The NHS’s finances are so dire that the whole health service may break unless it receives a massive cash injection, Whitehall’s spending watchdog has warned. Years of underfunding have left the NHS in England so cash-strapped that it cannot treat patients quickly enough, and the rising tide of ill-health will make matters worse, the National Audit Office (NAO) said. The NAO does not specify how much extra funding the health service needs to get it back on its feet and ensure trusts that provide care can balance their books. But a leading thinktank recently put that figure at £38bn more a year by the end of this parliament. Its grim conclusions raise serious questions about whether Keir Starmer’s government can fulfil its ambitious pledges to rescue the NHS, and again meet key waiting time targets on surgery and A&E care, without spending significantly more money. A growing number of NHS bodies have overspent in recent years despite their best efforts to avoid doing so, the watchdog said in a strongly worded report published on Tuesday. But it warned that, based on current funding trends, the situation is likely to get worse – and that the NHS needs a significant budget boost so it can cope with the increasingly sick population. Cases of cancer, heart disease, dementia and other killer diseases are due to rise sharply in the near future. “When we consider how the health needs of the population look set to increase, we are concerned that the NHS may be working at the limits of a system which might break before it is again able to provide patients with care that meets standards for timeliness and accessibility,” the NAO said. “There is a wider question for policymakers to answer about the potential growing mismatch between demand for NHS services and the funding the NHS will receive. Either much future demand for healthcare must be avoided, or the NHS will need a great deal more funding, or service levels will continue to be unacceptable and may even deteriorate further.” Strikes by various staff groups over the last 18 months, rampant inflation, more staff sickness and the increasingly decrepit nature of much of the NHS’s estate have exacerbated it not getting the cash it needed to perform properly in recent years, the NAO added. Health trust bosses have “enormous concern” at the likelihood that the service is likely to exceed its budget by as much as £3bn this year, because it was given too little money in the first place, said Matthew Taylor, the chief executive of the NHS Confederation. “Despite their best efforts to balance the books, cuts to services and frontline clinical teams are now a reality in some areas. Unless the new government can act quickly, unfortunately these risks will grow and we will see a further deterioration in key areas, including waiting lists.” The government blamed the previous Conservative administration for leaving NHS finances in such a parlous state. “The NHS is broken,” said a Department of Health and Social Care spokesperson. “Not only has this government inherited the worst economic circumstances since the second world war, but also an NHS in deficit. “Getting the NHS back on its feet is our priority, but it will take time.” The DHSC pointed to Ara Darzi’s urgent investigation into the state of the NHS, and 10-year “radical reform” plan that will follow, as proof of its commitment to improving the service.