Intended for healthcare professionals


What would a sustainable health and care system look like?

BMJ 2017; 358 doi: (Published 04 September 2017) Cite this as: BMJ 2017;358:j3895
  1. Nigel Crisp, independent member of the House of Lords
  1. London
  1. nigel.crisp{at}

Making health and care systems fit for the future requires a strategy involving all sectors of society and maximises the contribution the system makes to the economy, writes Nigel Crisp

Key messages

  • Sustainability of the health and care system depends on internal and external factors and public and political acceptability and support

  • The system’s contribution to the economy—through supporting a healthy workforce and providing a platform for the UK’s world leading health research and development—is generally overlooked and should be maximised

  • Cross-sectoral partnerships of private and public organisations have crucial roles in building healthy and health creating communities, towns, and cities

  • A new strategy and narrative are needed to embrace these wider issues

Current problems in the NHS and social care raise questions about the long term sustainability of the whole system. Sustainability is not just about finance and affordability, important as they are; nor is it purely about the efficiency and effectiveness of the system. It also depends on factors outside the control of the health and care sector.

Here I argue that sustainability depends on seven factors, all of which need to be tackled, and that new emphasis should be given in particular to cross-sectoral partnerships that help create healthy and resilient people and communities and to understanding and increasing the health and care sector’s contribution to the economy.

Changing context for sustainability

Sustainability is a moving target in a system that is changing rapidly. A transition is under way around the world from hospital and illness based systems to person and health based ones, where, aided by technology, more services are provided in communities and homes. This is a long and difficult transition dating back at least to the Alma Ata Declaration of 19781 and most recently represented in England in the Five Year Forward View and related policies.2

Much of …

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