The future of the NHS: no longer the envy of the world?

Elias Mossialos, Alistair McGuire, Michael Anderson, Emma Pitchforth, Astrid James, Richard Horton

Research output: Contribution to journalComment/debatepeer-review


The UK's National Health Service (NHS) is one of the most comprehensive public health-care systems in the world and has provided free, high-quality care to millions of people since its inception. It was established on July 5, 1948, with the National Health Service Act based on the bold assumption within the 1942 Beveridge Report that a post-war UK would have “a national health service for prevention and for cure of disease and disability” that “will ensure that for every citizen there is available whatever medical treatment he requires, in whatever form he requires”. The NHS replaced a patchwork system of voluntary public and private hospitals and independent practitioners with a universal health system funded by general taxation. At its foundation, it was underpinned by three core principles: that it should meet the needs of everyone, be free at the point of delivery, and that care should be provided according to clinical need, not the ability to pay. That the UK was such an early adopter of universal health care is remarkable considering what Richard Titmuss termed the “residual” nature of the other pillars of the British welfare state. Other than the NHS, the British state provides only fairly limited benefits for those who cannot obtain needed services from the free market.
Original languageEnglish
Pages (from-to)1001-1003
Number of pages3
JournalThe Lancet
Issue number10125
Publication statusPublished - 17 Mar 2018


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