Tackling the NHS’s unprecedented deficit and securing reform

The Conservative Party finds itself unexpectedly in government without a coalition partner and able to pursue its own health policies at last.1 It has called for seven day working in hospitals and primary care; sought improvements in rates of early diagnosis of cancer; and endorsed the vision in the NHS Five Year Forward View2 of radically different models of care, such as integrated accountable care organisations and a stronger role for preventive care.

But many of these initiatives require an increase in health spending. In a review of the government’s first 100 days,3 the King’s Fund outlined the miscellany of government initiatives so far—financial control, devolution, quality and safety, primary care, mental health, public health, and social care. But Chris Ham, its chief executive, said that the immediate concern should be dealing with the looming financial crisis.4

The financial position is indeed dire. The Chartered Institute of Public Finance and Accountancy predicts a £2.1bn (€2.9bn; $3.2bn) overall deficit for the NHS this year,5 two and a half times last year’s record £820m deficit. Most NHS trusts and foundation trusts, including those that have been financially secure in the past, are …