Intended for healthcare professionals


NHS in 2017:Keeping pace with society

BMJ 2017; 356 doi: (Published 05 January 2017) Cite this as: BMJ 2017;356:i6738
Read all the articles in this series on the NHS in 2017
  1. Gareth Iacobucci, senior reporter, The BMJ
  1. giacobucci{at}

Nearly 70 years since its establishment, the NHS is struggling to care for a vastly changed population. In the second article of his series, Gareth Iacobucci examines how societal trends have affected the health service

The NHS’s ability to provide universal, equitable, comprehensive, high quality healthcare that is free at the point of use is being tested by challenges facing society as a whole. One of the biggest of these is demographic change.

The UK has an ageing population—the median age rose from 33.9 years in 1974 to 40 years in 2014, a rise of 6.1 years. By 2024, there are predicted to be more people aged over 65 than aged 0-15.1 The number of people living with multiple chronic conditions is also growing rapidly. In England, this is forecast to have increased from 1.9 million in 2008 to 2.9 million by 2018.2

These trends have increased costs and pressure on the NHS. The Department of Health estimates that long term conditions now account for 70% of total health and social care spending in England.3 The picture is similar across the UK; the Scottish government estimates that long term conditions account for 80% of all general practice consultations and over 60% of hospital bed days, for example.4

The government estimates that the average cost of providing hospital and community health services for someone older than 84 is around three times greater than for a person aged 65 to 74.5 In 2014, 1.5% of the UK’s population was aged 85 or older. This is projected to rise to 3.6% by 2039.6

In acknowledgment of the changing needs of the population, NHS England’s Five Year Forward View has set out an ambition to integrate family doctors, hospitals, and social care.7

“The future will see far …

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