Protesters from the National Health Action Party lead a mock funeral procession for the NHS along Whitehall. Photograph: Getty Images.
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The NHS funding crisis is now impossible to ignore - which party will grip it?

Without new money, the health service will be condemned to years of dangerous decline. 

After four years of austerity, the NHS funding crisis is becoming impossible for the government to disguise. More than one in three trusts (58) are now running a deficit, compared to just one in ten (16) before the coalition entered office. Meanwhile, the BBC reports today that health service faces a funding gap of up to £2bn next year as its budget is burst by rising demand. 

All of this was entirely predictable. Contrary to the conventional view that it has been shielded from austerity, the NHS is currently 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 current parliament it will rise by an average of just 0.5 per cent. Consequently, in the words of a recent Social Market Foundation paper, there has been "an effective cut of £16bn from the health budget in terms of what patients expect the NHS to deliver". Should the NHS receive flat real-terms settlements for the three years from 2015-16, this cut will increase to £34bn or 23 per cent.

If the health service, the most popular spending area among the public (71 per cent believe that its budget should be increased and just 5 per cent that it should be reduced) is to survive in anything like its present form, the question of new funding can no longer be deferred. Jeremy Hunt is involved in talks on additional funding for the next financial year (potentially to be announced in George Osborne's pre-election Budget) but this will only be a sticking-plaster solution at best. 

If they wish to avoid a significant fall in the quality and quantity of services, this government and future ones are left with three choices: to significantly raise taxes, to cut spending elsewhere, or to impose patient charges. The third of these is proposed today by the Royal College of Nursing, which calls for a £10 fee for patients to see their GP. If this seems heretical, it's worth remembering that our free health service hasn't been truly free since Labour chancellor Hugh Gaitskell introduced prescription charges for glasses and dentures in his 1951 Budget (although they have now been abolished in Scotland, Wales and Northern Ireland). But unsurprisingly, the Department of Health has responded by dismissing the idea out of hand: "We are absolutely clear that the NHS should be free at the point of use, and we will not charge for GP appointments." Labour, needless to say, takes the same view. 

The most concrete suggestion on how to solve the crisis has come from Labour's Frank Field, who has called for a 1 per cent rise in National Insurance, comparable to that introducd by Gordon Brown in 2002, with the additional funds put into a dedicated fund that would be run as a mutual. But after spending much of the last year warning of a "cost-of-living-crisis", senior Labour figures, most notably Ed Balls, are doubtful that the party can afford to go into the general election pledging to raise general taxation. In an attempt to start a political bidding war, I'm told by Field that he will shortly meet with Hunt to try and sell the idea to the Tories. But all the signs are that David Cameron and George Osborne intend to run a classic 1992-style campaign in which they pledge to clear the remainder of the deficit through spending cuts alone and denounce Labour's "tax bombshell". 

But unless the parties are soon willing to confront voters with the truth that if they want the NHS to survive, they will have to pay for it (that is to say, they cannot enjoy Nordic-style services on US-style tax rates), the health service, rated by a new US study as the best in the world, will be condemned to years of dangerous decline. 

George Eaton is political editor of the New Statesman.

John Moore
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The man who created the fake Tube sign explains why he did it

"We need to consider the fact that fake news isn't always fake news at the source," says John Moore.

"I wrote that at 8 o'clock on the evening and before midday the next day it had been read out in the Houses of Parliament."

John Moore, a 44-year-old doctor from Windsor, is describing the whirlwind process by which his social media response to Wednesday's Westminster attack became national news.

Moore used a Tube-sign generator on the evening after the attack to create a sign on a TfL Service Announcement board that read: "All terrorists are politely reminded that THIS IS LONDON and whatever you do to us we will drink tea and jolly well carry on thank you." Within three hours, it had just fifty shares. By the morning, it had accumulated 200. Yet by the afternoon, over 30,000 people had shared Moore's post, which was then read aloud on BBC Radio 4 and called a "wonderful tribute" by prime minister Theresa May, who at the time believed it was a genuine Underground sign. 

"I think you have to be very mindful of how powerful the internet is," says Moore, whose viral post was quickly debunked by social media users and then national newspapers such as the Guardian and the Sun. On Thursday, the online world split into two camps: those spreading the word that the sign was "fake news" and urging people not to share it, and those who said that it didn't matter that it was fake - the sentiment was what was important. 

Moore agrees with the latter camp. "I never claimed it was a real tube sign, I never claimed that at all," he says. "In my opinion the only fake news about that sign is that it has been reported as fake news. It was literally just how I was feeling at the time."

Moore was motivated to create and post the sign when he was struck by the "very British response" to the Westminster attack. "There was no sort of knee-jerk Islamaphobia, there was no dramatisation, it was all pretty much, I thought, very calm reporting," he says. "So my initial thought at the time was just a bit of pride in how London had reacted really." Though he saw other, real Tube signs online, he wanted to create his own in order to create a tribute that specifically epitomised the "very London" response. 

Yet though Moore insists he never claimed the sign was real, his caption on the image - which now has 100,800 shares - is arguably misleading. "Quintessentially British..." Moore wrote on his Facebook post, and agrees now that this was ambiguous. "It was meant to relate to the reaction that I saw in London in that day which I just thought was very calm and measured. What the sign was trying to do was capture the spirit I'd seen, so that's what I was actually talking about."

Not only did Moore not mean to mislead, he is actually shocked that anyone thought the sign was real. 

"I'm reasonably digitally savvy and I was extremely shocked that anyone thought it was real," he says, explaining that he thought everyone would be able to spot a fake after a "You ain't no muslim bruv" sign went viral after the Leytonstone Tube attack in 2015. "I thought this is an internet meme that people know isn't true and it's fine to do because this is a digital thing in a digital world."

Yet despite his intentions, Moore's sign has become the centre of debate about whether "nice" fake news is as problematic as that which was notoriously spread during the 2016 United States Presidential elections. Though Moore can understand this perspective, he ultimately feels as though the sentiment behind the sign makes it acceptable. 

"I use the word fake in inverted commas because I think fake implies the intention to deceive and there wasn't [any]... I think if the sentiment is ok then I think it is ok. I think if you were trying to be divisive and you were trying to stir up controversy or influence people's behaviour then perhaps I wouldn't have chosen that forum but I think when you're only expressing your own emotion, I think it's ok.

"The fact that it became so-called fake news was down to other people's interpretation and not down to the actual intention... So in many interesting ways you can see that fake news doesn't even have to originate from the source of the news."

Though Moore was initially "extremely shocked" at the reponse to his post, he says that on reflection he is "pretty proud". 

"I'm glad that other people, even the powers that be, found it an appropriate phrase to use," he says. "I also think social media is often denigrated as a source of evil and bad things in the world, but on occasion I think it can be used for very positive things. I think the vast majority of people who shared my post and liked my post have actually found the phrase and the sentiment useful to them, so I think we have to give social media a fair judgement at times and respect the fact it can be a source for good."

Amelia Tait is a technology and digital culture writer at the New Statesman.