Sandeepa Arora | NHS

Sandeepa Arora is a research analyst at the Nuffield Trust. That means she looks at what is happening in health care in the UK and helps people decide what to do about it.  She has read your posts and comments and responded to some of them.

Dear Burnet News Club members,

It has been an absolute pleasure to provide comments and answers to your thoughtful and relevant questions.

I am a research analyst at the Nuffield Trust. The Nuffield trust is an independent, health think tank and aims to improve the health and care of the people in the UK. We do this with research that would allow us to improve our health and social care systems.

One of the great things about my job is that I get to work closely with NHS staff and policy-makers to develop solutions to the challenges that are currently being faced by the NHS. Currently, I am working closely with a consultant paediatrician (children’s doctor) to research improving care provided to children with long-term conditions such as asthma, epilepsy and diabetes. My day-to-day work involves dealing with lots of data. I find it hugely satisfying to unpick data and gather information to build a case for informed decision-making.

I believe that the NHS as a whole is a huge source of national pride. I think the British general public would agree that it’s one of the best of its kind in the world. It’s not beyond criticism, but it has been seen as absolutely essential to national life.

I have tried to answer your questions and I hope you would find them useful. I also hope you are even more encouraged to participate in this area of public debate. After all, none of us want to be ill but at some point in our life we will need health care. And at that point, we hope we get access to good quality and compassionate care.

In my personal opinion a perfect medical system is something that everyone wishes for, when you’re ill the worst thing you want is to be unable to see a doctor that isn’t skilled enough but unfortunately if you wanted that perfect health care you might have to pay a lot of money and maybe your whole wage. This is especially hard for people who may be homeless because if they fall critically ill they cannot pay for treatment.

From: Bessiebear | Grace Academy Coventry

I completely agree. Everyone does deserve to receive good quality health care. You’ll be pleased to know that most of the UK does! Like a lot of things, there is no such thing as the perfect or the best health system and you could argue that it doesn’t exist in any one country. But there are examples of good health care systems around the world, including our own.

The NHS comes quite close to meeting almost all of the requirements set out in your question. The NHS exists because of a belief that health care should be free at the point of use for everyone, not just those who can afford it. The UK is not a totally equal or a perfect society in some respects, and inequalities do exist, but health is one area where there is a strong national agreement on it being free for all. One of the great things about the NHS is that it has stuck to its founding principle since it was established in 1948. It's not a perfect system and it has a lot of challenges ahead, but it works well for the majority of UK citizens. So, for example, if a homeless person in Britain needs to be operated on then the care provided to them is no different to that of someone with a different background or profession. I think that is one of the best things about the NHS.

I don’t think we will need to spend more taxes to help the NHS, as we are already putting enough money forward to the Government every year that they should have enough money to go to the NHS.

From: WallBuilder11 | Barnes Wallis Academy

I think quite a few people would share your view. To give some background, in the UK approximately a sixth of our taxes goes to fund the NHS, but compared to other similar countries we do not spend the most – we sit somewhere in the middle.

It’s important to keep in mind when you’re thinking about funding for the NHS the challenges it faces over the next 30 years. Like many countries, Britain has an ageing population with people living longer than they did before. When the NHS was first established in 1948 the health needs of the population were very different than they are today. People were using the NHS to treat diseases like tuberculosis or scarlet fever. They might have even died young from things that we can now easily treat. Advancement in medicine means that we are now able to treat those sort of conditions and older people now live with much longer-term conditions (like diabetes or cancer) that can be managed or treated by doctors and nurses. This is great news for us, our parents’ and even our grandparents’ generation but demand on the NHS has increased over time as a result. Improvements in access to care and technology combined with an increased range of complicated health needs mean the NHS needs money. How this is funded is a difficult question and governments are always trying to find the best solution.

Since 2010 the NHS budget has not gone up as much each year as it had done in previous years. This is because the NHS faces pressure from rising costs – in particular from pressures to pay for more staff to treat the increasing number of patients and high-cost drugs. To meet these pressures without reducing the quality of care we receive, some would argue, means more funding.

I think we need to get patients seen quicker. The NHS needs more doctors and to get these it needs more money from the Government.

From: Boomerang1 Minecraftlover39 Minecraft01 | Wold Academy

I think you are absolutely right. More is needed to be done so that patients can be seen more quickly. Lengthy waits for operations or diagnosis can be stressful and upsetting to patients and their families. In hospitals there is a target that says people should be sent home from A&E or sent for further treatment within 4 hours of arriving and sadly, due to high demand, a lot of hospitals have been struggling to meet this target for a while. These types of delays are being seen all around the NHS, including the ability to see your GP quickly and waiting a long time to have a planned operation. It is concerning because lack of fast access to the right type of care may mean avoidable health problems go undetected, while delays in treatment may mean minor problems can become much bigger problems in the long run.

Money is definitely tight in the NHS at the moment and the Government would say that they have already given a lot of money to the NHS. In order to fill the missing numbers of doctors and nurses, we need to pay for them. Even if we had money to pay for them there are only so many trained doctors in Britain and so we can’t simply pay for more if they’re not currently there. In the future we will need more staff but in the meantime we need to question whether we can do more with the staff we already have.


Everything that is being changed is all inside of the NHS. What are we going to do about the rising population of elder citizens in Britain and small social care to support them? 
From: Goldrhino | Faringdon Community College

Yes you’re absolutely right; there is an ever-increasing population of older people in the UK. Around the world we have seen people living longer than before, which is a great thing. However, we also have people living longer with long-term health conditions. People can now live with lots of quite complicated conditions like diabetes, arthritis and dementia and continue to be treated for them all by doctors and nurses. But as you can imagine this is quite expensive and requires a lot of NHS staff time.  

One thing the NHS is trying to do at the moment is move care you would expect to receive in hospital, into the community instead. Patients and staff agree, and I’m sure you would too, that receiving treatment in your own home is much nicer than receiving it in hospital.

Social care is an important issue at the moment and it is definitely under a lot of pressure. In the latest Budget (when the Chancellor sets out what the Government will be spending money on over the next few years) the Chancellor Phillip Hammond said they would give £2 billion more (over the next three years) to social care in the UK. Later this year the Government will be reviewing how we pay for care at the end of our lives, which will be interesting and worth you keeping an eye on in the news.

I disagree with the statement “Everyone should get free health care when they need it”. The reasons are:

  • If a foreigner goes to live in the UK just to get free health care.
  • People hurting themselves or the sake of health care being free and this causes people who actually live in the UK and don’t hurt themselves “for the sake of it”. Who actually need health care but can’t use health care because there are no medical resources and hospitals are shutting down because they are losing money for resources.

I agree with the statement “people who don’t make an effort to be healthy, don’t deserve free health care”… because as I explained above people who don’t look after themselves don’t deserve free health care because it’s wasting money and resources.

From: The Great Papyrus | Charles Read Academy

British nationals are automatically entitled to NHS care, free at the point of use as are European visitors. For other people, such as non-European visitors or residents, only emergency treatment is free. Recently the Government has introduced a £200 charge for people who arrive in the UK and have to use the health service while they are here. People have to first register with a local GP (general practitioner), who acts as a gatekeeper for hospital treatments. Therefore people cannot just usually demand a treatment; they first need to be referred by their GP.

I would say, however, that the majority of foreign people living in the UK from abroad are often younger and therefore healthier. They pay taxes and require little from the NHS, or at least cover the cost of the health care they do use.

Your point about people not looking after themselves properly or harming themselves presents a very difficult ethical question for the health service. My question would be where do you draw the line in a health service which was originally set up to be free for all? Undoubtedly people who smoke, drink alcohol or take drugs to excess, or who are very overweight put pressure on the NHS. But some people might say these are people who need the most help. You might want to consider what happens if people take part in risky sports like skiing or snowboarding. Even though they’re a sport and have lots of health benefits, there’s a high chance of being injured and needing treatment – should they be penalised for that? I think you present an interesting problem in the health service which will always be up for debate.  


We have three questions:
1. Could charities or fundraising subsidise the NHS?
2. Should age be a consideration when deciding who has free health care?
3. Should doctors be paid less and have the money spent on equipment?

From: Gilwern Primary School

  1. That’s a great question because in fact, they already do! The air ambulance is a charity and plays a really vital role in getting people to and from hospital. There are loads of examples of charities and local support groups based in communities across the UK that offer a range of activities for patients such as exercise and lunch clubs and so on. At the Nuffield Trust we recently did a study looking at how voluntary groups help people after they have had a stroke. Those sorts of groups can improve the mental health and wellbeing of patients and could then make them less likely to use further health care treatments or even suffer from social isolation. The obvious concern though is that charities need money to keep going to provide these services, which is never a given.
  2. NHS was set up to be entirely free at the point of use for everyone. If you were to consider age as part of free health care, you also need to consider need. The type of people who use the health system most are usually those who are able to contribute the least, like pensioners and young children and babies. I would also think that many younger healthy people would be happy to contribute their taxes to the NHS, in order to ensure it is there for them when they become ill or get older.
  1. The financial pressure on the NHS is well known. To address this in recent years it has been decided that NHS staff pay should be kept to a minimum so we can spend money in other areas. When you take into account that it’s getting more and more expensive to rent a house, pay bills and buy food and travel, NHS staff have not been getting a pay rise to reflect this. If we continue to put pressure on staff pay then unfortunately we might see them changing jobs or moving abroad to work – this would be a big problem for the NHS.

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