On 11 July 2013, the NHS published a report 'The NHS belongs to the people', which seeks to identify the pressures facing the NHS and encourage change. With the NHS's chief executive having announced his retirement from the position for March 2014, the sense of urgency of this report illustrates both the limited time that the NHS has to decide on the next steps to take and the limited time that Sir David Nicholson has to launch them, if not to see them through.

The report estimates the gap between funding and service costs to reach GBP 30bn by 2021, and uses this figure as an illustration of the NHS's need for change. For the pharmaceutical industry, the report recognises the benefit of new medicines and aims to invest in those that demonstrate the best value, and stresses that the NHS must consider how to work with industry partners to ensure that the life sciences continue to be a growing part of the UK economy. The central point of this report is a call for an "honest and realistic debate". NHS England thus commits to provide support to local GPs, charities and patient groups to hold meetings, discuss these issues, and determine what changes need to take place. This programme of engagement should be in place by early 2014, and is hoped to feed into future Clinical Commissioning Groups plans as well as national plans.

Several bodies have shown their support for this report. The British Medical Association (BMA), the Royal College of Nursing (RCN), and the Health and Social Care Information Centre (HSCIC) all acknowledged the need for a debate while emphasising their respective concerns. Dr Peter Carter, RCN Chief Executive & General Secretary, stated that “The NHS faces significant challenges and we agree that it cannot hope to meet these without change”, and mentioned the importance of "getting the basics right, such as ensuring safe staffing levels throughout the NHS”.

While the report's call for a national debate hasn't been confronted with much opposition, the alternatives likely to arise from this consultation are likely to become very controversial. Propositions such as the focus on giving care at home or the centralisation of certain services in order to have less hospitals to fund has already been contested. One of the Report's supporters, the Better Services Better Value (BSBV) healthcare review, made similar suggestions and was met with significant local opposition. Only time will tell whether this programme of advancement will see local concerns with the future of some of these hospitals turn into a nation-wide opposition, or whether the majority will consider these alternatives as necessary to the survival of the NHS.