Intended for healthcare professionals

Feature NHS in 2017

A service under pressure

BMJ 2017; 356 doi: (Published 03 January 2017) Cite this as: BMJ 2017;356:i6691

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Read all the articles in this series on the NHS in 2017
  1. Gareth Iacobucci, senior reporter, The BMJ
  1. giacobucci{at}

With the NHS’s ability to deliver on its founding principles under greater threat than ever, can the service survive? In the first of a new series, Gareth Iacobucci looks at the challenges

The NHS’s founding aims—to provide universal, equitable, comprehensive, high quality healthcare free at the point of use—have not changed since its establishment 69 years ago. And yet the society that conceived the service has changed immeasurably, along with the challenges it faces.

In a post-war Britain, the focus was on eradicating disease—one of the “five giants” that William Beveridge declared should be slain (along with want, squalor, ignorance, and idleness). Today, the focus has shifted to treating long term chronic illnesses and conditions caused by socioeconomic factors and lifestyle. Add multimorbidity in a rapidly ageing population, rising patient demand and expectations, the cost of new treatments, and precarious public finances to this mix, and it’s not difficult to see why the NHS is facing an existential crisis.

Period of turbulence

The current pressures in the NHS can be traced back to 2010, when the newly elected coalition government in England published a blueprint for arguably the biggest NHS restructure in its history.1

In his 2008 series for The BMJ examining the NHS on its 60th birthday, Tony Delamothe concluded, “The most thoughtful birthday present the NHS could receive would be …

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