Change in external factors, such as environmental legislation and climate change, will mean the future of sewerage systems is likely to be different from the past. Combined sewerage systems comprise the vast majority of existing sewers in countries such as the UK. A study funded by UK Water Industry Research Ltd has reviewed the current state of sewerage within the UK, the likely drivers for change and the consequent future impacts over a 75 year timescale. Potential responses to address the anticipated changes have also been considered. It is concluded that due to the wide extent and value of existing sewer systems, these will continue to be used for the foreseeable future. However, in order to meet the major challenges as a result of changing external factors, these need to be operated more effectively, new ideas need to be explored and moves to develop better and more integrated water management systems need to be started if sewer systems in the UK are to provide the anticipated required levels of service well into the 21st century.