This article first appeared in the BMJ Current tax revenues cannot maintain healthcare standards, writes Christopher Smallwood , but David Wrigley worries that introducing inequity sounds the death knell of a service free for all who need it Yes—Christopher Smallwood It is hardly controversial to suggest that standards of healthcare in the NHS are declining. A stream of recent reports has shown the strain the NHS is under, drawing attention to a near universal failure to meet the target of four hours’ waiting time in emergency departments, 1 the longest waiting times for operations since 2007, and unprecedented staff shortages. The principal cause of this lamentable state of affairs is unquestionably underfinancing of the system. In 2012-13, few trusts were in deficit but by 2015-16 the proportion had reached 85%. 2 As the King’s Fund has said, we are “facing a health system buckling under the strain of huge financial pressures.” 2 Cur...