The National Health Service is at a crossroads. Systemic pressures are lengthening hospital waiting times. Resources are finite. That’s why the government is coming up with a 10 year plan to make the NHS ‘fit for purpose’. But what is the ethical purpose of the NHS? The ethical ambition has always been that everyone, regardless of their background, should have equal access to healthcare. It’s seen as a moral triumph of civilization and political suicide to meddle with it. But when we look at the statistics about the effectiveness of care alongside other comparative countries – the cancer survival rates, premature deaths from cardiovascular disease, and the disparities of life-expectancy according to UK postcode – is it time to question this foundational principle? This is not simply a matter of which funding model works best. It is fundamentally ethical. For example, rather than focussing on equality of access to healthcare, should the goal instead be the equality of health outcomes across society? In other words, should we prioritise care for the most disadvantaged patients? Or would doing so be addressing a symptom and not the cause of deeper intersecting inequalities? Practically, it’s a question of who gets treated first. Philosophically, it’s a collision between competing notions of equality and fairness. Should we care more about equality of outcome – being equally healthy – or equality of access – treating everyone the same? What is the ethical purpose of the NHS?

Michael Buerk chairs a special debate at the Nuffield Trust Summit 2025.

Producer: Dan Tierney Editor: Tim Pemberton

Panel: Mona Siddiqui Tim Stanley Matthew Taylor Inaya Folarin-Iman

Witnesses: Kiran Patel Sheena Asthana Tony Milligan Jamie Whyte