The government knows the consequences of getting things wrong. And are currently attempting to repair Britain’s public finances after a run on the pound and the bond-market upheaval during the short premiership of Liz Truss. Data on Jan 2024 showed the UK sank deeper into debt in Dec 2023, with the budget deficit almost tripling in a year to £27.4 billion. With inflation still near four-decade highs, there remains no margin for fresh policy errors.

This analysis is based on interviews with senior NHS executives, consultants, experienced doctors and other associated stakeholders, many of whom spoke anonymously as they were not authorised to speak in public about these very sensitive issues. Their testimony, and the fiscal evidence, reveals that the UK government faces a humongous task to resuscitate a chronic NHS.

Sunak’s spokesman Max Blain said that the government would focus its attention on improving access to health services, and keeping it free at the point of delivery and access.

At the heart of the financial problem is an impossible quandary: How to keep taxes down when health spending is spiralling way faster than GDP? Meeting costs that are slowly overwhelming the economy was once possible — its share of public service spending increased from 20% to 26% in the two decades to 2019 — but there is little left to cut elsewhere, and the NHS can no longer leach other public service budgets.

In any case, diverting resources was not enough in the austerity years after the financial crisis. As budgets tightened, NHS capacity was hollowed out, leaving the system well behind European peers.

According to the charity, "Health Foundation", the UK has 2.5 beds per 1,000 people, the second lowest of the 14 countries that European Union members before 2004, and three practicing physicians per 1,000 people, against an EU14 average of 3.9. The number of CT scanners, MRI scanners and mammography machines is well below the OECD average. Capital investment in health was £33 billion below the EU14 average from 2010 to 2019.

Former Prime Minister Boris Johnson did increase annual spending by £12 billion in 2021, and during the pandemic the NHS increased both hospital consultant and nursing numbers by a little more than 10%. Yet today, research by the IFS has found that the NHS is treating fewer patients than before the pandemic.

One senior NHS England director insisted that the service is overwhelmed but not broken, arguing instead that staff numbers have only kept pace with escalating demands for acute care - the current crisis is primarily about the shortage of beds. Digital monitoring of patients at home is helping but is not seen as a viable long-term alternative to increased funding. The director insisted that capital investment is needed.

The NHS, which employs 1.4 million people overall, is also an increasingly difficult place to work. In four of 12 months in 2022, mental health issues were the leading cause of employee absence, according to data from "GoodShape", a workplace health and well-being provider. Some 130,000 positions were vacant in NHS England in June 2022, including 10,600 medical positions. Currently, medical school places in England are capped at just 7,500 per year. A 15-year workforce plan, to be published soon, is likely to recommend training more UK staff.

One pressing reform is to link the NHS better with social and community care, where many elderly patients are eventually discharged to; but that sector is run by cash-strapped local authorities that have had their own funding gutted during 13 years of Conservative government.

Reform itself is no optimal solution. Labour-intensive industries like healthcare cannot keep endlessly improving productivity. Yet staff costs account for half of the NHS budget and pay demands keep rising, as proven by this year’s NHS strikes.

Many of these pressures are not unique to the UK. New drugs cause financial strain everywhere, and populations grow older and sicker in all the advanced economies. However, the NHS tries to absorb those costs in a centralised, taxpayer-funded model within a society that has voted for low-tax government for much of the past 40 years. For their part, the government has vowed to get waiting lists down but has said little about how that will be practically achieved.