When I launched Health Policy Insight in 2008, four years ago (and let's face it, you get less than four years for manslaughter these days), it seemed clear that the financial crisis was likely to screw things up for public sector spending.

It wasn't certain, but it was likely.

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Today's new report by the Institute for Fiscal Studies, funded by the Nuffield Trust, The NHS and social care funding: the outlook to 2012-22, concludes that "public funding for health is set to be tight until at least the end of the decade. If NHS productivity does not increase sufficiently fast to bridge the gap between funding and demand pressures, then access to and quality of care is likely to deteriorate. Serious thought must then be given to options for the NHS. These include reconsidering the range of services available free of charge to the whole population or the level of taxation needed to finance those services in the future".

This is A Thing That Is Not Surprising.

The IFS worked with the Kings Fund in 2009 to produce one of the Michael-Fish-John-Kettley-school-of-title How cold will it be? Prospects for NHS funding: 2011-2017, which gave us arctic, cold and tepid scenarios.

More recently, Sally Gainsbury revealed in the FT that "the service will need to find a further £20bn or more of efficiency savings as soon as the current target is met in 2015. The DH figures (were) based on its discussions with the Treasury ... the warning was given by Richard Douglas, DH director-general of policy, strategy and finance ... in a frank discussion about the prospects for health service funding beyond the current spending period, which ends in 2015, Mr Douglas warned NHS managers they were deceiving themselves if they believed the pressure on the service would be relaxed after the current £20bn target was met".

The IFS / NT report concludes that the NHS must either explicitly ration more care; or see taxes rise to pay for care.

Whichever strategy is chosen - abandoning whole areas of formerly NHS-funded provision; more user charges; or explicit rationing - each is such a well-known policy zombies that HPI readers are unlikely to be fooled.

Alan Maynard took down Mark Britnell's last crack at this here for us in May 2011.