Introduction

One of the first lessons I was taught at medical school was that the career we were being trained for was by no means the most important factor in promoting good health or a long life. Clean water, sanitation, nutrition, housing, employment and money are all more important than medical care as factors in the improvement in life expectancy. One might now add to the list social networks (Wilkinson and Marmot, 2003) and equality (Wilkinson and Pickett, 2009).

It remains true, however, that medical care does contribute to improvements in both the quality and duration of life. It is also true that societies generally place a high value on the provision of such care; when we are ill we all want someone to look after us, and, if possible, to make us better. In this chapter, therefore, I shall concentrate on the health care that is provided by health services such as the National Health Service (NHS). In the same way, I shall focus on the social care that is normally paid for, rather than the wider social support provided by family, friends, neighbours or colleagues.

The second point of clarification that I need to make is that austerity is a conscious act of policy. It is not an ‘act of God’. Total government spending is a choice, and I would argue that the policy of austerity as exhibited by the UK government, among others, has deepened and prolonged the economic downturn since 2007:

The economic case for spending on health and social care

It does nevertheless fall to governments at a time of reduced government revenue to consider carefully what their priorities for spending should be.