Intended for healthcare professionals


NHS in 2017: Where next?

BMJ 2017; 356 doi: (Published 24 January 2017) Cite this as: BMJ 2017;356:j331
  1. Gareth Iacobucci, senior reporter, The BMJ
  1. giacobucci{at}

In the last of his series, Gareth Iacobucci looks at what needs to be done to ensure that the NHS can keep up with changing demands

In this series I have assessed the extent to which the challenges facing the NHS threaten its founding principles, to provide universal, equitable, comprehensive, high quality healthcare free at the point of use.1234 Although many of the problems are complex and multifactorial, there are common themes and even some consensus on what action is needed if the NHS is to survive beyond its 70th birthday in 2018.

Public health

Whether any healthcare system can cope with the demands placed on it depends crucially on the state of the public’s health. The epidemics of chronic disease caused by poor diet, physical inactivity, alcohol and drug misuse, smoking, and air pollution have put huge pressure on NHS resources. Government’s failure to take key policy decisions that would protect and improve the public’s health is making such pressure unsustainable.

After the failure of its responsibility deal, which relied on voluntary action by the food and drinks industry, the UK government has committed to tougher action. Its pledge to impose a tax on sugary drinks recognises the urgent need to tackle the UK’s growing obesity crisis and an increasingly strong evidence base in support of such action. So it is disappointing that the government’s long awaited childhood obesity strategy failed to impose mandatory restrictions on sugar in food.

Good evidence also supports the public health benefit of introducing a minimum unit price for alcohol, and Public Health England has recently endorsed the policy. This should prompt England to follow Scotland’s lead, and ministers have now pledged to examine the evidence. England has also toughened its guidelines on safe alcohol levels.5

However, even if there is …

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