Studies consistently rate the NHS as the most efficient healthcare system in the developed world, but funding pressures, reorganisations, and population changes mean the health service is facing a very rough ride.
These three charts from The Health Foundation's latest report on hospital finances show just the level of pressure the NHS is under.
1) Costs are increasing, but income isn't keeping up
The Coalition says it has protected NHS spending and increased it every year. However, an aging population and the cost of providing the latest treatments means it needs funding increases every year to stand still.
In mental health, trust incomes have actually fallen despite a rise in costs. Only specialist trusts are seeing funding increases outstrip rising costs.
2) The NHS needs to use its resources more efficiently, but it's using them less efficiently
One of the arguments the Coalition made for its NHS reforms was that it would make the health service more efficient. All the parties agree that hospitals need to do more with the resources they have to avoid a funding shortfall - what economists call 'increasing productivity'.
Unfortunately, the reforms don't seem to have turned around NHS productivity. Productivity actually fell in the NHS by nearly 1% in 2013/2014 the first year the reforms came into force - the biggest fall under the Coalition so far.
One of the problems the health service faces is that in the first few years of belt-tightening the NHS picked all the 'low-hanging fruit' when it came to cost-cutting. From now on finding savings will be more difficult and cuts could be more counterproductive.
3) More and more NHS trusts are having to spend more than their income to keep patients well
The result of funding shortfalls and the inability to improve productivity quickly enough is that trusts are having to go into deficit in order to make sure patients get the treatment they need.
The number of trusts in deficit has grown rapidly over the last few years and this year so far is looking worse than the last.
The Heath Foundation says the NHS is projected to overspend its budget by £626m in 2014/15, despite a £250m injection of cash from the Treasury and an extra £650m taken from capital budgets.
Will this be an election issue? We'll have to wait and see.Reuse content