Katie Mantell

As the NHS struggles to meet rising demand amid funding constraints and a growing sense of crisis in social care, it can be difficult to look beyond the immediate pressures and think ahead to the longer term future of health and social care in England.

Last year, in a bid to look beyond the here and now, we started a programme of work to generate new thinking on the future of the NHS – thinking unconstrained by today’s limitations and boundaries. We asked experts both inside and outside the Fund to set free their imaginations on a range of ‘What if…’ scenarios for the future of health and care.

Their essays challenged us to consider a carbon-neutral NHS, an NHS in a world in which antibiotics stopped working and a scenario in which obesity were eradicated, among others.

Then, aware that we might be constrained by our own particular world view and lists of contacts, we decided to throw the net wider and invite anyone – patients, carers, students, those working in health and care – to share their vision of a hypothetical future for health and care, in the Fund’s first-ever essay competition.

It was a bit of an experiment. We weren’t sure how many people – if anyone – would apply. We assembled a panel of judges, contacted universities and other organisations to spread the word, shared widely on social media, and set a closing date of 3 January.

And over the Christmas holidays, the essays piled in. This past week I’ve had the privilege of reading all 94 essays we received. As you’d probably expect, they covered a wide range of subjects – from an NHS with no immigration to an NHS dominated by artificial intelligence – and reflected different writing styles and author experiences.

Nevertheless, there were some recurring themes. A large number of essays focused on what I’d describe as a more holistic, non-medicalised vision of health. These essays imagine a world in which we’ve broken down the divisions between mental and physical health; a world in which promoting healthy living is a cornerstone of all government and NHS policies; a world in which doctors prescribe healthy activities as readily as they prescribe drugs. None of these ideas are new, but the fact that such a range of people were able to take a leap of faith and imagine what might need to happen to achieve these hypothetical scenarios gave me a real sense of what might be possible.

If the tumultuous political events of 2016 have taught me anything, it’s that people can have unexpected and very different views of the world, and that change of the kind many thought impossible can happen – for better or for worse. As one author, writing about how we could drastically change our behaviour to reduce health inequalities, put it: ‘We have done it with seatbelts and dog poo. A combination of legislation and individual expectation changes culture. The NHS needs to lead on this’.

As you might expect, the long-term sustainability of the NHS was another recurring theme, with many essays imagining different ways of funding and managing the NHS. These ranged from social insurance, to refusing to treat ‘self-inflicted diseases’, to offering cashback to encourage patients to pay privately rather than using the NHS.

Several essays suggested that the future survival of the NHS as a tax-funded service, free at the point of use, depends on us engaging young people in the principles of the NHS and how it works. One author proposed developing ‘a health and social care service akin to youth military service in some countries’, arguing that ‘this social movement will be the start of a renaissance of the NHS’. Another author – a 19-year-old student who has personal experience of the failings of the mental health system – touched on a similar point, saying, ‘I do not really know how the [health] system works. Maybe a little bit of self-promotion and explanation for students and school children alike could be a good first step, just to help … understanding’.

With so many thoughtful essays, covering such a range of issues, from such a diversity of perspectives, it won’t be easy to choose a winner. The judging panel meets next week and I’m expecting we’ll have some lively debate before coming to a decision. It’s challenging to take a leap forward in our thinking at a time when the health and social care system is under unprecedented financial and operational pressures; technological and medical advances are moving so fast; and other aspects of society (eg, health inequalities) are changing so little. We hope that our ‘The NHS if…’ series has helped people pause for a moment and think beyond the here and now. Keep an eye out for the publication of our winning essay and runner-up next month.

• See ‘The NHS if…’ essay series