THE National Health Service (NHS) is in a sickly state. In the first week of this year, eight of England’s 153 acute hospital trusts issued a “black alert”, the most serious level of warning, after becoming so stretched that they were “unable to deliver comprehensive care” to patients. The immediate cause of the crunch is the winter weather, but the health service’s long-term problem is financial. Britain-wide spending on health as a share of GDP in 2014-15 was 7.3%, lower than in most of its peers. That figure is projected to fall to 6.6% by 2021. No other rich European country is going through as steep a deceleration in funding.

The worsening condition of the health service has prompted calls for more money to be made available. But Philip Hammond, the chancellor of the exchequer, has told The Economist that there is no spare money for the NHS, nor any appetite for raising taxation.

“We’ve got to work within the existing envelope. We don’t have any spare cash. There isn’t a pool of cash available,” the chancellor said in an interview on January 9th. “We’ve been asked to provide the NHS with a certain amount of funding by its own management through to 2020. We’ve done that and more, and we expect the NHS to deliver within that envelope.”

And he all but ruled out tax increases. “Additional public spending has to be financed by additional taxation and I don’t personally think there’s going to be a great appetite for that, given where we are, given that rising inflation will squeeze wages this year. I don’t imagine a great enthusiasm for rising taxes,” he said.

The chancellor argued that some parts of the health service were meeting their targets with their current budgets, and that it was up to others to do the same. “Across the NHS there is dramatic variation in performance and I don’t think it is appropriate to start talking about more resource when it’s already clear that in the best-performing areas the existing resources are being made to deliver quite adequately,” he said. “The problem we’ve got is a bit like the problem of the UK economy as a whole, really: the best-performing areas do not cover 100% of the country. And we’ve got to make sure that, whether it’s prescribing practice, hospital performance, health and social care interfaces, we spread best practice.”

Read Bagehot’s interview with Mr Hammond here