Sitting in the Edward Heath Room at the 7th Global Patients Congress at the Selsdon Park Hotel, Croydon, discussing universal health coverage (UHC) for all by 2030 (a target in the sustainable development goal for health), one is quickly reminded that if health is a political goal, then UHC is one of the ultimate political choices.

Listening to the debates, one can appreciate that the NHS needed the powerful personalities of Beveridge and Bevan to help the UK found the oldest system of UHC after great political and social upheavals in 1948.

The room, however, has ghosts. The echoes remind us of the Selsdon Group, a free market pressure group that has its roots here in a Conservative Party meeting in 1969, which included the young Margaret Thatcher. The Selsdon Manifesto, an idea born in the room, set in motion the dismantling of the welfare state in the 1970s and 1980s and the introduction of free markets in key social welfare services. The group did not cover the NHS in its manifesto then, perhaps as it had become such a sacred cow that even the Selsdon Group did not dare to touch it. One delegate at the congress, however, observed that this sacredness has gone. The butchers are gathering, he warned.

The patients from Poland shared stories of their country’s UHC and its 360 degree turnaround from exemplar system to flagging model. Their system was modelled on Semashko’s approach and the Marxist and Leninist political, philosophical, and economic ideology to centralise everything. It became an EU and a free market model.

However, Poland’s UHC began to free fall in 1989 after Poland became independent from the disintegrating USSR. It stabilised a little after Poland joined the European Union in 2004. Poland’s system of UHC has now been in transition for over 10 years as the country’s underlying political, economic, and social/demographic changes put pressure on its sustainability.

In counter to Poland’s reversal of fortune, the patients from Rwanda shared their story of Africa’s rising star, the first ever UHC system in Africa.

It is now a question of having systems of UHC that are for patients, by patients, and with patients, and a whole of society and whole of government partnership between patients, and the public and private sectors.

The sustainability of existing UHC systems is increasingly under question, with the growing perception that these old systems are no longer sustainable. They require innovative solutions to improve their effectiveness, efficiency, quality, and safety, and to generally stabilise them.

The NHS’s sustainability was questioned when it came under attack during the monetarist policies of Margaret Thatcher in the 1980s as the legacy of the Selsdon Manifesto began to bite. Part of the NHS’s resilience is that the NHS is a political hot potato. There are powerful stakeholder bodies defending the NHS, such as the professional doctors’ and nurses’ associations and organisations representing patients at all levels. If a bedpan falls in a ward in Wales, its clamour can still be heard in London’s parliament and raised at Prime Minister’s Questions by the afternoon.

The patient delegates in the room agreed that innovation to improve sustainability of the NHS must be patient led. The NHS is adopting innovative approaches to become effective, efficient, and equitable by decentralising and shifting the balance of power and decision making to local communities.

The Selsdon ghosts ask of us that if in every industry it is good practice that its consumers engage in product design and business strategy development, then why does the health industry shirk away from patient engagement?

Kawaldip Sehmi is CEO of the International Alliance of Patients’ Organizations.

Competing interests: None declared.