The NHS: Decline and fall, or resurrection?

Think tank: Social Market Foundation

Author(s): Lord Norman Warner

July 4, 2022

This report from UK think tank the Social Market Foundation looks at change programme that could reverse the decline of the NHS.

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.

Key points:

  • 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.