The National Health Service (NHS) in Britain was described by former Chancellor of the Exchequer Nigel Lawson as the closest thing Britain has to a national religion. This was an exaggeration, but the state of the NHS will probably be the biggest political issue at the next election in Britain, due in May.

Ed Miliband, leader of the Labour Party opposition, is alleged to have said that he wanted to weaponize the NHS. This was a clumsy and unfortunate phrase suggesting that he would use the state of the NHS as a major theme in criticizing the governments record over health issues.

Both the government and the opposition agree on the electoral importance of the NHS and on the need to ring-fence the NHS budget. The differences are mainly over management and recruitment issues and the source of extra funds for the NHS.

The pressures in recent weeks on accident and emergency (A&E) departments of British hospitals have been so great that some hospitals have had to declare emergencies and postpone routine operations. There are multiple causes for the current pressures on the NHS. One is Britains population is growing as the proportion of elderly people increases.

Thanks to modern medicine the elderly are living longer. But the new drugs and procedures to treat them are expensive and the costs have had to be capped. This has led to accusations of rationing of care.

Funds for care of the elderly within the community have been stretched. As a result, hospitals have been unable to discharge patients who have nowhere suitable to go and hospital beds have been blocked. Health and care services need to be better coordinated.

Another factor increasing the pressures on A&E has been the difficulty some patients have had in fixing appointments with their general practitioners. Most general practitioner (GP) surgeries dont operate in the evenings or on Saturdays and Sundays, and GPs no longer must provide care 24 hours a day, seven days a week.

Patients unable to get appointments with their GPs are encouraged to ring a general NHS helpline rather than go straight to A&E departments in local hospitals. But the helpline is alleged to have had too few qualified staff able to give expert advice. The NHS, faced with increasing demands, has had to recruit expensive agency staff. More permanent doctors and nurses are needed but recruiting and training them takes time.

The government declared on taking office that it would not undertake a major reorganization of the NHS, but almost immediately proceeded to make organizational changes. This affected moral in the service.

To improve the levels of service, the government imposed a series of targets, which hospitals and other parts of the NHS were obliged to meet. This led to what critics have termed targetitis and to some parts of the organization making the meeting of targets the top priority rather than the provision of proper care. Scandals at a small number of hospitals have been exposed. The NHS has been accused of having too many managers and bureaucrats.

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Health care pressures grow