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If two areas of public spending have become sacred cows they are the NHS and welfare for pensioners. The former has long been a hot potato – £116 billion, “the envy of the world” (an accolade oft repeated but sometimes disputed), permanently ensconced towards at or near the top of the electorate’s concerns, in evident need of reform but hugely risky for politicians to touch. The latter has gained quasi-religious status more recently – after the poor treatment of the Blair years, the Coalition introduced the pensions triple lock and Westminster has become more nervous about offending the group of voters who are most likely to turn out at election time, even maintaining universal free bus passes and TV licences through the austerity years.

But what happens when two sacred cows come into competition?

We’re about to find out. The crisis in social care provision is overflowing into large extra costs for the Health Service, which has spurred Simon Stevens, the Chief Executive of NHS England, to propose an end to the triple lock and to freebies like bus passes in order to make up some of the funding shortfall.

This is easy for an unelected official to say, MPs and Ministers might well grumble. Stevens doesn’t have to face the fury of a group whose turnout rate in 2015 was 78 per cent. And yet his proposals clearly have merit – he has been willing and able to say what many of his masters are allergic to even muttering. The triple lock, and other associated policies, have worked – bringing a drastic fall in pensioner poverty and propelling older people above their younger counterparts in terms of disposable income. To preserve it wouldn’t maintain that position, it would accelerate it further, at a large cost when money is tight elsewhere.

An end to the triple lock already seemed to be a growing possibility, sacred status or not. Stevens’ intervention may well make that path easier – if the choice is between helping the ill and the relatively well-off, between the NHS and pensioner welfare, I know which I would bet on.

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