In his first budget the chancellor should create strong incentives to spur innovation in primary and community health sectors. First, a dedicated £1bn investment and development fund, second, better mechanisms to share ‘what works', and third, a consultation on statutory changes to make co-commissioning a reality. Only this level of central government commitment will give local politicians the steely determination to push through hospital reorganisation.  

The NHS has on average received annual funding increases of 4% since it was founded in 1948. On a per capita basis from 2009/10 to 2019/20 spending will increase by less than 5%. But on an age weighted basis – taking into account the higher cost of our growing elderly population – real spending will actually decline.