Intended for healthcare professionals


Tackling the NHS’s unprecedented deficit and securing reform

BMJ 2015; 351 doi: (Published 01 September 2015) Cite this as: BMJ 2015;351:h4670
  1. Kieran Walshe, professor of health policy and management1,
  2. Judith Smith, director and professor of health policy and management2
  1. 1Manchester Business School, University of Manchester, Manchester M15 6PB, UK
  2. 2Health Services Management Centre, University of Birmingham, Birmingham B15 2RT, UK
  1. Correspondence to: K Walshe kieran.walshe{at}

The new government’s response has so far largely missed the point

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 …

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