnout is no longer a warning sign — it’s endemic. In the GMC's National Training Survey 2023, 40% of doctors were identified as being at high risk of burnout. Among GPs specifically, 71% described their workload as unmanageable or barely manageable. We’ve normalised exhaustion. It's pretty commonplace now to question "how much diarrhoea is too much diarrhoea" when deciding whether to risk taking the day off.

Preventative medicine — once the golden goose of public health — has been sacrificed at the altar of short-term crisis management. And even where prevention works, it raises new dilemmas. When early detection leads to decades of medicalisation, polypharmacy, and side effects, we have to ask: are we helping people live better, or just live longer — sicker?

Overdiagnosis plays a growing role here. The BMJ estimates that up to 30% of screen-detected cancers may represent overdiagnosis, with patients undergoing invasive treatments for conditions that would never have harmed them. Beyond cancer, the scope of diagnosis itself is widening. “Diagnosis creep” — expanding criteria for common conditions — has drawn more people under medical labels. At the same time, we face rising numbers of overlapping “functional” diagnoses: chronic fatigue, fibromyalgia, IBS, chronic pain. These conditions are real. They are disabling. But they don’t always fit neatly into the biomedical model we’re trained in, and the people are suffering now - not whenever science and understanding catches up to them.

Many patients come in seeking clarity — a label, a cause, a plan. But when the label offers no cure, it often leads to more confusion. More tests. More medications. More referrals. It’s exhausting — for patients, and for the clinicians trying to walk a line between “this isn’t dangerous” and “you’re not imagining this.” That margin for error is paper-thin.

We’ve built a system that struggles not just to care, but to explain. A system where ticking boxes is rewarded more than listening. And when patients present with real, complex, hard-to-solve problems? We hand them leaflets. Or worse, we send them home with nothing.

Meanwhile, online spaces — TikTok, YouTube, wellness influencers — are reshaping the doctor-patient relationship. Misinformation spreads faster than we can counter it (yes, I did just reference myself quietly - I am that wanker). Health-related misinformation outperformed evidence-based content across major platforms, measured by likes, shares, and comments. And trust in healthcare professionals has suffered. GPs, once ranked among the most respected professions, are now vilified in comment sections and tabloid headlines.

There are glimmers of hope. The “realistic medicine” movement — which began in elderly care — is gaining traction. It urges clinicians to question whether every intervention is actually helpful. It encourages dialogue over defaulting to drugs or diagnostics. But it’s not enough.

Because fundamentally, we’re trying to deliver 21st-century care through a 20th-century framework — on a 19th-century budget.

The NHS isn’t broken. It’s exhausted. And unless we stop pretending that slogans and shiny announcements will fix it, we’re going to lose what little we have left.

So what now?

We need honesty — from politicians, clinicians, and the public. We need to redefine what healthcare is for, and what the NHS can realistically deliver. And we need to value the people still holding this ship together — before they, like so many already have, decide it’s no longer worth it and risk the waters of the North Atlantic to die frozen when he could have legitimately fit on the door. (I'm just saying, he really could have. F**king Billy Zane.)

Because the truth is, it’s already breaking. The only question now is whether we rebuild it — or let it collapse under the weight of our denial.

Stay positive, somehow

DW