The health service across the United Kingdom is facing unprecedented scrutiny and criticism, with voices from both Northern Ireland and Sussex highlighting deep-rooted issues and a desperate need for reform. In Northern Ireland, the situation has become so dire that Dr Tom Black, a senior GP with more than 35 years of experience in Derry, delivered a stark warning on August 16, 2025: the region's health system "has already failed and no-one has a plan of how to fix it." According to The Irish News, Dr Black's assessment was nothing short of devastating, as he compared the quality of care to something "we wouldn’t accept for our pets."
Dr Black’s words cut to the core of public frustration. He placed the blame squarely on politicians, stating that it was time for "hard decisions" and challenging those unwilling to make them to "resign and get out of the way." His critique went beyond rhetoric, offering concrete examples of how the system’s failings have real-world consequences. Waiting lists and ambulance response times, he warned, can now be longer than the life expectancy of some patients. For many, this is not just an administrative failure but a human tragedy unfolding in real time.
The problems, Dr Black argued, are rooted in chronic underfunding and the resulting staff retention crisis. He highlighted the exodus of healthcare professionals from Northern Ireland to the Republic of Ireland, where better investment has created more attractive working conditions. In a pointed comparison, he likened Northern Ireland’s NHS to "East Germany" and the Republic’s health service to "West Germany," underscoring a widening gulf in standards and opportunities.
"And it’s going to get worse," Dr Black warned, offering a grim forecast for the future. "By every measure, the NHS in Northern Ireland isn’t failing; it has already failed and no-one has a plan of how to fix it." His comments have resonated widely, serving as a rallying cry for change and a wake-up call for those in positions of authority.
The political response has been swift but divided. Sinn Féin MLA and party health spokesperson Philip McGuigan acknowledged the "enormous challenges" facing healthcare in the north, attributing them to "15 years of British government underfunding and cuts." According to The Irish News, McGuigan emphasized the need for a new approach, arguing that the British government "just do not provide the resources we need." He called for greater cooperation between the Irish government and the Northern Ireland Executive to reduce duplication of services and improve health outcomes for people on both sides of the border.
"On an island of under seven million people—less than the population of most of the world’s great cities—it makes no sense having two separate health services," McGuigan said. "It is obviously better to work together to deliver better health outcomes for the people of this island. That work can start now." With these remarks, Sinn Féin is pushing for an all-island approach to healthcare planning, a move that could reshape the future of medical services in Ireland.
Meanwhile, the Northern Ireland Department of Health has pointed to the scale of the financial crisis it faces. A spokesperson revealed a projected £600 million gap between available funding and the cost of maintaining existing services in 2025. The department recently published a healthcare "reset plan" aimed at easing these pressures, but acknowledged that GPs and their teams are "struggling to meet the demand from patients."
"The financial challenges facing the Department of Health are well known," the spokesperson said. "In that context, the £9.5 million in additional funding included in the 2025/26 General Medical Services (GMS) contract represented the best possible offer the Department could make for 2025/26." Total investment in GP services this year will exceed £414 million, including pay uplifts from last year and recently announced investments in multidisciplinary teams (MDTs) designed to expand capacity in GP practices. An additional £2.9 million has been allocated to GP elective care, aimed at directly supporting GPs and meeting patient needs.
Health Minister Mike Nesbitt has stated his intention to implement the pay recommendations from the recent Review Body on Doctors’ and Dentists’ Remuneration report for 2025/26 "in full," which would see a further £11.5 million invested in General Medical Services. The department has also invited the Northern Ireland General Practitioners Committee to engage in formal negotiations to develop a new GMS contract for 2026/27, signaling a willingness to collaborate on long-term solutions.
While Northern Ireland grapples with these systemic issues, a different but related conversation is unfolding in Sussex, England. There, NHS Sussex has launched a public survey running from August 6 to September 7, 2025, inviting residents to share their experiences and ideas for improvement. According to NHS Sussex, more than 300 people participated in the first week alone, reflecting a keen public interest in shaping the future of local healthcare.
The survey, which aims to inform NHS Sussex’s commissioning plans for 2026-27, focuses on addressing health inequalities and improving outcomes. Feedback so far has highlighted familiar concerns: access to GP practices, long waiting times, and communication issues with health and care services. The initiative is part of the region’s broader strategy, "Improving Lives Together," and aligns with the UK Government’s 10 Year Health Plan.
Health leaders in Sussex are urging more people to participate, emphasizing that every voice matters in the effort to build a more responsive and equitable NHS. All feedback collected through the survey will help shape the final commissioning intentions for next year, ensuring that services are tailored to the needs of local communities and that persistent problems are addressed head-on.
What emerges from both Northern Ireland and Sussex is a picture of a health system at a crossroads. In the north, the crisis has reached a tipping point, with senior clinicians calling for radical change and political leaders debating the best path forward. In Sussex, there is a concerted effort to involve the public in decision-making, recognizing that sustainable improvement depends on listening to those who use the services every day.
Yet, the challenges are strikingly similar: underfunding, staffing shortages, long waits, and communication breakdowns. Whether through sweeping structural reforms, increased investment, or grassroots engagement, the future of the NHS will depend on the willingness of leaders and citizens alike to confront these problems honestly and work together on solutions.
As the debate continues and plans for 2026 and beyond take shape, one thing is clear: the health of millions hangs in the balance, and the choices made now will echo for years to come.
