The 2015 General Election will be a pivotal moment for the long term direction of public policy, including health policy. The Chancellor of the Exchequer has suggested that the 2015 Parliament will see spending settlements that are just as tight as the current one, if not tighter. As the Deputy Prime Minister has argued, 2015, and not 2010, will see the “first full blown scarcity election”. Health policy will be one of the most challenging issues for any future government. In the next Parliament budgets are expected to remain tight and there will be continued need to deliver value for money in the face of an ageing population and the growing prevalence of chronic illness. All political parties are now calling for greater integration of services to improve outcomes and value for money. Rising expectations means new ideas will be needed to ensure access to new treatments and create more patient-centred care.