Intended for healthcare professionals

Opinion Critical Thinking

Matt Morgan: Rekindling the NHS’s foundational flame

BMJ 2024; 385 doi: (Published 14 May 2024) Cite this as: BMJ 2024;385:q1069
  1. Matt Morgan, consultant in intensive care medicine
  1. Cardiff
  1. mmorgan{at}
    Follow Matt on X @dr_mattmorgan

One of the joys of writing this column is receiving emails from readers who work across a wide spectrum of medicine, from students to retired professors. I read one such email from a retired, fellow Cardiff alumnus in response to my last column discussing the new play Nye.

After I’d watched the play at the National Theatre1—which dramatises the NHS’s origins through the eyes of Aneurin Bevan, former minister of health and architect of the NHS—a quote from Mark Twain came to my mind: “History doesn’t repeat itself, but it often rhymes.” Bevan’s proposals for a universal healthcare system came at a time of crumbling infrastructure, long waits for medical treatment, wide health inequalities, and a postcode lottery for services. Sound familiar? But my email from E H Reynolds, who qualified from Cardiff in 1959, pointed out something different and less familiar.

Reynolds described to me the partnership model that Bevan had used between the government and the health professionals. In Bevan’s first speech as minister of health he said, “Doctors as a profession must have a greater say in the management of their own services.” This original NHS model thrived on a collaborative ethos, where professionals wielded considerable influence over policy and service delivery, ensuring that care standards were upheld through a symbiotic relationship between healthcare providers and their governing bodies.

In his email Reynolds convinced me that these partnership models have morphed into “gig economies” where employees have little influence on policy and service delivery.2 This change is now undermining the foundational principles that once made the NHS a beacon of collaborative healthcare.

We need a restoration of that partnership model, with a modern twist to incorporate patient and public groups. Their inclusion in the decision making process is not just a nod to democratic ideals but a strategic move to ensure that the NHS reflects the needs and aspirations of the communities it serves. The homogenisation of policies at a national level fails to account for the nuanced health needs of diverse communities. Instead, a return to local-centric models of care, inside a partnership model, would offer a blueprint for a more agile, responsive, and sustainable NHS.

Our pathway out of the current NHS crisis would benefit from a deep dive into its past, understanding the shifts that have led us to this precipice, and forging a future that rekindles the spirit of partnership. It’s a journey that demands collective will, historical insight, and an unwavering commitment to the principles of collaborative care. It’s also a reminder that we need to listen to those who have gone before us. We should open our minds to emails from strangers who, despite being retired—or perhaps thanks to its insights—can still care for future patients through the rhymes of history.


Many thanks to Dr Reynolds for his wonderful email.


  • Competing interests: I have read and understood BMJ policy and declare that I have no competing interests.

  • Provenance and peer review: Commissioned; not externally peer reviewed.

  • I am an adjunct clinical professor at Curtin University, Australia, an honorary senior research fellow at Cardiff University, UK, consultant in intensive care medicine in Cardiff, and an editor of BMJ OnExamination.