NHS’s greatest achievement after 70 years: The BMJ shortlist

1. Providing care based on need and free at the point of delivery

Chris Ham, chief executive of the King’s Fund: “Providing care free at the point of delivery is the single biggest achievement of the NHS. It has removed the fear of how to pay for care that existed before the establishment of the NHS and ensures that no one is denied care because they lack the means to pay for it.”

Niall Dickson, chief executive of the NHS Confederation: “The NHS was the first health system to offer free care for all, and its founding principles were revolutionary. The most fundamental founding principle—that care would be provided on the basis of need not ability to pay—remains the backbone of the service today.”

2. General practice as the foundation for patient care

Richard Vautrey, chair of the BMA’s GP committee: “The past 70 years have seen the health landscape change considerably. One thing that hasn’t changed over that time, however, is the role that general practice plays as the cornerstone of the NHS. It is the direct link between a practice and its patients, embedded within the community, that provides the basis for continuity of care—and by doing so cares for and supports people in their local area and enables them to access other services, including specialist secondary care, when it’s necessary. Building on this comprehensive foundation has delivered a sustainable, cost effective, and clinically effective NHS.”

3. Staff working for a common good

Helen Buckingham, senior fellow at the Nuffield Trust: “The NHS employs over 1.3 million staff in hundreds of different roles, all of whom joined the service to make a difference to people, from cradle to grave. Collectively, they touch the lives of every single person in the UK.”

4. Encouraging and supporting research and innovation

Jonathan Sheffield, chief executive of the NIHR Clinical Research Network: “The NHS has supported some of the most innovative and cutting edge research discoveries in the past 70 years to make them part of the standardised care patients receive today. For example, after β blockers were discovered in the UK in the late 1950s, more than 37 million prescriptions a year are now written for these drugs to treat a wide range of cardiovascular disorders. The NHS works alongside charities, funders, patients, and the life sciences industry to introduce new and better treatments though research, and as a result it continues to provide patients with world leading healthcare.”

5. Comprehensive childhood vaccination programme

Helen Stokes-Lampard, chair of the Royal College of General Practitioners: “We cannot underestimate the sometimes lifelong impact that dreadful infectious diseases such as measles, mumps, meningitis, and polio can have on our patients’ health and wellbeing. There are undoubtedly many thousands of people who are alive and healthy today because of the comprehensive childhood vaccination programme we have in the UK.”

6. Free contraception for all women

Janice Rymer, vice president for education at the Royal College of Obstetricians and Gynaecologists: “Contraception is a vital part of sexual and reproductive rights for women. Free access to all methods of contraception empowers women to take control of their fertility, prevents transmission of sexually transmitted diseases, and improves sexual health at every age and stage of life.”

7. Raising the status of anaesthesia as a specialty

Liam Brennan, president of the Royal College of Anaesthetists: “Anaesthesia is the largest single hospital specialty in the NHS. Over the past 70 years, anaesthetists’ roles have grown to be responsible for patients’ wellbeing before, during, and after surgery, not just in the operating theatre. It was in 1948, the same year the NHS was founded, that equal pay and status were afforded to all consultants working in the specialty. This was a milestone moment because it provided the impetus to raise standards of education and training for anaesthetists. Anaesthesia is now widely recognised as a specialty at the forefront of patient safety and quality improvement.”

8. Promoting patient centred care

Rachel Power, chief executive of the Patients Association: “As more and more people live with multiple long term conditions, and present with increasingly complex care needs, it is really important to them that they experience care that joins up around them and meets their needs. Patients with multiple complex health needs only want to have to tell their story once; they want one person to coordinate their care who can listen to and understand what matters to them.”

9. Access to in vitro fertilisation

Janice Rymer, vice president for education at the Royal College of Obstetricians and Gynaecologists: “Infertility affects one in seven couples and can have a devastating effect on people’s lives—it can lead to distress, depression, and the breakdown of relationships. The Nobel Prize in Physiology or Medicine in 2010 was awarded to the UK’s Robert Edwards for the development of pioneering IVF treatment, which has helped millions of people across the world to become parents. In the UK alone, more than a quarter of a million babies have been born as a result of IVF treatment.”

10. Championing evidence based medicine

Susan Bewley, chair of trustees of the charity HealthWatch: “Evidence based medicine means integrating individual clinical expertise with the best available external clinical evidence from systematic research. The science does not exist independently of clinical acumen and patient values—the concepts are intertwined in the philosophy of evidence based practice. The NHS has been a spectacular success: problems with high expectation, fear mongering, and overdiagnosis shouldn’t overshadow the achievement of more health and longer lives. They will be overcome with the transparency, learning, innovation, and testing that evidence based medicine implies and which the NHS at its best seeks to embody.”

11. Leading the world in cost effective healthcare

Muir Gray, visiting professor at Nuffield Department of Primary Care Health Sciences, Oxford: “The NHS created evidence based healthcare through the Cochrane Collaboration, and then the Centre for Evidence based Medicine, both funded by the NHS research and development programme. It added cost effectiveness as a key criterion with the development of the National Institute for Health and Care Excellence (NICE) and created value based healthcare.”

Anita Charlesworth, director of research and economics at the Health Foundation: “NICE has a vital role in providing robust evidence so that the NHS and care system can make informed decisions on the best care to buy in for patients.”

12. Limiting commercial influence on patient care

Margaret McCartney, Glasgow GP and The BMJ columnist: “Apportioning healthcare shouldn’t be an exercise in commerce—you only have to glance at the adverts for private whole body screening scans and executive ‘check-ups’ to know that the size of your wallet doesn’t dictate the evidence base of invitations. The NHS at its best should make it possible to give care on the basis of need and evidence—not demand and popularity.”