First report of the BMJ Commission on the Future of the NHS calls for an urgent reset for the NHS with a clear long term vision and plan

The health service is as relevant today as in the 1940s, but radical change is needed, say experts

The government in post after the election should declare a national health and care emergency, calling on all parts of society to help improve health, care, and wellbeing, say experts in the first report of The BMJ Commission on the Future of the NHS.

The new government should, in effect, relaunch the NHS with a renewed long term vision and plan, they argue.

“The NHS has never seemed so embattled—and its core principle of ‘free to all at the point of use’ has never been so under threat,” said Kamran Abbasi, The BMJ’s editor in chief when he announced the Commission last year. Is it even possible to continue to provide high quality care for all, regardless of ability to pay, funded through general taxation? “We believe it is,” says the Commission.

The BMJ Commission brings together leading experts from medicine and healthcare to identify the key challenges and priorities and make recommendations aimed at ensuring that the vision of the NHS is realised

The first paper in the series examines the relevance of the founding principles of the NHS, now and for the future, and recommends critical changes in the scope, organisation, and governance of the service.

The authors, led by Lord Nigel Crisp, believe that the NHS founding principles are still appropriate today and provide a strong foundation for the future, and they urge the new government to re-commit to these principles as part of a wider set of actions.

The NHS also needs long term thinking and stable, consistent policies, they write, and as such, they recommend establishing an independent Office for NHS Policy and Budgetary Responsibility to hold government to account for delivery of NHS plans and policies.

Additional recommendations include creating a cross-government and cross-sector health, care, and wellbeing strategy, developing better ways to connect patients, the public, and community groups with the NHS, particularly at local level, and giving immediate priority to tackling inequalities in access and outcomes, with particular attention to the disadvantage and racism suffered by ethnic groups both as patients and NHS staff.

Future papers in the series will examine and produce recommendations on how we deliver health and equity, how we should fund and pay for the health service, and how we develop a motivated, happy, well trained workforce while prioritising sustainability and producing a greener NHS.

“The national health and care crisis we are facing requires an urgent, robust, and values based response,” say Kamran Abbasi and Commission co-chairs Victor Adebowale, Parveen Kumar, and Liam Smeeth in an editorial.“It requires new thinking and old values.”

“Above all, it requires us to recommit to the founding principles of the NHS, to put the health and wellbeing of our population first, and to revive the spirit of Aneurin Bevan and a nation that came together in the hope of creating a better, fairer, healthier world,” they conclude.



Notes for editors
Editorial: The BMJ’s NHS commission: an emphatic recommitment to the founding principles doi: 10.1136/bmj.q187
Analysis: The NHS founding principles are still appropriate today and provide a strong foundation for the future doi: 10.1136/bmj-2023-078903