“…The answers are even more complex, but they begin with hope, a vision of something better, a sense of the key challenges that must be tackled from here on out, including the elephant in the room of climate disaster (doi:10.1136/bmj-2022-072328), doi:10.1136/bmj.p1331). 89 The BMJ ’s Commission on the Future of the NHS will help lead that thinking, and some of our commissioners spell out their personal aspirations in a feature this week (doi:10.1136/bmj.p1422). 10 They promise values, principles, and evidence based and people centred strategies.…”