An epic struggle is occurring within the NHS to sustain current services and at the same time transform how care is delivered to better meet changing needs.
This struggle is being played out in an uncertain political and economic context. Brexit and its consequences mean that public finances remain tighter than ever, and domestic issues like health and social care are receiving much less attention than usual at the heart of government.
The resignations of David Cameron and George Osborne have removed the two members of the Cabinet – apart from Jeremy Hunt – who had a personal commitment to the NHS five year forward view. Theresa May and Philip Hammond have much less understanding of the NHS and social care, and unlike their predecessors they lack access to advisers who do. May and Hammond are also known to be unsympathetic to the claims being made for extra funding for health and care, having previously run government departments whose budgets were not protected.
Against this background, 2017 promises to be another testing year. Leaders at all levels have focused on achieving financial control totals and getting back on track in meeting waiting time targets. They have done so under intense political and media scrutiny and scepticism in some parts of Whitehall about their ability to deliver their plans.