Are you brave enough Mr Hunt? Are you brave enough Mr Burnham?

I am very proud of living in the UK where there is a National Health Service (NHS) that is (more or less) free at the point of delivery. However, it is becoming widely acknowledged that the health service in England needs to change significantly if it is going to survive the next decade and beyond. The new chief executive of NHS England (Simon Stevens) has tried to tackle this head on and laid down the gauntlet for political parties ahead of next year’s UK-wide general election. Five Year Forward View (FYFV) was published on 22 October (http://www. england.nhs.uk/wp-content/uploads/2014/10/5yfv-web. pdf). In this Mr Stevens sets out a vision for the NHS and outlines the changes that need to be made. A key part of the vision is to have a strong emphasis on preventative measures to reduce the need for healthcare. Long-term health conditions—many of which are preventable—now take up 70% of the health service budget. England is not alone in trying to address this area and it is not the first time an attempt has been made to do so. The Wanless report in 2002 warned that changes needed to be made if the health service was to survive financially. Twelve years later many of the same issues are being raised and we have a situation where: