Intended for healthcare professionals


The three crises facing the NHS in England

BMJ 2015; 351 doi: (Published 14 October 2015) Cite this as: BMJ 2015;351:h5495
  1. Chris Ham, chief executive
  1. 1King’s Fund, London, UK
  1. c.ham{at}

Ministers need to be honest with the public about the consequences for patient care

The NHS in England is in crisis. For now the crisis is financial, with providers in deficit by almost £1bn (€1,4bn; $1.5bn) at the end of the first quarter of this financial year.1 2 It will soon extend to patient care as waiting times—already under huge pressure—lengthen and providers look for ways to cut costs. Before long, the crisis will become political as the government decides what to do about funding in this parliament.

None of this is surprising. Regular surveys by the King’s Fund of NHS finance directors have shown growing concerns about funding and performance and increasing pessimism about the future.3 And the fund’s recent submission to the government’s spending review shows how this is already affecting patient care.4 The government can’t claim it wasn’t warned, but it has been much too slow to act.

The hard question is what to do now, with care and cost pressures set to increase as winter approaches. In the short term, it will not be possible to get budgets back into balance because NHS providers have to meet demanding targets for patient care …

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