The NHS: Decline and fall, or resurrection?

The NHS is in serious decline, plagued by extensive and deep-seated issues and facing immense pressures from the pandemic and Brexit. In this briefing, Lord Warner sets out a change programme that could reverse the decline – involving radical but necessary steps.


  • The National Health Service (NHS) is in serious decline – struggling to recover from the devastating impact of the pandemic and Brexit.
  • The issues are deep-seated and more extensive than the pandemic’s treatment backlog. The future sustainability of a tax-funded comprehensive NHS is now open to doubt.
  • Throughout its history, the NHS has focused on treating ill-health, even as the disease profile of the UK has vastly changed.
  • Rising demand will mean the NHS is unable to provide services to all, ushering in a two-tier health system that no longer provides free universal care.
  • Politicians must be much braver in making major changes to the way the country structures and delivers health and care services.


  1. Reform public health and prevention – by creating an independent public body, the Office of Public Health, which will make decisions on policy and resource distribution
  2. Expand community health services and social care – rather than expanding hospitals, much more of the NHS capital should be allocated to community health facilities, including GPs
  3. Consolidating specialist health services – create a new system for determining the consolidation of specialist health services on fewer sites
  4. Creating elective surgery and diagnostic hubs – NHS England should be directed to establish either surgical hubs or standalone surgical centres to undertake elective surgery
  5. Reforming workforce planning and delivery – DHSC should be given new powers and a long-term budget to meet future NHS labour demands


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