Health outcomes have improved substantially during recent decades and life expectancy is high compared with other OECD countries. Overall, the universal National Health Service offers good quality-care and has delivered high vaccination rates, while public spending remains contained. However, challenges related to staff shortages and heavy pressures on staff, long waiting lists in the public sector and high out-of-pocket expenditures have been building and were further compounded by the COVID-19 pandemic. This partly reflects a system that remains strongly based on hospital care and has suffered from underinvestment in the years following the global financial crisis. In addition, obesity, a lack of physical activity and high alcohol consumption are weighing on long-term health outcomes, while the ageing of the population will increasingly require more and different healthcare services. The government has initiated a wide-ranging reform agenda through the Recovery and Resilience Plan and the 2022 reform of the National Health Service, with the aim of enhancing the integration of primary, community and hospital care. Reforms will need to address the generally weak budgeting and accountability practices, building on improved information systems and regular evaluations to ensure more efficient spending. Reforming primary care should remain a priority to scale up efficient prevention programmes, promote cost-efficient choices by care providers, improve access for low-income households and limit avoidable hospitalisations.