The NHS founding principles are still appropriate today and provide a strong foundation for the future

The vision of a comprehensive health service is as relevant today as in the 1940s, but new and different societal challenges require a rethink on how to deliver the NHS as it faces a national health and care emergency

The NHS is currently experiencing the gravest crisis in its history. While much excellent treatment and care is being delivered, too many people are not receiving the care they or their relatives need. Staff, patients, and the public are experiencing a loss of hope, confidence, and trust which must be reversed.1 Austerity, the covid-19 pandemic, and major financial and staffing problems, have left the NHS in a weakened state.23

Radical change is needed in the way services are designed to make better use of the technologies available and to provide more services in homes and communities. These changes should be led by the professionals and communities directly involved. They can build on the UK’s world class biomedical science and professional education,4 the skills and passion of NHS staff, and new contributions to improve health and wellbeing from all sectors. They can be modelled on best practice in the UK and other countries. These changes must be supported by an engaging vision for the future and by adequate levels of funding and staffing.

This article addresses the question of whether, given the problems and scale of change needed, the NHS founding principles are still appropriate now and for the future. The article is the first in a series of papers from the BMJ Commission; others will deal with equity, finance, workforce, wider health determinants, redesigning the health and care systems, and sustainability and the physical environment.

We begin with the founding principles, review how science and the wider environment have changed since 1948, and describe the current problems …

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