Take a moment away from the NHS ten-year plan and ask not what the NHS can do for you, but what the state is really struggling to do. A struggle that is burdening and breaking the NHS with tasks and expectations it was not designed for.
The NHS needs repair, reform, and refocus on purpose. The National Hospital Service cannot continue. But the NHS has also become the input and output of everything around it, asked to address health inequalities, a symptom driven by well-researched social determinants that have their own institute and decades of evidence.
Economic fragility. Heating or eating, a few pounds away from homelessness. Education quality limiting opportunity. Environments that are transport deserts lined with chicken shops and poor-quality housing. Communities that do not exist, or are fragmented by identity rather than enabled by connection. Cultures that are not understood.
The same burden is laid on the NHS. The NHS is paying the price of an increasingly inequitable society.
The signals
A GP described her Monday to me recently. Not a single patient came with a primary health need. Every issue was social. Anxiety and depression from social distress. Trying to make ends meet with two jobs. A single parent not coping. A 72-year-old about to be made homeless by a private landlord. A train driver wanting a sick note because the family is in chaos with two neurodivergent children.
A Guardian investigation into Barrow found 11 women accounted for 9% of local A&E demand. The driver for every attendance was social, not clinical. A taxi driver in the deeper reaches of the North West described people no longer coming out of their homes. Disappearing. Becoming isolated. Growing anxiety. Growing disease. Only the GP and A&E left to reach for help.
Sir James Mackay has warned that if we lose the population on the NHS, we will lose the NHS. Public satisfaction has dropped to 21%, a record low. A potential break in the social contract between the state and the population.
The NHS is a signal. The many stories are signals. But they are signals that the NHS is going to fail because social policy has failed.
What the NHS can and cannot do
At STRASYS, the Decision Intelligence engine for healthcare, our Population Need Segmentation maps not just clinical need but consumer behaviours, motivations, and access patterns. It reveals the social context behind the patient record: the housing, the economics, the education, the isolation.
This is critical because it separates what the NHS can address from what it cannot. The NHS can redesign services to better meet the needs of the population it serves. It can stop warehousing the frail and dying in expensive acute buildings. It can reallocate resources from hospital to community using the evidence from population need analysis. We proved this through our work with Alder Hey Children's NHS Foundation Trust, where needs-based redesign shifted the organising principle from maintaining services to improving life chances.
What the NHS cannot do is fix the conditions that make people sick in the first place. That requires social policy: investment in education from STEM to the arts, environments that encourage walking and cycling with clean air and safe housing, affordable public transport, communities enabled by connection rather than divided by identity, and economic opportunity that means a single parent does not need two jobs to survive.
The missing plan
Being at war with ourselves for fourteen years was enough time for our own version of the Beveridge Report, the Marmot Review, to be totally ignored.
The 1945 Labour manifesto could have been written for our times. It described the forces that had captured capital and built power. It promised food, work, and homes. Eight decades later, the repair team is working hard to rebuild the past, transaction by transaction, without the story or the courage.
Naeem Younis, STRASYS CEO, argues that if we do nothing to reform social policy, we will demand more and more from the NHS until we end up killing it, deemed unaffordable, crushed by political and social policy failure. The nation needs a ten-year plan that connects the dots: education, environment, economics, community, and culture. A plan that saves the NHS by fixing what the NHS cannot fix itself.
We need a ten-year plan that saves the NHS. Just not the one filling copy right now.
Decision Intelligence for Healthcare Leaders
How we help NHS organisations make better decisions with better data.
Key Definitions
- Population Need Segmentation
- Behavioural segmentation analysis mapping consumer needs, motivations, and access patterns. Reveals the social context behind clinical presentations, separating what the NHS can address from what requires social policy action.
- Decision Intelligence
- The discipline of converting complex healthcare data into structured, actionable decisions for NHS leaders. STRASYS coined and owns this category in UK healthcare, combining analytics, behavioural science, and systems thinking.
- Social Determinants of Health
- The non-medical factors that determine health outcomes: education, economics, environment, community, and culture. STRASYS's position is that the NHS cannot address these determinants alone. Social policy reform is the prerequisite for sustainable NHS reform.
Frequently Asked Questions
The demand crushing the NHS is substantially driven by social policy failure: poverty, poor housing, failing education, and fractured communities. The ten-year plan focuses on NHS delivery reform. Until the conditions making people sick are addressed through social policy, NHS reform will continue to manage symptoms rather than causes. The NHS is the signal of societal failure, not the cause of it.
GPs report that the majority of presentations are driven by social distress rather than primary clinical need. A&E attendances in deprived areas are overwhelmingly social in origin. The social determinants, economic fragility, poor education, degraded environments, absent community, and cultural barriers, generate the disease burden and the demand that the NHS then absorbs at enormous cost.
The NHS can redesign services to better meet population needs through data-led resource allocation. STRASYS's Population Need Segmentation reveals the social context behind clinical demand. The Alder Hey case study demonstrates that starting from population need produces fundamentally different service design. But the NHS cannot fix the social conditions that produce inequalities. That requires political and policy action on education, housing, economics, environment, and community.
A plan that connects the dots across education, environment, economics, community, and culture. Investment in foundational education. Enabling environments with clean air, safe housing, and affordable transport. Economic opportunity that restores dignity. Communities enabled by connection. The Marmot Review provided this framework. It was ignored for fourteen years.
Population Need Segmentation separates what the NHS can address from what it cannot, enabling focused resource allocation. The SMASH methodology redesigns services from consumer need outward. The Alder Hey case study proves that needs-based redesign works within existing resources. STRASYS's position is that the NHS can make a meaningful contribution to better outcomes within its sphere of control, but it cannot be the instrument for building an equitable society.
This article is adapted from the Friday Fish and Chip Paper, Dr Nadeem Moghal's weekly newsletter on LinkedIn.
Dr Nadeem Moghal
Chief Medical and Innovation Officer