• Government is taking the threat of antimicrobial resistance (AMR) seriously but resistant infections are rising
  • Only one of the government’s five targets to help contain the threat posed by AMR was met or is on track
  • It is proving hard to shift the behaviours of millions of citizens and thousands of institutions

AMR is a serious threat globally and to the UK1 and, if not addressed, the consequences for health, life expectancy, the functioning of the NHS and the wider economy will be huge.

But a new report2 from the National Audit Office, Investigation into how government is addressing antimicrobial resistance, finds that the government’s response to the issue over the last five years, the AMR National Action Plan 2019-2024, has made limited progress.

Antimicrobials are therapeutic substances, such as antibiotics, designed to treat infections and prevent their spread. Their use, overuse and misuse mean public health could be compromised in future as more pathogens (the organisms which cause disease) evolve and develop resistance to antibiotics and other antimicrobials. Already, AMR contributes to an estimated 35,200 deaths annually in the UK.

Government is taking the problem seriously, with AMR identified as one of 26 chronic national risks. But, despite a 20-year vision, a cross-government approach and some innovative solutions, including subscription arrangements for procuring antibiotics, the report finds that the UK remains a long way from the vision and objectives the government expressed in 2019: a lower burden of infection; the optimal use of antimicrobials; and new treatments so that everyday illnesses can continue to be cured.

Of five domestic targets set in 2019, only one – reducing the use of antibiotics in food producing animals – was met. Drug-resistant infections in humans have increased by 13% since 2018, despite a target to reduce them by 10%3.

The COVID-19 pandemic and demographic changes have complicated efforts to combat AMR. Patients are arriving in hospital with more pre-existing conditions and staying for longer, leading to an increase in the potential for opportunistic infections4. The condition of the NHS estate has also seriously deteriorated in recent years, which can make it harder to keep buildings clean and isolate infectious patients.

A number of areas now need particular focus, the report says:

It is not clear that health workers and the public yet have sufficient awareness of the threat AMR poses. In 2018, only 49% of the UK public knew that antibiotics do not work against viruses and there is limited evidence so far of the impact of public awareness campaigns.

NHS England has made progress with trialling a subscription model to procure antibiotics, which could incentivise the development of new drugs. The results of this important new approach, set to cost an estimated £1.9 billion for supplying these antimicrobials to the NHS over 16 years, need to be carefully tracked and evaluated.

More work is needed to understand the impact of the UK’s aquatic environment on AMR, especially through the increasing incidence of untreated wastewater spills5.

The report found that the new AMR National Action Plan, covering 2024-20296, had more achievable targets than its predecessor, but in some cases it was unclear whether meeting them would reduce the burden of AMR in the UK. 

"Antimicrobial resistance presents a major public health threat and addressing it is a multifaceted challenge. Government is responding but, so far, the results have been limited and the country needs to become more resilient to this long-term risk. 

“Government needs to consider whether its existing commitments and other efforts across the public sector will be enough to achieve its 20-year vision to contain and control AMR."

Gareth Davies, head of the NAO

Read the full report

Investigation into how government is addressing antimicrobial resistance

Notes for editors

  1. AMR is and will always be a global phenomenon. The UK has sought to play a leading role in the international fight against AMR, with DHSC spending £417 million on research and international aid related to AMR between 2020-21 and 2023-24 (out of total direct spending by government on AMR of £567 million).
  2. We conduct investigations to establish the underlying facts in circumstances where concerns have been raised with us, or in response to intelligence that we have gathered through our wider work. We are investigating the government response to AMR because it is a serious public health threat, and because the UK’s experiences during the COVID-19 pandemic showed the country was not as resilient to such threats as it expected to be.
  3. Government’s second target was to deliver a 10% reduction in specific drug resistant infections in the UK between 2018 and 2025
  4. All parts of the NHS remain under operational and financial pressure, as also evidenced in our 2024 report, NHS financial management and sustainability 2024.
  5. The build-up of AMR-driving chemicals in wastewater and the wider aquatic environment can affect the prevalence and diversity of AMR in the environment. In the UK, this impact is likely being exacerbated by the increasing incidence of here has been a substantial increase in both the monitoring and reported volume of untreated wastewater entering waterways via storm overflows.
  6. Stated areas of focus include the need to improve public and professional awareness of AMR, and to apply a UK-wide One Health approach.

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