In an article for the Daily Telegraph in June, Andrew Lansley, England’s health secretary, made an interesting prediction. By 2030, he said (referring to England), “If things carry on unchanged, this would mean real terms health spending more than doubling to £230 billion.” He also stated that, “This is something we simply cannot afford.”1 It is of course then a short step to an argument that the NHS must change (because unchanged equals unaffordable) and that the change it needs are the secretary of state’s reforms. This is a version of the “politician’s syllogism”:

• 1. The NHS must change (otherwise it is unaffordable)

• 2. This (the reforms) is change

• 3. Therefore we must do this (the reforms).

As the “pause” and subsequent changes …