Editorial
The NHS at 70 and Alma-Ata at 40
2018 welcomes two important anniversaries for
health. In the UK, the National Health Service (NHS)
will be 70 years old in July, and the global health
community will mark the 40th anniversary of the
Alma-Ata Declaration at a conference on Oct 25–26 in
Almaty, Kazakhstan. Common to both anniversaries
will be recognition of universal health coverage (UHC)
as a goal, and the place of primary health care in
achieving that goal.
Founded in 1948 to provide a comprehensive health
service based on clinical need, not on the ability to
pay, and available to all, the NHS is admired by many
for its ambitious goals and achievements. But in its
70th year, the NHS now faces a genuine crisis. The
proposed accountable care organisations are the latest
target for critics, but in response Bruce Keogh, NHS
England’s national medical director, writing on Jan 1
in The Guardian, said “Rather than the Trojan horse for
privatisation that some critics may fear, this is a bold
attempt to unite a fractured system”.
As recognised by a House of Lords Select Committee
report in April, 2017, the biggest internal threat to the
sustainability of the NHS is the lack of a long-term
strategy to secure an appropriately skilled, well trained,
and committed workforce. Last month, the first step
to remedy this gap was taken with the publication of
a draft strategy for the health and care workforce for
England. Published by Health Education England, the
draft is open for consultation until March 23, and the
final strategy will be published in July, 2018.
Specific measures recommended by the draft strategy
include targeted retention schemes; improvements
to medical training and career support, especially
where there are the biggest shortfalls in doctors such
as in primary care (general practice) and psychiatry;
a technology review; and making the NHS a more
inclusive, family-friendly employer.
With the General Medical Council’s annual report in
December, 2017, also highlighting the NHS workforce
in crisis and describing “a crunch point” in the
development of the medical workforce, the next few
years are critical in determining how clinicians can
meet patients’ needs in the future NHS. A key priority
is recruitment and retention of primary care staff,
particularly general practitioners.
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The 1978 Declaration of Alma-Ata was the first
international declaration to advocate for primary health
care as the main strategy to achieve WHO’s stated goal
of health for all. Since then, strong primary care systems,
based in local communities, are recognised to be essential
to achieving UHC. The core values and principles of
the 1978 Alma-Ata Declaration still stand, while the
BSIP/Contributor
Declaration 2.0 to be discussed in October is expected
to renew the emphasis on primary care as the main
driver of people-centred health systems leading to UHC.
Zsuzsanna Jakab, WHO Regional Director for Europe, told
The Lancet “Making health care truly universal requires a
shift from health systems designed around diseases and
health institutions towards health systems designed
around and for people”. Yelzhan Birtanov, Minister of
Health of Kazakhstan, added “there are some significant
changes that should be reflected and adopted…ranging
from the name of the Declaration from ‘Alma-Ata’ to
‘Almaty’ and the need to focus on non-communicable
diseases, which are responsible for 70% of deaths globally,
to the role that the citizens should be playing in health
prevention and protection by actively participating in the
maintenance of their health status.”
The Almaty Declaration 2.0 will reflect the changing
expect­ ations of health-care providers, the needs of
patients, and the challenges posed by the Sustainable
Development Goals 2030. The draft Declaration 2.0 will
undergo global consultation and will be put to the World
Health Assembly in May, 2019, for adoption.
Investment in health should be part of an economic
growth strategy, but what is often overlooked is the
importance of investing in the health workforce. World
For Bruce Keogh’s article in
Bank Chief Economist, Paul Romer, promotes investing The Guardian see https://www.
in “human capital” as a key part of revenue growth. theguardian.com/
commentisfree/2018/jan/01/nhs-
With 2018 set to be a crucial year for the NHS and more 70-britain-medical-heath-service-
generally for primary care globally, now is the time penicillin-ivf
For more on the House of Lords
for bold thinking and action on reforms to ensure a report see Lancet 2017; 389: 1491
sustainable future. Almaty Declaration 2.0 could shape For the Health Education
the future of primary health care. A partnership between England report see https://hee.
nhs.uk/our-work/planning-
the London School of Economics and The Lancet will commissioning/workforce-
result in a Commission on the future of the NHS, which strategy
For the GMC report see https://
aims to report in 2019. The health workforce is an www.gmc-uk.org/publications/
often underestimated critical component to all health somep2017.asp?utm_
source=media&utm_
strategies and is where substantial investment should medium=media&utm_
be made. n The Lancet campaign=somep2017