Take Two Aspirin and Call me (or the NHS) in 1948

Oliver Taylor | Europe and Eurasia Fellow

Image sourced from Roger Blackwell via openverse

William Beveridge was wrong about one thing. When the economist produced his 1942 report, the blueprint for what became the National Health Service, he assumed that making people healthy would eventually reduce the demand for healthcare; a more robust population would need fewer doctors. The NHS was therefore predicated on a logic that would, over time, work against its own necessity.

It has not worked out that way. In September 2024, then-Health Secretary Wes Streeting commissioned a report investigating the NHS in England which concluded that the system is in “serious trouble.” By June that year, 7.6 million people were waiting for treatment, up from 2.4 million in 2010; those waiting more than a year had risen from 20,000 to over 300,000. At Labour’s party conference, Streeting called the NHS “broken but not beaten” and issued his prescription: “reform or die”. It is the Sisyphean quality of United Kingdom (UK) health politics; the boulder rolls up, the boulder rolls down, and the architecture of the hill is never examined.

The funding formula is endlessly renegotiated; the structural mismatch between design and demand is not.

A System Designed for a Country That No Longer Exists

Approximately 70 per cent of NHS activity now involves managing long-term chronic conditions like diabetes, cardiovascular disease, dementia and respiratory illness. Yet every structural feature of the system—its hospitals, its referral chains, its workforce ratios, its funding model—was calibrated for acute and episodic care. It was designed for a younger, more acutely unwell population, living shorter lives. The Health Foundation projects that the number of people in England living with major illness will rise from nearly one in six in 2019 to one in five by 2040.

The workforce reflects the same structural atavism. GPs per 100,000 residents fell by 1.9 per cent annually between 2016 and 2024. Accident and Emergency (A&E) performance saw 94 per cent of patients within four hours in 2010; by May 2024, that figure had fallen to just 60 per cent. The system has accumulated the cost of a gap that was never acknowledged, because acknowledging it would have required something the political culture could not provide: an honest admission that the system’s original purpose had expired, and the will to overhaul rather than simply refinance it.

Europe’s Quiet Reckoning

Watching from continental Europe, self-satisfaction would be a mistake. In 2024, Germany’s then-Health Minister Karl Lauterbach called his country’s hospital consolidation program a “Zeitenwende” (“turning point”) when it passed and entered into force; nonetheless, Germany’s statutory health insurance funds have continued to record multi-billion-euro annual deficits. France has quietly rationed GP access through appointment reform, redirecting demand without transparency. The Scandinavian systems, so frequently cited as the UK’s corrective, are producing their own signals of workforce exhaustion and waiting list crises.

But the pressure is sharpest in post-Soviet EU accession states, where the defining feature is systematic medical emigration. It’s estimated that in the decade following Romania’s accession to the EU, over 40,000 doctors emigrated according to the Ministry of Health, with brain drain resulting from “allure of better opportunities abroad”. Countries such as Moldova, Georgia, and the Western Balkans are aligning their health systems to EU membership standards while the professionals trained to meet those standards depart for London, Berlin, and Vienna. EU accession, intended to elevate these systems, has instead accelerated the outflow of the people needed to run them.

Australia’s Closing Window

The NHS, in resolving its own staffing crisis through overseas recruitment, exports a version of that problem to the countries least equipped to absorb it—then Australia does the same to the NHS. Between July 2022 and April 2024, 8,910 overseas doctors joined the Australian health workforce; the United Kingdom was the single largest country of origin, in numbers that dwarf the reverse flow. Over 30 per cent of doctors practising on our shores are now foreign-trained. The chain runs from Chisinau to London to Queensland and New South Wales, and at no point in it is anyone solving a structural problem. The standard of care is always visible, always just out of reach, and always receding as the hand extends.

Medicare was built on comparable post-war assumptions. Australia’s 2023 Intergenerational Report is direct about what is coming: health spending is projected to grow from 4.2 per cent of GDP today to 6.2 per cent by 2062, with spending on over-85s expected to increase ninefold. The conversation is already there. In 2023, bulk-billing rates fell to their lowest in a decade before a multi-billion-dollar government injection temporarily stabilised access—the instinct, as in the UK, was to refinance rather than redesign.

Australia has one advantage the UK lacks: time. The reasons are partly demographic—sustained immigration has moderated Australia’s ageing trajectory—and partly historical. Medicare is four decades younger than the NHS; its structural assumptions are equally outdated, but the compounding has had less time to accumulate. The window for an honest institutional conversation, before demographic pressure makes redesign involuntary and incoherent, remains open. The UK’s experience suggests it closes faster than anyone expects, and the debate reverts to the same loop: fund more, privatise, repeat.

The jury’s still out whether the countries watching from outside, Australia among them, can absorb what they see before they are sitting in the same chair. That window, unlike so many of the ones Beveridge left open, will not stay ajar indefinitely.

Ollie Taylor is the 2026 Europe and Eurasia Fellow for Young Australians in International Affairs (YAIA). He studies Commerce and Biomedical Science at the University of Queensland and has lived across Europe, Asia, and Australia. As a 2025 Westpac Asian Exchange Scholar, he studied cancer biology at the National University of Singapore, undertook Mandarin language training while working in Singapore, and led healthcare-promotion volunteer teams in rural Thailand through Challenges Abroad. He has also backpacked widely across Asia to deepen his regional literacy and cross-cultural understanding.

Ollie previously studied International Relations at the London School of Economics, informing his interest in global governance, health resilience, and cross-regional cooperation.

As YAIA’s Europe and Eurasia Fellow, he is committed to strengthening Australia’s engagement with the region and advancing more resilient health systems in less-economically developed rural communities, where development and security challenges intersect most sharply.

Disclaimer: The views and opinions expressed in this article are those of the author, and do not necessarily reflect the views and opinions of Young Australians in International Affairs. AI tools were used by this author for grammar checks and, in some instances, phrasing but all content is original, and no plagiarism has been used in the preparation of this article.