The NHS must undergo radical change or it will continue to decline and lose public support, Tony Blair has argued on the service’s 75th anniversary. It must embrace a revolution in technology to reshape its relationship with patients and make much more use of private healthcare providers to cut waiting times, the former Labour prime minister says. The prevalence of chronic health conditions, long waiting times, the NHS’s stretched workforce and tight public finances in the years ahead mean the service must transform how it operates, he said. “The NHS now requires fundamental reform or, eventually, support for it will diminish. As in the 1990s, the NHS must either change or decline,” he writes in the foreword to a new report from his Tony Blair Institute thinktank, which sets out ideas for safeguarding the NHS’s future. He adds: “Change is never easy and requires brave political leadership. If we do not act, the NHS will continue down a path of decline, to the detriment of our people and our economy.” Every patient should be given a new online personal health account, hosted by the NHS app, Blair proposes. That would let people see a record of every test, appointment and treatment they had had and would collate personal health data, including from wearable devices such as Fitbits. It would also allow the NHS to send information designed to make people more responsible for their own health, as well as details of services on offer from private healthcare firms. On six occasions in his foreword, Blair backs the private sector playing an expanded role, including in the provision of high-volume, low-complexity services, such as dermatology. When in No 10 Blair used independent sector treatment centres, run by private companies, to help tackle long waiting lists. But Dr John Puntis, the co-chair of the campaign group Keep Our NHS Public, urged caution on Blair’s ideas. “Caring is about people, and although technology supports healthcare it can never be a magic bullet and replace the need for staff. “The Blair years demonstrated that with increased investment, NHS performance and patient satisfaction improved. On the other hand, use of the private sector undermined NHS services, and independent sector treatment centres pushed up costs,” he said. More people will resort to private healthcare unless the NHS banishes long treatment delays, Blair predicts. Several pieces of research over the last year have found that about one in eight people have used private healthcare. But new polling out on Wednesday, by YouGov for the IPPR thinktank, puts the figure higher at one in six (17%). Most (41%) had done so to avoid delays in accessing NHS care. However, many more – 27% – had paid for private dentistry. Once those people were included, almost 37% – two in five people have paid for some form of private healthcare since early 2020, the start of the Covid pandemic that disrupted NHS services. There is an increasing risk of “a two-tier system, where healthcare quality, and therefore life chances, depend on what you can afford”, the IPPR said. Meanwhile, the three leading health thinktanks will tell political leaders on Wednesday that the NHS is “unlikely to reach its century” unless the next government commits to a long-term plan to fund it properly, stop staff leaving and tackle the UK population’s “fraying health”. A Department of Health and Social Care spokesperson said: “Harnessing technology and artificial intelligence to improve services for patients is one of the health and social care secretary’s key priorities and we are rolling out new features to the NHS App’s 32 million users and giving NHS patients greater choice over where they are treated at the point of referral, including in the independent sector.”