The NHS didn't receive a mention in Nick Clegg's speech yesterday, but the state of the service is likely to become one of the government's biggest headaches in 2013. The latest King's Fund survey found that 40% NHS finance directors expect patient care to "worsen over the next few years" and that two-thirds believe there is a "high" or "very high" risk that the service will not achieve efficiency savings of £20bn by 2015.
Although spending is ring-fenced, healthcare inflation is significantly higher than the general rate, so the NHS will be continually forced to do more with less, particularly if, as expected, George Osborne carves out £1.7bn from its budget in order to pay for social care reform.
The political problem for the government is that while it could have blamed the service's problems on the fiscal situation, its inept reforms (for which it had no mandate) mean that it will now take the flak. Patient satisfaction fell from 70% to 58% last year, the largest annual drop since 1983 , a trend that is likely to continue this year. The number of patients who are waiting for more than four hours in A&E, for instance, is at its highest level since 2005. And David Cameron's decision to appoint Jeremy Hunt as Health Secretary provides the media with every incentive it needs to highlight the NHS's failings.