Intended for healthcare professionals

Feature Review of the Decade

The 2010s: a decade of disappointment in UK healthcare

BMJ 2019; 367 doi: (Published 12 December 2019) Cite this as: BMJ 2019;367:l6895
  1. Nigel Hawkes
  1. freelance journalist, London
  1. nigel.hawkes1{at}

Despite health system reforms, improvements in life expectancy and neonatal mortality have stalled. Nigel Hawkes reflects on the past 10 years

A decade that began with a Conservative health secretary promising to transform the NHS in England through market discipline, legally enforced, ended with an election manifesto from his party embracing the polar opposite. Competition is dead; long live cooperation.

This meant that, even before the general election votes were counted, a 30 year experiment in the English NHS was over. “Choice and competition,” a mantra pursued as energetically by the Labour governments of Tony Blair as by the Conservatives, was dead.

How the NHS is organised generally makes less difference than its planners hope, though competition and choice seemed to have some successes, including shorter waiting times. But this was before the 2008 financial crisis cast its long shadow over the succeeding decade.

Faltering progress

Since then, progress has faltered, not only in the UK but across Europe. Decades of improvement in life expectancy have plateaued, even gone into reverse.1 Neonatal health has paused in …

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