Emergency care: There is not enough money in the NHS to go around – and politics is trumping long-term strategy

So much for the “ring fence” guaranteeing NHS funding while cuts savaged almost all other areas of public spending. According to the King’s Fund, a crisis is looming in the health service, nonetheless. One in every eight trusts and clinical commissioning groups overspent last year and, more alarmingly, a mere 16 per cent of hospital finance directors expect to balance the books in 2015-16. Although performance is holding up so far, waiting lists are on the rise and the four-hour A&E target is under pressure. The Government must either stump up more money or accept that services will be reduced, the think-tank concludes.

Neither, of course, is a palatable choice. On one side of the equation, health cuts are politically toxic in any event, even more so given that the medical demands of an increasing – and ageing – population are only rising. And yet, for all the recent improvements in Britain’s economic outlook, the public finances are still in dire straits – so much so, in fact, that many economists predict tax rises after the next general election if deficit reduction targets agreed across the political spectrum are to be met. The central issue is not about scarce resources, however. Even without the acute pressure from the financial crisis, questions about the wisdom and practicality of ever-rising health budgets would want answers. Nor is this simply a matter of doing more for less. While the efficiency programme slashing £20bn from annual costs over the past five years is admirable, it is hardly a model that can be replicated indefinitely.

The problem is that to trim budgets and deliver the services needed requires structural changes for which there is little public support. The traditional model of the district general hospital no longer makes sense, either financially or medically. Yet it remains a staple of grassroots campaigning to characterise the closure of a specialism, let alone an entire institution, as tantamount to a medical blackout – a misperception with which local MPs connive.

The immediate future for the NHS is rocky, indeed. Not so much because there is not enough money to go around; but because local politics is trumping long-term strategy.