Abstract

Background:

The United Kingdom’s National Health Service (NHS) faces escalating sustainability challenges driven by population ageing, rising multimorbidity, persistent health inequalities, workforce shortages, and fiscal constraints. Despite repeated reforms, policy responses have often prioritised short-term performance rather than long-term system resilience.

Methods:

This study employs a mixed-methods public health policy analysis integrating quantitative analysis of national routine datasets (NHS Digital, Office for National Statistics, UK Health Security Agency) with qualitative interviews involving policymakers, healthcare professionals, and patient representatives. Public and Patient Involvement (PPI) is embedded throughout the research process.

Results:

Quantitative analysis revealed a 22% increase in emergency admissions between 2010 and 2024, with the highest growth in older adults (≥65 years) and socioeconomically deprived areas. Elective care waiting times exceeded 7.5 million in 2024, and workforce vacancies reached 11% for nursing roles and 9% for general practice. Qualitative interviews identified five recurring themes: (1) the NHS is reactive rather than preventive; (2) health inequalities drive avoidable demand; (3) workforce constraints limit system resilience; (4) integrated care implementation is inconsistent across the UK; and (5) prevention is underfunded and under-prioritised. Stakeholders emphasised that effective reform requires embedding equity, prevention, and workforce sustainability at the core of NHS policy.

Conclusions:

This study provides evidence-based insights into structural drivers of NHS unsustainability and highlights actionable policy levers. Repositioning prevention and equity, strengthening workforce planning, and enhancing integrated care governance are essential to develop a resilient and sustainable health system. The findings inform a public health–led roadmap for NHS reform applicable across all four UK nations.

License

Copyright (c) 2026 Dr. Hassan Khan (Author)

This work is licensed under a Creative Commons Attribution 4.0 International License