The coalition government has finally wielded its long threatened axe with results that do not bode well for the NHS and social care.1 Spending on the NHS is to be slashed from an annual increase of 6% to 0.4% over the next four years, starting in April. Excluding the £15bn (€16.8bn; $23.6bn) to £20bn savings target, and with the promised modest increase amounting in practice to a cut in purchasing power once pay and other increases have been factored in, the key question is now whether what was announced by the chancellor will actually be implemented. By cutting public spending so far and so fast, the entire economic recovery may be at risk⇓.2

If a week is a long time in politics then four years is an eternity, and a great deal may (and can) yet happen to modify, or even derail, the government’s various plans for spending cuts and restructuring. At the same time, strategic health authorities, primary care trusts, and local authorities are rushing to make deep cuts, often ahead of the need to do so, which means that many of the half million public …