Junior doctors protest against contract changes. But is there actually a chance the NHS will collapse? Photo: Flickr/Rohin Francis

The financial pressure facing the NHS has never been greater. The decision to cancel all non-urgent operations in January signals that it can no longer guarantee universal access to comprehensive care. Nurses are leaving in droves, and below the radar, the status of the NHS as the habitual provider of medical services to the great bulk of British citizens is beginning to crumble, with more patients going private—even for things like cancer care. For 70 years, the idea that the NHS is “there for us all” is what has sustained it politically, and so here, perhaps, we are starting to see the outlines of an endgame for the service.

Nobody in the political crucible yet puts it that way: it would provoke outrage. Instead, voices are being raised in favour of a Royal Commission to examine health funding, including sources beyond taxation. The idea has been proposed by the right-wing Centre for Policy Studies and has  won support from the Sun, the Mail, the Telegraph and several Conservative MPs.

Despite its unprecedented severity, the current winter crisis will pass. Its cause—a sustained deterioration in NHS capacity in an ageing society—will continue to wreak havoc. Funding has simply grown too slowly for too long: at an average of a little over 1 per cent a year since the Cameron government arrived in 2010, compared to an average of 4 per cent over the life of the NHS. This sustained slowdown occurred while the population was growing, so real spending per head has actually fallen.

The effects have been brutal. Taking account of inflation, an average hospital is given just £760 this year to treat a patient they’d have received £1,000 for in 2010, according to the Nuffield Trust. The little relief offered in the Budget (amounting to a modest funding boost of 0.7 per cent per head next year, and next to nothing after that) will be overwhelmed by huge cuts to public health and social care.

Unsurprisingly, rationing has increased. Four million people were waiting for hospital admission in England in November—50 per cent more than five years ago, the King’s Fund says. Many affluent middle-class people—especially those aged over 60—are choosing not to wait, and making their own arrangements in…

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