Declaring a health and care emergency

Do you think the NHS as we know it has a long term future? Will it remain possible, in decades to come, to continue using collective contributions to fund high quality care for all, regardless of ability to pay?

Many politicians and commentators in the UK would argue not (https://iea.org.uk/motion-should-the-nhs-be-privatisedhttps://www.cityam.com/fears-of-privatising-nhs-stop-from-saving-health-servicehttps://news.sky.com/story/sajid-javid-ex-health-secretary-issues-warning-over-nhs-as-he-admits-odds-stacked-against-tories-at-next-election-12768611https://www.telegraph.co.uk/news/2022/10/02/insurance-based-system-way-save-nhs).1234 After all, the challenges facing the health service grow every week, as The BMJ continues to show. The NHS faces an ongoing workforce crisis, and consultants in England have rejected the government’s pay offer, with a mandate to continue their industrial action until June (doi:10.1136/bmj.q222).5 The BMA’s Junior Doctors Committee for England is to reballot its members for another six months of industrial action (doi:10.1136/bmj.q200).6

Demand on the service also continues to rise, with the need for surgical abortions increasing, at the same time as many of the UK’s abortion surgeons are nearing retirement (doi:10.1136/bmj.p2982).7 The incidence of sexually transmitted infections such as gonorrhoea, chlamydia, and syphilis has risen among young people (doi:10.1136/bmj.q202), and the prevalence of overweight and obesity has increased among 10-11 year olds (doi:10.1371/journal.pone.0296013).89 A drop in uptake of the measles, mumps, and rubella vaccine has led to a sharp rise in cases of measles in England and the declaration of a national incident (doi:10.1136/bmj.q221).10

Stark inequalities across social groups continue to determine the degree to which people are affected by ill health. Black people and people living in areas of socioeconomic deprivation are more likely than other groups to be detained under the Mental Health Act (doi:10.1136/bmj.q209), and UK prisoners die 20 years earlier than the general population (doi:10.1136/bmj.q198).1112

Despite these challenges, the first paper (doi:10.1136/bmj-2023-078903) from a new BMJ commission and an editorial by the chairs of the commission (doi:10.1136/bmj.q187) argue that it is possible to provide high quality care for all, regardless of ability to pay, and to fund it through collective contributions.1314 The BMJ Commission on the Future of the NHS (bmj.com/nhs-commission), comprising healthcare leaders, clinicians, and patients’ representatives, has discussed these issues over the past nine months, listening to patients and clinicians and drawing on their experience to identify impactful, evidence informed, and implementable solutions.

In the first paper Nigel Crisp and fellow commissioners call on the incoming government to declare a national health and care emergency, to recommit to the NHS’s founding principles, and to establish an Office for NHS Policy and Budgetary Responsibility to provide independent and expert scrutiny of plans and policies (doi:10.1136/bmj-2023-078903).13 They also call for the next UK government to launch a national conversation to agree a long term vision and plan for the NHS. The government in post after the election should call on all parts of society to help improve health, care, and wellbeing, they say. “And, in effect, relaunch the NHS with the active participation of the whole of society.”

The workforce, demand, and inequality challenges facing the NHS are not unique to the UK and its collectively funded health service. Another new series beginning this week (bmj.com/collections/us-covid-series) considers the lessons for future US health from the covid pandemic (doi:10.1136/bmj-2023-076623).15 In an auspicious election year in the US, the series lays out the societal actions and systemic reforms now needed to improve US health preparedness. These actions should be central to the manifestos of the 2024 US presidential candidates, say the guest editors in their introduction to the series (doi:10.1136/bmj.q150), and are essential to prevent the loss of another million citizens in the next pandemic and to protect population health more broadly.16