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Significant cost cutting measures are now being put in place across the global health care industry. In the UK, a £20 billion pound saving has been requested by central government, causing NHS managers to take drastic steps. For example, at St. Gregory’s NHS foundation trust, Managers have canceled Easter as it is felt to be too expensive, and no one will be allowed to watch the Royal Wedding to save on Electricity. This has already lead to a significant increase in mortality on some of the care of the elderly wards, where in particularly severe cases, the royal wedding was the only thing keeping patients alive.

Bloom, P et al. warn in this issue that by 2013 homeopathy could replace modern medicine altogether because populations will loose faith in state sponsored health care and it is really cheap (Some hospitals are now ‘growing their own’). However, the pain is unlikely to end here. The coming months are likely to see a long list of simply appalling lead articles in the Daily Mail which could in some instances cause mass immigration. Probably to Australia, or maybe Canada. But things aren’t so rosy there either. TJOM has found evidence that in Adelaide, hospitals have stopped serving beer on the ward, and there is no access to Vegemite.

So, if you have central crushing chest pain at Heathrow terminal 5, where should you go for your treatment? Here we publish a randomised control study of people suffering heart attacks in international airports. Patients were randomly selected to fly with a low cost airline (e.g. Ryan air, who incidentally charge an extra £35 for flying on a plane with a defib) to a destination of their choice for treatment or to receive care within their home nation. Our detailed and thorough cost/benefit analysis indicates that when faced with this life of death scenario, most patients choose to be treated in their home country however it would be far more cost effective to fly them to Angola.NHS managers at St. Gregory’s have already set up links with the Cameron (no relation) memorial hospital.

The future is going to require some tough decisions. Some really tough decisions. People are likely to loose their jobs (and the government will choose the wrong people) and services will be cut. However, analysis presented in this special supplement suggests that politicians are unlikely to stop taking for granted the good will of the clinicians that provide the service so everything will probably be fine. In 15 years, economic modeling also shows that the world will be run by a single insurance company charging us all a fortune, so resistance is reasonably futile.

We are currently accepting papers on the topic of health reform. Please adress all enquires to The Editor, [email protected]

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