The BMJ’s Commission on the Future of the NHS

The UK’s new king has something of a reputation in health. His medical pronouncements have often been met with bemusement, even outrage (doi:10.1136/bmj.329.7457.118 doi:10.1136/bmj.o310).12 Among edicts from high office, the king’s ramblings on health rank several degrees in credibility below an epistle from the Archbishop of Canterbury. Since King Charles has argued that he has been misunderstood, he now has an opportunity to restore his reputation (doi:10.1258/jrsm.2012.12k095).3

It doesn’t take much regal perception to understand that most professionals and the public doubt the sincerity of his majesty’s government towards the NHS. What may therefore be required is a royal commission, by definition independent of government, to examine the future of the NHS. It’s an opportunity that King Charles should seize, but in the expectation that he may not The BMJ is taking on the task.

The nation’s love for the NHS may be romanticised and irrational, as any true love tends to be, but it exists. A survey of BMJ readers on the 70th anniversary of the NHS identified the three biggest successes as providing care according to need and free at the point of delivery, general practice being the foundation of patient care, and staff working for a common good. Today, each of these “values” or “principles” is under threat (doi:10.1136/bmj.k2121 doi:10.1136/bmj.k1540).45

Some people are willing to see the destruction of the NHS as we know it, to be replaced by more privatisation or an insurance based system. But both these approaches can further widen inequalities. In a world pledged to universal health coverage, it seems a backward step to erode something achieved 75 years ago through a public service that largely, despite its challenges, delivers on its promise to the population.

The NHS isn’t perfect, and it never will be. You read its failings and missteps every day in The BMJ (doi:10.1136/bmj.p830 doi:10.1136/bmj-2022-073613 doi:10.1136/bmj.p930 doi:10.1136/bmj.p845 doi:10.1136/bmj.p974 doi:10.1136/bmj.p898).67891011 But that doesn’t mean it can’t be revived. Nor does it mean that other models are better. Take the US, for example. Anne Sosin and colleagues note that with the political declaration of the end of the pandemic, covid has “simply joined the ordinary emergency that is American health” (doi:10.1136/bmj.p949).12

The US offers at least two lessons for the UK. First, more money isn’t necessarily the answer. In the short term it might be, to fix the current crisis, but longer term investments in prevention and primary care will deliver better health and economic returns. Second, being in a perpetual state of health crisis should not become business as usual.

In its 75th year the NHS has never been in a deeper crisis, and although the problems may seem insoluble we believe that the central premise of the NHS—a health service free at the point of care for all the population—is worth fighting for. It is possible to create a vision for a society that prioritises outcomes related to health and wellbeing, with the NHS at the heart of it (doi:10.1136/bmj.p991).13 Our commission will lay out that vision and make recommendations as to how we get there.

The purpose of The BMJ’s NHS commission (bmj.com/nhs-commission) is to identify key areas for analysis and bring them together in a publicly available report by early 2024.14 The commission will be chaired by Victor Adebowale, Parveen Kumar, and Liam Smeeth. We have a formidable group of commissioners and will appoint more over the coming weeks in key areas. We will engage a broad range of stakeholders. The commission will certainly take a hard look at the NHS, but we have an important opportunity to help define the future of the NHS on behalf of the people who care about it and its founding principles.