The BMJ today calls on the next Secretary of State for Health to "secure the NHS's future as the best and fairest health service in the world."
In an open letter, Editor in chief, Dr Fiona Godlee, and colleagues say England's NHS is stretched close to breaking point - and they set down what they believe is needed to heal the NHS.
They point to current problems, such as virtually flat-line funding in real terms since 2010, the growing demands of an aging population, and extreme cuts to social care, that have "exacerbated the pressures, causing knock-on effects across the service."
As a result, waiting times for treatment are the longest for many years, while staff morale in many parts of the service is at rock bottom because of real terms pay cuts and the relentless workload, they write.
Patient safety is now also at risk, they warn, with 13 NHS trusts currently in special measures because of concerns about the quality of care being delivered - and eighty per cent of acute trusts are now in deficit.
They explain that in his five year plan, NHS England's chief executive, Simon Stevens, demands savings of £22bn over the next five years. But say this level of saving "will still require efficiency gains never before achieved by the NHS, and a further £8bn is needed from government by 2020 just to stand still."
And they point out that additional election promises - seven day working, guaranteed shorter access times, and more GPs and nurses - have been described by Mark Porter, the BMA's chairman, as "outlandish and unachievable."
Against this background, the editors ask the Secretary of State to give "an unshakable commitment" to providing a publicly funded national health service, free at the point of need and to resist the temptation to undertake further major top-down reorganisation.
They call for a focus on collaboration not competition and marketisation, for public health budgets to be ring fenced to protect vital services, and for "good transparent governance and less political interference."
Finally, they urge the government "to properly fund England's health service."
They point out that the UK spends the joint lowest of any G7 country on healthcare as a proportion of gross domestic product, and the NHS is widely acknowledged to provide the most cost effective care of any developed nation. The NHS is not unaffordable, they say, but if it is deprived of the funds it needs to meet demand effectively, it could become so.
"History will not forgive another health secretary whose actions contribute to its decline," they warn. "Let this be the five years that secure the NHS's future as the best and fairest health service in the world."
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Journal
The BMJ