A manifesto for a 21st century National Health Service

Published: 20/11/2019

In our 2019 General Election manifesto, the Royal College of Anaesthetists (RCoA) is calling on the next government to address the critical issues preventing the delivery of a 21st century national health service. Focusing on staff wellbeing and integrated care is what’s needed to create a sustainable NHS, not a total restructure.

The next government must agree to remove barriers to multidisciplinary perioperative care1 in clinical practice; implement a new no-blame NHS culture; invest in NHS staff throughout their careers; and commit to collaborative long-term planning to deliver an appropriately resourced, effectively integrated and sustainably delivered healthcare service, which delivers the safest and best care for all patients.

We call on our elected politicians to:

  • take a whole-person approach improve the patient experience, the health of populations and reduce healthcare costs by embedding multidisciplinary perioperative care into clinical practice
  • care for the people who care for us – develop and publish a national morale and welfare strategy to ensure that all NHS staff are well-supported and motivated to provide the safest and  best possible patient care
  • ensure a future doctor and nursing ‘pipeline’  renew the UK’s commitment to the Medical Training Initiative in parallel with other international schemes and a supportive immigration environment, and deliver the investment needed to grow a sustainable domestic workforce
  • safeguard a sustainable NHS establish an independent Office for Health and Care Sustainability to plan services 15-20 years ahead, guided by demographic trends, disease profiles and demand
  • remove the culture of blame to maintain patient safety – foster a ‘no-blame’ learning environment, reduce avoidable harm, while maintaining professional accountability and improving system-wide learning
  • deliver 21st century care modernise our clinical infrastructure and staff facilities by committing to a ring-fenced NHS capital-spending fund
  • integrate health and care remove legislative barriers and offer more time and financial support for integrated care leaders to take their work to the next stage of development
  • take a population health approach – deliver an increased public health settlement and commission an independent, evidence-based, review into provision of public health services, including the role of the NHS in prevention
  • support multi-disciplinary working implement a statutory register for Anaesthesia Associates as soon as possible, and realise the vision of a multi-disciplinary workforce designed around the patient.


Professor Ravi Mahajan, President of the Royal College of Anaesthetists, said:

“The UK public and NHS clinicians across all medical disciplines are expecting our politicians to listen to those with the experience and understanding on how to start resolving the on-going healthcare crisis. Anaesthetic-led multidisciplinary teams across the NHS continue to work incredibly hard under unrelenting pressures to deliver safe patient care with the resources available to them.

“Workforce retention is low and there is poor morale amongst clinicians of all grades. What the next government needs to deliver is not a comprehensive re-structure but a focus on integration across services as well as investment in infrastructure and staff wellbeing so we can make the best use of our resources and work together to build a truly sustainable 21st century NHS.”

Read our full manifesto here

Anaesthesia is the UK’s single largest hospital specialty and is a critical bellwether for secondary care. Anaesthetists play a vital role in the care of two-thirds of all hospital patients.


  1. Perioperative care is the integrated multidisciplinary care of patients from the moment surgery is contemplated through to full recovery. Good perioperative care should improve patient experience of care, including quality of care and satisfaction with care, improve health of populations, including returning to home/work and quality of life, and reduce the per capita cost of healthcare through improving value. For more information visit: www.cpoc.org.uk