ANALYSIS
THE BMJ COMMISSION ON THE FUTURE OF THE NHS The NHS founding principles are still appropriate today and provide a strong foundation for the future The vision of a comprehensive health service is as relevant today as in the 1940s, but new and different societal challenges require a rethink on how to deliver the NHS as it faces a national health and care emergency Nigel Crisp, 1 JSBamrah, 2 Jessica Morley, 3 Charlotte Augst, 4 Kiran Patel 5, 6
1 House of Lords, London, UK 2 Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK 3 Yale Digital Ethics Center, Yale University, CT, USA 4 Diabetes UK, London, UK 5 University Hospitals Coventry and Warwickshire, Coventry, UK 6 Medical School, University of Warwick Correspondence to N Crisp crisp@parliament.uk Cite this as: BMJ 2024;384:e078903 http://dx.doi.org/10.1136/bmj-2023-078903
political will against opposition from the BMA and other powerful interests. The next government should be similarly bold and declare a national health and care emergency, calling on all parts of society to help improve health, care, and wellbeing. It should, in effect, relaunch the NHS with the active participation of all sectors. Government needs to be honest about the scale of the problems, the financial, staffing, and other constraints, and the length of time and effort that will be required. It should establish an Office for NHS Policy and Budgetary Responsibility to provide an independent and expert assessment of NHS plans and policies, which would help protect the NHS from short term political pressures and policies that are poorly thought out. Equally, the NHS should prioritise tackling inequalities in access and outcomes and give particular attention to the disadvantage and racism experienced by different ethnic groups both as patients and staff of the NHS. These developments should be supported by embedding NHS policy within a cross-government and cross-sectoral health and wellbeing strategy, and by developing better ways to involve patients, the public, and community groups alongside other stakeholders in policy, planning, and improvement. The founding principles The 1946 NHS Act (fig 1) made the minister of health responsible for establishing “ a comprehensive health service designed to secure improvement in the physical and mental health of the people of England and Wales and the prevention, diagnosis and treatment of illness [ … ] and to provide or secure the effective provision of services. [ … ] The services so provided shall be free of charge, except where any provision of the Act expressly provides for the making and recovery of charges. ” 5 Parallel legislation was enacted for Northern Ireland and Scotland.
The NHS is currently experiencing the gravest crisis in its history. While much excellent treatment and care is being delivered, too many people are not receiving the care they or their relatives need. Staff, patients, and the public are experiencing a loss of hope, confidence, and trust which must be reversed. 1 Austerity, the covid-19 pandemic, and major financial and staffing problems, have left the NHS in a weakened state. 23 Radical change is needed in the way services are designed to make better use of the technologies available and to provide more services in homes and communities. These changes should be led by the professionals and communities directly involved. They can build on the UK ’ s world class biomedical science and professional education, 4 the skills and passion of NHS staff, and new contributions to improve health and wellbeing from all sectors. They can be modelled on best practice in the UK and other countries. These changes must be supported by an engaging vision for the future and by adequate levels of funding and staffing. This article addresses the question of whether, given the problems and scale of change needed, the NHS founding principles are still appropriate now and for the future. The article is the first in a series of papers from the BMJ Commission; others will deal with equity, finance, workforce, wider health determinants, redesigning the health and care systems, and sustainability and the physical environment. We begin with the founding principles, review how science and the wider environment have changed since 1948, and describe the current problems before returning to the principles. We identify three areas for development to help the NHS deliver — policies on wider health and wellbeing, the roles of patients and citizens, and use of technology and data — before presenting a final section on implementation and a recommendation. A national health and care emergency TheNHS ’ s problems require urgent and speedy action. The NHS was founded through a major act of
This article is part of The BMJ Commission on the Future of the NHS. The purpose of our NHS Commission is to identify key areas for analysis, lay out a vision for a future NHS, and make recommendations as to how we get there 1
the bmj |BMJ 2024;384:e078903 | doi: 10.1136/bmj-2023-078903
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