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Observations Future of the NHS

It’s time to be honest about NHS funding for the next five years

BMJ 2015; 350 doi: (Published 16 April 2015) Cite this as: BMJ 2015;350:h1978
  1. Rob Webster, chief executive, NHS Confederation
  1. Rob.Webster{at}

If we had all the money in the world we would still need to change the NHS

Whoever wins the UK general election in May, funding for health is expected to stay below the long term NHS average. Even where a new government is willing to commit to additional funding—and there has been much debate this week, some of it acrimonious, over the various political pledges1—it is likely that unprecedented savings will still be required from the NHS, in line with figures set out in the Five Year Forward View.2

Politicians may experience déjà vu. Before the 2010 election the former NHS chief executive David Nicholson wrote to set out the efficiency challenge over the next parliament, stating, “We need to look at 2010-11 as the first year of this new five-year strategy, not just the final year of growth.”3 Despite this notice, a debate on funding was absent from the political campaign, and NHS finances were barely mentioned in the main parties’ manifestos.

The NHS met the challenge and has delivered around £19bn (€26bn; $28bn) of efficiency savings. In doing so it has continued to increase its productivity by 1.5% a year, from a …

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