The NHS is well into its more austere decade ever, whilst funding for social care has declined every year since 2010. The system has attempted to respond to this crunch in resources by increasing productivity – which it has done – but there is now overwhelming evidence that it is also resulting in growing deficits; increased waiting times and the re-emergence of rationing.

Since the creation of the NHS in 1948, spending on health in the UK has grown, on average, by 3.7 per cent per annum, with similar pressures on social care spend, as a result of demographics, rising expectations, and new treatments and technologies coming on stream.

In the wake of the financial crisis in 2010/11 however, while pressures on the system remained, the funding settlement for health and care changed. The NHS is now well into its most austere decade ever and, with the exception of 2015/16, social care funding has declined year on year since 2010.

This paper argues that without further investment in health and care there the health and care service will continue to lag behind the curve. Better quality care will be technically and scientifically possible but will not be delivered without an increase in funding. The evidence suggests that the combined funding gap in health and care will increase to £8.4 billion in 2020/2021 and £28.6 billion in 2030/31.