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50 People Who Matter 2011 | 7. Christine Lagarde

Figure of fund.

Depending on taste, the International Monetary Fund is the pre-eminent institution for the advancement of global economic stability or it is the agent of US imperialism, bullying broke governments into budgetary servitude. Either way, its vast influence in the recent years of financial crisis is beyond doubt. That makes its new managing director, Christine Lagarde, one of the most powerful women in the world. She took over the job in July, having worked her way up the French ministerial ranks to become her country's first female finance minister. She was backed for the IMF job by her UK counterpart, George Osborne - a mark of confidence in her distinctly un-Gallic commitment to liberal market economics. She has cited Adam Smith as her inspiration; many of her compatriots are suspicious of her Anglo-Saxon tendencies. Just as uncharacteristically French, she is teetotal and a vegetarian.

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This article first appeared in the 26 September 2011 issue of the New Statesman, The fifty people who matter

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Is anyone prepared to solve the NHS funding crisis?

As long as the political taboo on raising taxes endures, the service will be in financial peril. 

It has long been clear that the NHS is in financial ill-health. But today's figures, conveniently delayed until after the Conservative conference, are still stunningly bad. The service ran a deficit of £930m between April and June (greater than the £820m recorded for the whole of the 2014/15 financial year) and is on course for a shortfall of at least £2bn this year - its worst position for a generation. 

Though often described as having been shielded from austerity, owing to its ring-fenced budget, the NHS is enduring the toughest spending settlement in its history. Since 1950, health spending has grown at an average annual rate of 4 per cent, but over the last parliament it rose by just 0.5 per cent. An ageing population, rising treatment costs and the social care crisis all mean that the NHS has to run merely to stand still. The Tories have pledged to provide £10bn more for the service but this still leaves £20bn of efficiency savings required. 

Speculation is now turning to whether George Osborne will provide an emergency injection of funds in the Autumn Statement on 25 November. But the long-term question is whether anyone is prepared to offer a sustainable solution to the crisis. Health experts argue that only a rise in general taxation (income tax, VAT, national insurance), patient charges or a hypothecated "health tax" will secure the future of a universal, high-quality service. But the political taboo against increasing taxes on all but the richest means no politician has ventured into this territory. Shadow health secretary Heidi Alexander has today called for the government to "find money urgently to get through the coming winter months". But the bigger question is whether, under Jeremy Corbyn, Labour is prepared to go beyond sticking-plaster solutions. 

George Eaton is political editor of the New Statesman.