England has a number of new health and care leaders, who stand at a defining crossroads. The pandemic has rapidly accelerated an existing trend of decline in access and outcomes. This is creating the conditions for an ‘opt-out’ by those who have the means – embedding a two-tier system.

There is near-universal public support for retaining a universal, free, comprehensive and tax-funded NHS. IPPR polling shows a consensus in public support for the basic principles of the NHS as a system that universalises the benefits of the best healthcare and shares the cost across the population.

In this report, the authors propose policies designed to better live with COVID-19, to help build back better, and to help prepare for the future. The proposals are based on three aims: recovery, building back better, and increased sustainability facing an uncertain future.