Debates over reform, quality and funding make it hard to imagine a day when change won’t be constant in the NHS

The NHS has had its fair share of headlines over the past 12 months. High profile debates over reform, restructuring, quality and funding make it hard to imagine a day when change won’t be constant in the NHS. For healthcare professionals in the thick of it, it can be hard to look beyond next year, let alone ten years’ time. But look ahead we must.

In 2023 the NHS will be 75 years old. Predicting the future is always difficult, but it is important that we prepare for it. If we make the assumption that our NHS will still exist as a tax-funded system that provides healthcare free at the point of delivery, what will have changed by 2023? Will the NHS still provide a comprehensive service? What role will technology play? What will the provider landscape look like? What role will commissioning have? Will private providers bring innovation? Will transparency shake things up?

There are some things we can say with reasonable confidence about 2023. More of us will be living longer, we shall probably be fatter and we will have had 10 years of slow economic growth with knock-on pressures on all public services, including health. This means that if we don’t take radical action now, we are facing a health service where demand greatly outstrips supply. It’s feasible that co-payments will feature large, with a high probability of an alternative health system for those that can afford it.

So, if members of the public were asked about the future NHS, what might they say? We ran a Citizen’s Jury in 2012 and those involved told us clearly how important the NHS was to them. They wanted the reassurance that it was a truly “national” health service providing consistent quality of care no matter who you are or where you live. Personal empowerment was also important – “the more information people have, the less healthcare they use” – as was investment in preventive healthcare. Seamless integration of services covering an individual’s “end-to-end” care was also a critical component to “their” NHS.

Over the next few months we shall be working with others to debate what the NHS could and should look like in 10 years’ time. By imagining the NHS at 75, we – providers, regulators, commissioners and patients – can start to take action to prepare for and shape our future health service.

What do you imagine the NHS will look like at 75? Send your comments via email to or tweet #NHS75

To read more about the NHS at75 programme go to

Dr Tim Wilson is a partner and Janet Dawson is healthcare lead partner at PwC