UK Healthcare: An Opportunity to Inspire a Nation and Beyond — a living testament to the lives harmed, and to the staff who dedicate their lives to acting for the good of others.

In one sentence. The NHS is one of the great stories of humanity; somewhere it lost that identity, and the harm is now documented in inquiry after inquiry.

It is fixable, not with money, but with humanity, activating the very humanity that created the NHS in the first place. Because humanity is a performance multiplier. Read on to find out why.

This page pulls the whole document together in about two pages. The detail, the sources and the caveats are in the volumes and annexes that follow. Sterling figures carry a US dollar equivalent at $1.35 = £1.

1. A story of humanity, a huge achievement for humanity

The idea at the heart of the NHS is nearly 300 years old, from the valleys of Wales that inspired a community to prove the model long before any government did.

From 1890, the workers of Tredegar, a Welsh mining town, paid a few pence from every pound into a medical aid society so that no neighbour faced illness alone; by the 1920s it covered some 20,000 people.

In February 1925, just over a century ago, a young miner from that town, Aneurin Bevan, held his father as he died of miners' lung disease, uncompensated because the law did not count it.

In 1948, in a country close to bankrupt after the war, Bevan scaled Tredegar's answer up to a nation. "We are going to 'Tredegarise' you," he is reported to have said.

He stood in a long British tradition: in 1840, Elizabeth Fry's nurses were attending the poor "with the same kindness and care bestowed upon the more wealthy".

Its roots go back to the 1730s: some 300 hundred years ago.

From 1731, Griffith Jones, a Carmarthenshire parson, sent teachers from parish to parish until more than 158,000 people in Wales had learned to read, in their own language.

By the early 1800s, Wales was one of the most literate nations on the planet. They became Nonconformists, Methodists and Baptists, as the Anglican church then represented the ruling class. Their children built chapels they governed themselves, establishing roots of local democracy and civil engagement. Their grandchildren built libraries, institutes and, in Tredegar, their own health service.

At each step a few people chose to act for the good of others, drew others in, and built something the next generation could stand on.

That is the spirit Bevan carried into the NHS: not care handed down from above, but called forward, people building it for one another. Annex 10 · Why we all love the Welsh

What it achieved is extraordinary, and the gratitude was overwhelming.

On 5 July 1948 the fear of the doctor's bill lifted from everyone at once — "It was just unbelievable," a radiographer remembered — and in the first year some four and a half million pairs of spectacles went to people who had lived for years unable to see properly.

Nurses and doctors came from the Caribbean, South Asia and beyond to staff it, often carrying its ethos more faithfully than the country that had asked them to come.

Since then infant mortality has fallen to less than a third of its 1980 level; British clinicians delivered the world's first IVF baby; the NHS gave the world's first Covid vaccination outside a trial; and some 1.5 million people in England still go to work every day to look after strangers.

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2. Somewhere, it lost that identity, lost its soul

The values were written down, but never built in.

In January 2009 the NHS set its founding values in a Constitution — compassion, respect and dignity, everyone counts.

The intent was great. The words are great. The introduction starts with, "The NHS belongs to the people".

And continues, "It works at the limits of science – bringing the highest levels of human knowledge and skill to save lives and improve health. It touches our lives at times of basic human need, when care and compassion are what matter most."

"The NHS is founded on a common set of principles and values that bind together the communities and people it serves – patients and public – and the staff who work for it."

It comprises seven key principles, all of which are great. You could not ask for better.

Bevan built the initiative and the money into the law of the land, and it has survived the past seventy-eight years. But its humanity was assumed. It was implicit rather than explicit.

Yes, fine statements, but how are these built into the fabric of the lived experience in the NHS and the wider social and children's care sector?

How would the system ensure that people, leaders, those responsible for carrying the baton forward would walk the talk?

Let me be direct here, because what follows is hard reading.

And this is personal. I, the author — Glen Ford — live in the UK, I am a British Citizen. My wife recently spent 8 days in the trauma unit at the Queen's Medical Centre in Nottingham. I am pleased to say, she received exceptional care and medical attention. And we are exceptionally grateful to Bevan, to those Welsh valley communities, and to all those in the NHS who hold to its values.

But that is not the normal. Or at least, it is so significantly wrong in large parts to ask some serious questions. And more than the proverbial canary in the mine.

So let me ask, as the Constitution says this is my NHS, our NHS:

What part of this Constitution were the leaders, the regulators, the managers and some of the clinicians reading when they allowed a system that resulted in the murder or the attempted murder of fourteen newborn babies?

The Inquiry found "a complete failure to protect babies on the neonatal unit", and "dysfunctional management and governance; a gulf between hospital leadership and clinicians".

The Thirlwall Inquiry, released this month, September 2026 is a damning indictment on this specific location and the wider NHS.

Because, as you will see, it is far from an isolated case.

Somehow, somewhere, not only has something rotten gotten in, it has started to be ingrained, normal — the way "we think and do". It has started to become the identity of the NHS and the very opposite of what was intended.

That is the clear message from the Thirlwall Inquiry [Chester] and the many others published since Francis [Mid Staffs, 2013].

Chester is the starkest proof: heartbreakingly so.

Placing the families involved at the centre is key, even if this is hard to read.

Proximity to the humanity of others, whether their suffering or their acts of courage, is what makes us human.

Fourteen new-born babies murdered or attempted to be murdered. All of the babies that survived, now young children, continue to live with long-term consequences, several with profound, lifelong physical and learning disabilities.

Their families have spoken about the profound psychological torment of watching their children navigate severe disabilities, knowing their injuries were deliberately inflicted and allowed by a system that was meant to care.

Between June 2015 and June 2016 a nurse on the neonatal unit at the Countess of Chester murdered seven babies and tried to murder seven more.¹

When consultants raised the alarm, the hospital's leaders drew up a plan to "manage out" the doctors.

The Inquiry, reporting on 15 September 2026, found "a profound failure of management, governance and safeguarding" and recorded "a total failure of safeguarding at every level".

And the outside check failed too — the people who failed the consultants were their own professional body.

When the concerns could no longer be dismissed, the hospital invited in the Royal College of Paediatrics and Child Health — the royal college of the very doctors raising the alarm.

The reviewers knew. They had been told there was suspicion of deliberate harm; the lead reviewer had seen the table showing one nurse on duty for almost every death; a second reviewer's own notes use the phrase "foul play".

They did not say the one thing that needed saying.

The Inquiry puts it in twelve words: "All that was necessary was to say we think you should call the police."

The College's own response is the measure of how serious this was.

Its president apologised to the parents, and to the Countess paediatricians for how their professional body had treated them.

The Inquiry recorded "an uncomplicated recognition that their review team had made serious mistakes", apologies that were "genuine and reflective", and changes since that "have been far reaching". Institutions do not make far-reaching changes over a technicality.

And the cost of that report was not only delay.

By 28 March 2017 the plan was to return the nurse to the neonatal unit from the week beginning 3 April, an hour a day; staff had arranged a welcome tea party, if you can really imagine that.

The chief executive had called them to tell them she was coming back, the board supported her return.

But, thankfully, the consultants held the line, they refused to work with her.

That is what a false reassurance does once it has travelled. Ordinary, decent people act on it. Annex 16 · When the sheriff gets it wrong

What stopped it was people who held the line at a cost to themselves.

Seven consultants kept saying the same thing for eleven months. It all came to a head in March 2017.

One NHS England official who was in the room in March 2017 remembered "the clinicians trembling", and that "they felt like they were putting their careers on the line, but they were prepared to do this given the seriousness of the matter".

In every case in this document the correction came from someone who accepted that cost: a family that would not stop asking, or a clinician who would not stop being a nuisance. Annex 17 · Holding the line

That is not just a few bad apples. It has become a system.

And the failure of governance and leadership continued, with different people.

By 2022, the leaders of 2016 had gone and the hospital was under national scrutiny. Letby had been arrested, July 2018, again in 2019 and the third and final time in 2020.

Yet four of its new senior leaders, including the new chair and the chief people officer, ran a covert campaign to remove Dr Susan Gilby — the chief executive brought in after the scandal — once she had raised a whistleblowing complaint.

An employment tribunal upheld her claims in full.

The conduct of the chief people officer — the executive responsible for how the hospital treated its staff — was so serious that her professional body, the CIPD, permanently expelled her.

By then, the chief people officer, had moved to the same post at another NHS trust — the dreaded revolving door.² She resigned from this new post following fit-and-proper-person concerns.

The Thirlwall Inquiry records the tribunal judgment, "contains excoriating criticism of the leadership of the Countess at that time" (Volume II, paragraph 27.10).

New leadership, same behaviour.

And it is a pattern, not an exception.

In the twenty-nine months between April 2024 and September 2026, eight major national inquiries and reviews reported, repeating what the Bristol inquiry found in 2001 and Francis at Mid Staffordshire in 2013.

Nine more are under way, four of them due to report within the next twelve months.

The mechanism is the same: concerns raised and explained away, candour delayed, regulators shown a curated picture, the person who spoke up managed out.

At County Durham, 315 of 514 breast-surgery patients reviewed so far were harmed, 61%, and 15% have been harmed significantly, including 20 women who had unnecessary mastectomies. Concerns had been raised in 2012 and continued through to 2025.

The earliest warning signs appeared when the General Medical Council (GMC) withdrew the trust’s status as a training centre for breast surgery. This escalation occurred because internal clinicians raised concerns about inadequate clinical supervision, outliers in surgical methods, and poor local clinical governance.

However, as the trust was performing well on financial metrics, senior leadership treated this as an isolated training issue rather than a wider patient safety crisis

Staggeringly, the UK national regulator, the Care Quality Commission (CQC) had rated the trust as 'well-led' or 'good' for much of this time because of its financial and operational metrics. They belatedly issued an emergency notice at the end of last year, and formerly downgraded their status this June.

You would be forgiven for asking that when they call themselves the 'Care Quality Commission' whose care are they referring to?

This past week, the review of cases by the hospital has been extended back to cover an additional 5,000 cases, which they estimate will take them up to five years to process.

Durham was brought into the light by peer review mechanisms, reviewing outcomes across a wider geography, which flagged serious anomalies. In 2025, the professional body was called in, the Royal College of Surgeons. Unlike Chester, their advice initiated the reviews. They found "direct evidence of patient harm, flawed multidisciplinary team (MDT) decision-making, and structural isolation of the surgical department".

By then over ten years had elapsed from the first warning signs in 2012, with thousands of patients subjected to potential harm.

And the carers are running on empty.

The NHS Staff Survey 2025 asked 766,285 people, and only 43% feel their organisation values their work.

31.5% are burnt out. 56% have gone to work while too unwell to be there. And 16.8% would leave as soon as they could find another job — an all-time high.

Half the doctors surveyed by the BMA report moral injury: knowing what good care looks like and being unable to give it.

One doctor in training in five is at high risk of burnout.

A workforce this depleted cannot be kind to anybody, whatever the values statement on the wall says.

And managers are people under pressure too, which this document keeps in view.

When Thirlwall reported, the editor of the Health Service Journal, Alastair McLellan, wrote that the inquiry "may be of some use to the families involved, but its summary findings and recommendations are patronising, confusing and in some cases plain ignorant".

From an outside perspective, this seems alarming, to put in mildly.

For the sake of brevity, I won't elaborate here. Maybe it is the usual human process when confronted with such realities: start with denial, reject or disbelieve reality, anger, shock.

But it is a view, representing the facts and feelings of many within the NHS, for sure. It is their reality. A system under immense pressure, people under immense pressure.

This is my personal view: I don't buy it. I understand it, yes, but I don't buy it.

But what I do know is that you cannot regulate people to care — it has to come from within.

The 'steel', the character that shows itself under pressure, the people willing to 'hold the line', this is developed over time. It comes from an environment, a system and a culture that calls this forward, rewards this behaviour, hardwires it into the fabric of its identity.

It is about ownership, individual and collective. And yes, it is about accountability, individual and collective. And it is about support, individual and collective.

It is what Bevan was born into and what he adopted and carried forward.

Being human is not simply a duty, it's something we do because we know it's right, we have developed the motivation, the internal capability to do so, and because we are supported by others.

This is exactly what humanity-first healthcare is all about: people first, humanity first — having the capability to act for the good of others, and hardwiring this into the fabric, the foundations of the organisation.

In social and children's care the most vulnerable meet the least oversight.

This report is focused on healthcare, the NHS especially. But it would be amiss to ignore some of the very grave and serious issues within the wider social and children's care services.

It is difficult to convey in a few words the seriousness of the current situation. The issue for healthcare is the knock-on impact when social and childcare is not functioning, including preventative care: people end up in hospitals.

Also, hospitals and clinics struggle to discharge people when they no longer need professional healthcare, taking up bed space and healthcare capacity.

Healthcare becomes the 'jam in the sandwich'. And as we know, in the UK, there is no restriction — accessible to all, comprehensive and free at the point of delivery.

No wonder staff and services in the NHS are under pressure. Who wouldn't in this context?

But the British public have again and again expressed their appreciation for the NHS. That means any remedy for the NHS can never look at the NHS only.

Below is an example from one particular aspect that highlights the issue.

What is happening with young people with very extreme needs.

Currently in the UK, 669 children with extreme needs in the care system are kept in illegal, unregistered children's homes. This is because there is a legal duty on local councils to provide for such children and there are no alternative provisions.

You'd be forgiven for thinking that, in the context of a nation, this is terribly sad for the children and families involved, but does not register at a national or strategic level.

But the provision for those 669 children is about £353m ($477m) a year, at an average of £10,500 ($14,175) a week, with some charging much more. Yes, in some cases it is costing £500,000 ($675,000) to over £1 million ($1.35 million) per child per year — Ofsted has described costs of up to £30,000 ($40,500) a week for a single child.

You would also be forgiven for thinking this would be 5-star treatment. But this is a broken system, the state doing its best to do what should be done by families, communities, by people who care because they care. In some cases, these children have then been abused.

Worse still, social and child care is funded by local councils, representing around two thirds of their entire budgets.

They are legally required to balance their books every year. Overspends cause reductions in other budgets, especially preventative care, like youth services — youth clubs and the like — compounding the problem further. Between 2010/11 and 2022/23 councils' spending on early intervention fell by 44%, while spending on late intervention rose by 57%. The cheapest help is the first thing cut.

And as of this week, that is the Prime Minister's position too.

On 27 September 2026, at his first Labour conference as Prime Minister, Andy Burnham committed to a national care service for England built on the NHS's own principles — free at the point of use, and paid for by everyone — with Baroness Casey's review settling how it is implemented and the plan put to the electorate at the next general election rather than legislated now. "I'm going to rip the plaster off," he said, "if I can put it that way, because someone has to do it."

The funding question is open, and he was candid that it is: everyone contributes and everyone is covered, but not necessarily in the way the NHS is paid for today.

But look at what he said about the people who cared for his late father, who had Alzheimer's. They "work day in, day out, with huge humour and humanity and skill in what they do … caring for other people's parents on poverty pay."

Humour, humanity and skill. Three intrinsic human qualities, named by the Prime Minister in a single sentence, in the part of the system that is paid least and watched least.

That is the whole argument of this document, in his words rather than mine. The question this document then puts is the one his sentence leaves open: those qualities are what we are relying on, so what in the design of the service forms them, protects them and keeps them when the pressure comes?

There are no quick fixes. But suffice to say there can be no serious review of the NHS that does not take social care, children's care and prevention with it. Somehow, this requires a joined up approach, one that works and achieves best value for money, because there can never be unlimited resource.

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3. Why it happens

It happens because you cannot regulate people to care. This has to come from within. And to endure, this needs to be hard-wired into the foundations and fabric of the NHS, our NHS. This should represent who we are and what we aspire to be. It is all about identity: own it, model it, live it — make it true.

When Bevan built the NHS, the country was a different place. Britain had just come through two world wars. People had queued, rationed, taken in evacuees and pulled neighbours out of the rubble. Humanity did not need building in — it was in the room.

What the country lacked was capability: hospitals, doctors, medicines, a system that reached everyone. So that is what he built, and he built it into law.

Seventy-eight years on we have the capability, and the thing he could take for granted has thinned. One marker will do: the share of young people with no close friends has risen from about one in 100 in 2014 to one in 20 today.

In the NHS, where people meet each other at their most frightened, that shows up in exceptionally painful ways.

The sad reality is that when you lose your humanity, you lose everything.

And that becomes especially true when under pressure, which is a constant reality for the NHS, in many cases, brutal pressure.

What is built in survives pressure. What is left to chance does not.

• Values without structure. Organisations are appraised on money and targets, never on how people are treated. Johnson & Johnson's Credo shows what the alternative looks like — and that even built-in values decay unless they are renewed.³
• Pressure exposes values. It reveals what was really holding them up. Where values are built into how an organisation runs, pressure meets resistance and the line holds; where they exist only on paper, pressure shows that nothing was there.
• People can break, because they are human. Like a muscle, the right kind of stretch, with support and time to recover, makes people stronger. Relentless strain without it tears them: they tire, burn out and leave — and, as in any team sport, every player lost puts more weight on everyone still on the pitch.
• When no one cares for the carers, the caring stops. Staff who are exhausted, unheard and treated as interchangeable run out of anything to give. They protect themselves: keep their heads down, do the job, go home — the "I'm alright, Jack" attitude people complain about. Patients feel it first, in a hurried word, a call bell left ringing, a question nobody answers. People treat others the way they are treated themselves. An organisation that cares for its staff gets staff who care for patients; one that doesn't gets the opposite.
• Small acts compound, and they are signals. Rudeness costs its target about a third of their performance;⁴ each act that goes unchallenged makes the next easier. Like near misses in safety science, incivility is an early warning of a system's health.
• Expertise is not enough. Germany's medical profession was regarded as the most advanced in the world in the 1930s. Yet this same profession was the most complicit in the atrocities that followed — and eighty years on, medical training worldwide has still barely absorbed the lesson.⁵ In June 2026, Lord Mann reported that he found racism "normalised in the NHS", including anti-Jewish hatred.
• Restructuring is not the cure. Health and social care are different sectors in England, resulting in a lack of coordination. Fixing this alone is not the solution, as Northern Ireland illustrates. Health and social care have run as one system in Northern Ireland since 1973, and on waiting times it is the worst-performing of the four UK nations. No one holds it up as a model; the Nuffield Trust found its integration "statutory rather than delivered in practice". Where joining up care has helped, as in Torbay and parts of Greater Manchester, it came from people working together around the patient rather than from the organisation chart, and it took years to show.
• "We know best" fails. When the powerful decide about people instead of with them, they stop seeing them. In 1847 three commissioners who spoke no Welsh passed judgment on a whole people; within decades Britain was ranking human worth, and by 1913 the law was segregating people judged "defective" in institutions the NHS later inherited — among them Ely Hospital in Cardiff, whose abuses were exposed in 1969. The same method — judging from above, trusting the account of those in charge — recurs in the modern inquiries: at Durham the board "accepted reassurance rather than seeking genuine assurance". Annex 11 · Why a top-down model fails
• The system cannot heal itself. Twenty-five years of internal reform have produced the same failures in the same words. As Rabbi Lord Sacks put it, "a prisoner cannot free himself".

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4. What it costs

The current cost is already unsustainable and will get worse. The NHS carries a £60.3bn ($81.4bn) provision for harm already caused — second only to nuclear decommissioning among the liabilities on the government's balance sheet — pays out £3.2bn ($4.3bn) a year, a quarter of it in legal costs, and loses an estimated £12.1bn ($16.3bn) a year to staff ill-health and cover.

Councils overspent on adult social care by £715m ($965m) in 2025/26. That is only about 3% of adult social care budgets, but a council must balance its books every year, so the gap has to be found within the year, from other services and from reserves. On children's social care the overspend was 21% in 2023/24.

Adult and children's social care together now take around two-thirds of councils' budgets. Overspends squeeze every other local service, including those focused on prevention, such as youth services. None of that buys any patient any care.

The human cost — in babies, in families left to fight for the truth, in staff who leave — is counted in terms of human misery.

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5. It is fixable, and money is NOT the key driver

The places that get this right almost always have humanity at their core. The best-rated care in England comes from its least-funded part: a quarter of hospices rated outstanding against about 6% of NHS acute hospitals.

Leeds and Manchester took their children's services from Inadequate to Outstanding under the same funding pressure as every other council, by keeping the same people around the same children.

Internationally, Mayo (USA), Buurtzorg (Netherlands), Nuka (Alaska) and Intermountain (Utah) have sustained humane care on ordinary budgets; Israel gets better results than England with fewer beds and less money.

But the copy usually fails, and how it fails is the most useful part of the evidence. England imported Buurtzorg's self-managing nursing teams twice and both pilots faded within two years; it imported Sweden's Esther question without the authority that made the question worth asking.

The mechanism rarely transfers. The principle usually does — and the copy only works when the people who have to run it own it, and when whatever sits above the team changes too. Annex 15 · Humanity in healthcare: examples

At the bedside, attentive care halves delirium in frail older patients and skin-to-skin contact cuts deaths among the smallest babies by a quarter.⁶

And being human is good for health. People with strong social relationships are 50% more likely to survive over the years they are studied than people with weak ones.

Patients who have kept the same GP for fifteen years or more are 25% less likely to die than those who have been with their GP for a year.

And in one trial where every patient received the same sham treatment, 28% of those left waiting reported relief, 44% of those treated briskly, and 62% of those treated with warmth and attention.⁷ The effects are often modest, but they are real and almost free.

Loneliness is a silent killer — and it is now young people who report it most. Across 2.2 million people, social isolation is linked to a 32% higher risk of early death, and loneliness to 14%; isolation also goes with a higher risk of heart disease and stroke.

The World Health Organization estimates that loneliness is linked to some 871,000 deaths a year.

And contrary to the usual picture, in England 16–24-year-olds report the highest rate of chronic loneliness, 9% against 4% of those aged 65 to 74, while the share of young people with no close friends has risen from about one in 100 in 2014 to one in 20 today.⁸

Money without humanity fails also. In November 2025, Lady Joan Branson, aged 80, died at the Lister Hospital, a private hospital in Chelsea, west London, where money was no object. At her inquest in September 2026 the coroner found that her death "would have likely been prevented".

The coroner stressed that it was not a case of neglect — she was being treated. Nobody lacked the knowledge or the resources. It was a seemingly small oversight: the team did not make sure somebody owned the task, yet getting that right could have prevented her death.

The doctor in question, Dr Kunduzi, said the circumstances surrounding Lady Branson's death under his care have caused him to "reflect on my role as a doctor", and spoke of the importance of "good communication between team members".

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6. The proposition: humanity-first healthcare

The philosophy: the capacity to act for the good of others. That is what humanity means in practice — not a feeling or a slogan, but the ability, under pressure, to see the person in front of you as a human being and do what is right for them.

At its best it becomes instinctive: the last of what Champions calls its Four Stages of Humanity, "unconscious humanity", where being human under pressure is simply another day at the office.⁹

It is what the miners of Tredegar did for one another from 1890; what Bevan built a nation's health service on — "no society can legitimately call itself civilised if a sick person is denied medical aid because of lack of means"; and what every inquiry in this document found missing.

Humanity-first healthcare is a return to the NHS's founding purpose, with one difference: this time the humanity is built in, so that it holds on a bad night.

One goal, three pillars. The NHS's founding principles are usually remembered in three words: universal, comprehensive, free at the point of delivery.

Humanity-first healthcare serves one goal, taken from the fourth principle of the NHS Constitution and widened to all care, NHS or not: the patient will be at the heart of everything.

Humanity-first healthcare adds three commitments about how people are treated:

1. Every person counts. It is universal — everyone is included: the patient who cannot speak up, the frightened family, the child in care, whatever their colour or creed, rich or poor. Everyone is inside the circle of care.
2. Caring for the carers. People treat others the way they are treated themselves. Staff who are known, supported, safe and treated with respect and dignity give kinder, safer care — and stay.
3. It's who we are. Humanity is not a programme, a policy or a poster on the wall. It is an identity — a settled answer to who we are and what we are for, lived by everyone from the board to the ward, and protected by how leaders are chosen and judged, how services are measured and how people are trained.

Every person counts. Caring for the carers. It's who we are. None of this is new. It is why the NHS was created, and why the public still hold to it: in 2025 only 26% were satisfied with the service, yet nearly nine in ten said it should still be free when you need it.¹⁰

As in 1948, when the NHS works, people respond with immense gratitude. When it fails, it is patients and families who pay the final, often terrible, cost.

And it has to be built in, not exhorted — which is the unfinished half of Bevan's settlement. He wrote the money into an Act of Parliament in 1948, and that half has survived seventy-eight years and every reorganisation since.

The humanity was left to the professions, to training and to chance, and it is the half that appears in every inquiry report. Finishing what he started means building the human half into the fabric the way the financial half was built in.

Three things do that, and none of them needs a reorganisation, new legislation or a heroic appointment. The individual: teaching and practising the capacity to act for the good of others, so that humanity is a trained capability rather than a trait some staff happen to have.

The community: small circles that belong to a network beyond the employer, so there is always a route management cannot close — to call it forward when something is being done well, and to call it out when it is not.

And accountable leadership: trust, so that people tell the truth early; forgiveness, so that an honest mistake does not have to be hidden; and being held to account, so that forgiveness is not mistaken for indifference.

The test of whether any of it has been built is one question, and a board can answer it in an afternoon: what here would still be true six months after the chief executive left? Annex 12 · Humanity-First Healthcare: applying lessons from the past · Annex 13 · Radical leadership · Annex 14 · Healthcare: why the Art of Enablership is critical

And the people who hold the line need someone to hold it for them. They get targeted, worn down and sidelined: the speaking-up score in the 2025 NHS Staff Survey is at a five-year low, the National Guardian's Office closed on 30 June 2026, and the doctor who described Mid Staffordshire most clearly is the one that culture broke and removed.

Bevan himself held a line for three years against his own Cabinet and a profession that balloted roughly nine to one against him — and he did it with a Cabinet majority behind him, which is the point.

Holding the line takes choice, connection and creation. It is a team effort, and champions need champions. Annex 17 · Holding the line

Where this comes from. Humanity-first healthcare draws on fields outside medicine that have studied, at their most extreme, how ordinary people come to harm others and how that is stopped: Holocaust education, and genocide and atrocity prevention.

Their lessons have already been turned into practice elsewhere — active-bystander training built on this research is now used by more than 430 US police forces.

Champions applies the same ideas to health and care.

Its first programme, at a community health service in Chicago, showed real change within 90 days (it is one small, non-randomised study).

And the principles themselves are not new. They are the ones that have held wherever care has lasted: in Griffith Jones's schools in the 1730s, in Elizabeth Fry's nurses in 1840, in the Quakers' belief in the equal worth of every person, in the miners of Tredegar — and in the NHS itself in 1948.

It has been lost, and it can be regained. The spirit that began in the Welsh valleys and became the beating heart of the NHS has not disappeared: it is in the 1.5 million people in England who still go to work every day to look after strangers.

What was built once, by ordinary people acting for the good of others, can be built again — and this time built in.

¹ The Thirlwall Inquiry proceeded on those convictions; an application to the Criminal Cases Review Commission is pending.

² The Thirlwall Inquiry heard "ample evidence of the 'revolving door' employment provided for NHS managers about whom serious concerns had been raised" (summary report, Part Two, paragraph 20). Its Recommendation 13 is that a senior manager may move to another trust only if it is shown that the move is not because of poor capability or misconduct, and that the manager meets the fit and proper person test.

³ Johnson & Johnson's Credo, written in 1943, sets out the company's responsibilities in order: first to the patients, doctors and nurses who use its products, then to employees and communities, and to shareholders last. In 1982, when seven people in Chicago died after taking Tylenol capsules laced with cyanide, the company recalled some 31 million bottles at a cost of about $100m, and its chief executive, James Burke, said the Credo gave him the authority to do it. Decades later the same company agreed settlements of up to $5bn over opioids — a reminder that values written down have to be kept alive, or they fade. Volume 4 tells the story in full.

⁴ From controlled experiments by Christine Porath and Amir Erez (Academy of Management Journal, 2007). People who were belittled before a task performed 33% worse on word puzzles and produced 39% fewer creative ideas than those treated normally; people who merely witnessed the rudeness performed 22–28% worse. The effect ran through reduced working memory. The same pattern has since been found in clinical simulations: neonatal intensive care teams exposed to mild rudeness made poorer diagnoses and shared less information (Riskin and colleagues, Pediatrics, 2015). Volume 5 sets out the full evidence.

⁵ The Lancet Commission on Medicine, Nazism, and the Holocaust (The Lancet, November 2023) — twenty scholars from ten countries, and the first Lancet Commission devoted to the history of medicine. It found that health professionals' part in Nazi atrocities reflected "corrupt moral agency in the face of potential dangers that are inherent to modern, scientific medicine". On the historian Robert Proctor's figures, German physicians joined the Nazi party in greater proportion than any other profession — nearly half by 1945 — and were seven times more likely than other employed German men to join the SS. Eighty years on, the Commission found that "health sciences curriculums, however, rarely cover this topic", and it did not treat this as a German or a British problem. It recommended that every training programme for health professionals worldwide should "include learning about the history of medical involvement in Nazism and the Holocaust", with emphasis on "the responsibility of medical professionals and their institutions to uphold human rights", and argued that "virtually every debate about health professional ethics can gain from an understanding of this shameful history". Its remedy is not more rules but the deliberate formation of professional identity. Volume 6 has the detail.

⁶ Delirium: the Hospital Elder Life Program pairs staff and trained volunteers with patients over seventy to keep them oriented, moving, eating, drinking, sleeping and in company. Across 14 studies and 3,605 patients it roughly halved the odds of delirium (odds ratio 0.47) and reduced falls, at an estimated saving of $1,600–3,800 per patient (Hshieh and colleagues, American Journal of Geriatric Psychiatry, 2018). It is a bundle of practical care, not warmth alone. Babies: in a World Health Organization trial of 3,211 babies weighing 1–1.8kg, starting continuous skin-to-skin contact with the mother immediately after birth cut deaths in the first 28 days from 15.7% to 12.0% — a quarter fewer — and the trial was stopped early because the benefit was clear (New England Journal of Medicine, 2021). The annex on why being human is good for health gives the wider evidence.

⁷ Relationships and survival: a meta-analysis of 148 studies and 308,849 people (Holt-Lunstad, Smith and Layton, PLoS Medicine, 2010). Continuity of GP care: a study of 4.55 million people in Norway, which also found 28% fewer emergency admissions and 30% less use of out-of-hours services (Sandvik and colleagues, British Journal of General Practice, 2022). Warmth: a trial of 262 people with irritable bowel syndrome (Kaptchuk and colleagues, BMJ, 2008). These studies show strong associations; most cannot prove cause. The annex on why being human is good for health weighs the evidence.

⁸ Isolation and loneliness: 90 studies, 2.2 million people (Wang and colleagues, Nature Human Behaviour, 2023); heart disease 29% and stroke 32% higher (Valtorta and colleagues, Heart, 2016). Deaths: WHO Commission on Social Connection, June 2025 — a modelled estimate, not a count. Young people: DCMS Community and Engagement Survey 2025/26 (chronic loneliness, "often or always"); Institute for Public Policy Research, September 2026 (no close friends; the underlying survey is reported to be Understanding Society). One national survey, the Health Survey for England 2024, finds the opposite on chronic loneliness among 16–24s, though still the most loneliness overall. The loneliness annex has the detail.

⁹ The Champions Four Stages of Humanity, inspired by Martin Broadwell's Four Stages of Competence (1969), describe a journey: from unconscious inhumanity ("I don't know what I don't know"), through conscious inhumanity ("I know... but I haven't changed") and conscious humanity ("I intentionally choose humanity"), to unconscious humanity ("Humanity has become part of who I am"). At the fourth stage, "after repeated intentional choices, humanity becomes instinctive": compassion, respect, curiosity, kindness and integrity "require less deliberate effort because they have become part of our habits and identity". Champions stresses that everyone moves between the stages, even within a day, and that stress and pressure pull people back. Steve Kelly, "The Four Stages of Humanity", 35champions.com, 13 July 2026.

¹⁰ British Social Attitudes survey 2025, published by the King's Fund and the Nuffield Trust on 25 March 2026: 26% "very" or "quite" satisfied with the NHS, up from a record low of 21% in 2024; 89% said the NHS should be free of charge when you need it, 81% that it should be funded mainly through taxes, and 74% that it should be available to everyone.

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