Debate about funding has highlighted the difficulty of persuading sceptics that the NHS is a good use of public finance. There is a widely held view – particularly in finance ministries and some sections of the media – that health systems such as the NHS are ‘black holes’, constantly demanding increased funding without concomitant returns to society.

In the 2018 OHE Annual Lecture, Professor Peter Smith argued that an economic case can be made for investment in the NHS. But it is not straightforward and will involve changes in the way the NHS thinks about itself. The NHS must show how it can promote the government’s macroeconomic objectives, including sustainable public finances; a stable economy and financial system; and structural reforms to increase employment, productivity, growth, and international competitiveness; and supporting societal wellbeing.