Intended for healthcare professionals

Observations Beyond the Nicholson challenge

The NHS is facing a deepening financial crisis

BMJ 2013; 347 doi: (Published 10 July 2013) Cite this as: BMJ 2013;347:f4422
  1. Jon Ford, head, Health Policy and Economic Research Unit, BMA
  1. jford{at}

The UK government’s recent comprehensive spending review must serve as a wake-up call

It is 65 years since the creation of a national health service, free for all at the point of delivery. It is this founding principle that makes up the DNA of the NHS. But for it to remain a reality the NHS has to remain financially viable. It is why politicians continue to promise to protect and increase the health budget year on year.

The reality, however, is very different. The government’s latest comprehensive spending review showed that the massive, annual, and recurrent “efficiency savings” target for the NHS in England—dubbed the Nicholson challenge—will continue for at least a year longer than originally mooted. This means that by April 2016 the service will have to make do with only three quarters of the budget it actually needs to keep pace with demand and technological advances. And the response so …

View Full Text

Log in

Log in through your institution


* For online subscription