No institution is more venerated than the NHS. Despite billions of pounds of investment over the last decade, which has seen it grow enormously and employ tens of thousands of extra doctors and nurses, it is regarded as untouchable. All political parties are agreed that it must be protected from cuts. None of them is proposing widescale reform.
Can this cosy consensus survive the storm clouds brewing over the state of the UK economy? History suggests not. Today the centre-right think-tank Reform attempts to puncture the prevailing complacency with a radical programme of cuts to shift more NHS care into the community, obtain more bang and save extra bucks.
In its report Fewer Hospitals, More Competition, it argues that tens of thousands of hospital beds should be removed in areas of the country with the highest numbers (the North and London), and that encouraging competition between services rather than between hospitals would encourage the development of extra community provision. If every region had the same number of beds as the South, the total for England would fall by more than 30,000 from 160,000 to 128,000.
It also criticises the Tory leader, David Cameron, for proposing a moratorium on hospital changes and takes Mike O'Brien, a Health minister, to task over his interference in plans by one NHS trust, Gloucester, to remove beds. The NHS should not be allowed to escape the pain inflicted on other public services and should take its share of the budget cuts, it says.
Will we see a political party adopting these robust proposals in advance of the election? Do pigs fly? Governments have struggled for decades to close hospitals and make the NHS more efficient, but they tamper with it at their peril. In the 2001 election, Labour lost a key seat when Dr Richard Taylor stood as a single-issue independent candidate, protesting about the closure of the A&E department at Kidderminster hospital. Dr Taylor won again in 2006.
Closing hospitals does not win votes. Politicians have promised to "restructure" the NHS for decades, but backed off in the face of sustained local opposition. Yet it is impossible to provide the highest-quality medical care in the modern age in every local community. The trade-off is between local access and quality of care. Closing some hospitals is unquestionably necessary, both for the health of the nation and the survival of the NHS.
Politicians can wring their hands and utter platitudes if they choose. But the problems facing the NHS cannot be avoided, only postponed. To all those who work for or depend on it – prepare for a bumpy ride.