NHS manifesto: the missing piece of the puzzle

The NHS Manifesto published in The Lancet by Nigel Crisp and colleagues (Dec 10, 2016, e24)1 is a broadly compelling one, and yet it mirrors an error made by National Health Service (NHS) England's Five Year Forward View2 in calling for a major transformation of the UK's largest public service without acknowledging the importance of public engagement in those plans. To be sure, Crisp and colleagues1 call for services to be made patient-centred, and for patients and carers to be engaged "in decision making and care". But the overwhelming role outlined for the wider public and communities is as a provider of the informal care required to shrink NHS services.

The absence of an empowered public role in this manifesto is problematic because the continued "great national coming together" of the NHS depends upon public support. This support should be nurtured through careful, genuine public engagement to build collective ownership of the future shape of the NHS. Instead, Crisp and colleagues present a ready-made blueprint for a future NHS, with transformation to be accelerated and improvement to be driven forward by central government "plan[ning] at scale", rather than a plan developed in partnership with the very public the NHS serves.