The case for change that we have set out in this programme of work is not new, having been debated for well over 20 years. Despite this, public awareness remains low, and while political consensus on the need for action exists, the lack of agreement on what should be done has meant a worrying lack of real change for far too long.

While we have not set out to suggest the answer in this work, it does help lay out the groundwork for a solution. We have set out viable options for change, to aid those in government to make the progress that is so desperately needed. Consensus must be quickly sought about whether to address concerns on current access and quality, equity and complexity, or protection against major costs and encouraging an insurance market. It is unlikely that all these issues can be addressed immediately, so prioritising them is the essential first step to producing a lasting solution.

The ongoing green paper process must lead to major improvement. Without it, real people will suffer and public anger will rise at continuing inaction in the face of ever more serious warnings.

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