The NHS in England at 75: report summary

The NHS’s 75th anniversary is an important moment to look back at where the service has come from; to consider where it stands today; and to look forward to how it needs to change to meet future needs.

This report from the NHS Assembly draws on the feedback of thousands of people who have contributed to a rapid process of engagement with patients, staff and partners.

It also draws on the huge breadth of experience within the Assembly itself. The report aims to help the NHS, nationally and locally, plan how to respond to long term opportunities and challenges. It is not a detailed policy prescription. But it does set out what is most valuable about the NHS, what most needs to change, and what is needed for the NHS to continue fulfilling its fundamental mission in a new context.

Where have we come from?

The NHS was born from hope. It was founded on the simple principle of providing universal care, based on people’s need, not their ability to pay. Today, this resonates as strongly as it did in 1948. In opinion polls, 19 out of 20 people say they want the NHS to remain free at the point of delivery.[i] Those who responded to NHS@75 highlighted the underlying principles and values of the NHS as the most important feature to celebrate and retain.

It is striking how much the NHS has adapted to meet changing needs. Treatments for heart attacks and cancer have helped dramatically raise life expectancy. Mental health provision has moved from around 100 Victorian ‘asylums’ to more humane and effective care provided largely in the community, although still not at the levels of provision needed.

The NHS has also been at the forefront of innovations including helping pioneer hip replacements, the first test tube baby and new gene therapy treatments for childhood leukaemia. More than half of those who responded to NHS@75 celebrated these improvements.

At the heart of this history are the people who provide care: the NHS workforce of 1.3 million staff from over 200 different nationalities, alongside around five million unpaid carers who support their friends and family. Behind these numbers, our engagement highlights the diversity, daily resilience and adaptability of those who work in the NHS, despite the pressures they are under. The response to the COVID-19 pandemic is just the latest example of that.

Where are we now?

Today, there is immense pride in how the NHS and its partners continue to develop services. For example, the recent creation of 9,000 virtual-ward beds to provide care at home supported by new technology and ways of working.

The NHS has enduring strengths, such as universal general practice, its links to science and research, and its education and training system. The service has recently made a big shift to integrate the care provided by GPs, hospitals and community services, working more closely with local government, social care, the voluntary, community and social enterprise (VCSE) sector, and other partners, through the creation of Integrated Care Systems (ICSs).

There is also clear recognition in the NHS@75 engagement that, despite the best efforts of frontline staff, the NHS is not always providing timely access to advice, diagnostics and treatment to all those who need it. Waiting lists are at an all-time high. Public satisfaction is the lowest since the late 1990s.[ii]The NHS, and social care, face very significant challenges of rising demand, constrained capacity and the need to recover from COVID-19. Taken together, this is a unique set of challenges in NHS history.

Although some of these challenges are partly a consequence of the pandemic, they also have deeper causes. Processes can often be too complex. There are too many vacancies for permanent staff. Growth in service capacity has not matched the rapid rise in the number of people with severe chronic health conditions and frailty. Inequality in access and health outcomes is too wide. The NHS’s estate and digital infrastructure need investment and renewal.

The NHS will only thrive when wider economic, social and environmental conditions support good health and there are strong social care and public health services.

Where is the NHS going?

The NHS is starting to recover from the long legacy of the COVID-19 pandemic. The feedback from patients and staff in NHS@75 highlighted the importance of continuing to improve access to treatment and making it easier for people to navigate and communicate with different NHS services. Supporting staff and investing in training the workforce of the future remain high priorities.

There is now also an opportunity to look to the longer term. The NHS has made a number of significant shifts in how it has delivered care in the past – tackling infectious disease in the 1950s, closing asylums in the 1980s and radically expanding treatments in the 2000s. These shifts succeeded when the NHS had a clear vision for transforming the way care is delivered, supported by the resources needed to implement new ways of working. Each vision has been rooted in an understanding of patient needs and local innovation and improvement.

Today there is a growing consensus around the need for three big shifts. Shifts that respond to the continuing rise of chronic ill health and frailty, the need for people to have greater involvement in their own health and wellbeing, and the opportunities offered by
new technology, data and modern forms of care.

The three shifts are:

Preventing ill health

Shifting funding to evidence-based measures to prevent and manage coronary heart disease and other causes of poor health, such as smoking and obesity. Working far more effectively with others to reach those at greatest risk and using NHS insights to advocate for effective action in tackling the wider determinants of health.

Personalisation and participation

Ensuring people have control in planning their own care, supported by a continuity of relationship with clinical teams and an NHS accountability framework giving greater priority to patients’ experience and voice, particularly those who have been marginalised historically.

Co-ordinated care, closer to home

Accelerating plans to strengthen general practice, wider primary care and community
services in every neighbourhood. Universalising much better care for those with complex needs and frailty based on community teams and hospital at home services, supported by outreach from hospitals.

These are all developments which started some time ago and they must now be more
firmly rooted, more quickly, in every aspect of healthcare.

This will require sustained transformation and long-term investment across a range of
different elements, within the NHS, and across public health and social care:

  • a thriving workforce and better supported carers, in line with the forthcoming Long Term Workforce Plan
  • stronger partnerships with others, harnessing the opportunities from the creation of ICSs
  • better use of digital technology and data
  • a modernised infrastructure, particularly in primary care, supported by a long-term infrastructure plan
  • maximising the value of care and treatment, alongside greater efficiency
  • creating a well-led, learning, and self improving service.

Above all, it will rely on strengthening the conditions for locally led innovation and renewing the mutual relationship of support and engagement between the NHS and the public. The lesson of the last 75 years is that when the NHS brings all these components together to support far reaching change, the service renews the way it delivers its fundamental principles for the next generation. This is the task the NHS once again faces.


  1. Public satisfaction with the NHS and social care in 2022, The King’s Fund and Nuffield Trust, March 2023
  2. Public satisfaction with the NHS and social care in 2022, The King’s Fund and Nuffield Trust, March 2023