Senior healthcare figures have warned that a serious debate is required on the funding crisis faced by the National Health Service as “business as usual won’t do”.

A letter has been sent to The Times, signed by chiefs of the royal colleges of nursing, general practitioners, physicians and anaesthetists, plus executives from Macmillan, the Alzheimer’s Society, Turning Point and the Foundation Trust Network. They note that the next 50 years will see a growth of “at least two and a half times as many people suffering from multiple problems [and] unless action is taken, by 2020 maintaining the current level of service provision will require an additional £30 billion for just the NHS — which is as much as we spend each year on defence”.

The authors state that there is an equivalent budget crisis in social care and housing and “the status quo is not an option. We are already seeing the signs of the system creaking at the seams. More must be done by us all to eliminate inefficiencies, wasteful variation in care and apply technology to transform care delivery. Resources and vigorous service reform must go hand-in-hand. Business as usual won’t do”.

The letter goes on to argue that “the longer-term response to this unprecedented financial challenge needs an honest, open dialogue between politicians and citizens. We need a new settlement; a fundamental, holistic agreement with the country on what health and social care should be, how and where it is delivered to maximise the quality of care, and how it should be paid for”.

The letter concludes by suggesting that the best route is “an all-party-mandated, independently conducted ‘national conversation’ on the scope, provision and funding of health and social care. It needs to start now and be completed by the end of next year”.