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Can we afford the NHS in future?

BMJ 2011; 343 doi: (Published 12 July 2011) Cite this as: BMJ 2011;343:d4321
  1. John Appleby, chief economist
  1. 1 King’s Fund, London, UK
  1. j.appleby{at}

If England keeps on spending on health at the current rate, the NHS will be unaffordable in 20 years’ time, says the health secretary. Not necessarily, finds John Appleby

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 …

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