Everybody but the government seems to accept that on its present course the NHS is living on borrowed time, with a budget frozen since 2010 while pressures on the system continue to rise.

Finance officers are gloomier than ever, and half the NHS trusts are in financial problems, along with a number of foundation trusts and clinical commissioning groups.

Many that are not yet reporting a deficit have hidden it or not yet done the sums.

It’s starting to hit performance. Without more money things can only get worse.

The Nuffield Trust figures are among the clearest in setting out the scale of the gap that is looming between NHS resources and demands.

They point to a further £28 billion gap between 2015 and 2021 if the current spending plans are left unchanged.

And even assuming the most ambitious and far-fetched plans to make savings and one-off disposals of assets all pay off, this still leaves a thumping £12bn gap over that same period which even the most hard-nosed management consultants have not been able to resolve.

Even to get this far assumes unprecedented increases in productivity — from a workforce whose wages have been frozen and falling rapidly against inflation for the past four years, and is already in most areas shouldering increased workload as a result of previous job losses.

Trying to force more work onto a stressed and demoralised front-line workforce ignores all of the lessons the Francis report on the Mid Staffordshire hospitals scandal, which a year ago called for increased staffing levels, more support to nursing and other professional staff and a focus on quality rather than cash savings.

Indeed the figures show that under the pressure of the Francis recommendations, and fearing the intervention of the Care Quality Commission and hostile headlines in the Daily Mail, many trust bosses have since boosted numbers of hospital nursing staff — but at a price.

At the same time numbers of community nurses have fallen and budgets of mental health services, which are regarded as outside of the Francis spotlight, have been suffering a heavier squeeze to funnel more resources to the acute hospitals. Mental health is suffering as a result.

This pattern of change makes a nonsense of the proclaimed government wish to shift more services out of hospitals and into “the community,” and the fanfares of publicity for yet another new, largely empty government statement, launched by Nick Clegg, declaring the “priority” of “closing the gap” and securing changes in mental health.

Even in hospitals, the dynamic is driving many desperate trust bosses towards more Mid Staffordshire-style disasters as they look for ways to save money by whittling down the numbers of more highly skilled — but expensive — staff they employ, leaving less experienced staff in charge while pushing up caseloads and scaling back on all forms of “back-office” and other support staff.

The misguided belief that substantial savings can be made by redirecting A&E services to GPs or relocating hospital care in “community settings” is still driving a relentless process of “reconfiguration” of hospital care — despite the complete absence of evidence that the alternatives are viable or likely to save any money at all.

To drive this forward faster, Jeremy Hunt is still battling to get draconian powers to close or reorganise hospitals at will, without public consultation, anywhere within cutting distance of a “failing hospital,” through Parliament as Clause 118 of the Care Bill.

If passed it would offer a fast-track to the implementation of bad decisions — but also institutionalise the implementation of policies regardless of public opposition and without troubling to make any attempt to secure any public consensus.

All this might give the impression that the changes are being driven by a financial imperative, the consequence of the public-sector deficit, after those profligate years of Labour spending on the NHS and public services.

But the reality is that many of the changes in the NHS forced through by Cameron’s hard-right coalition government not only save no money but saddle the NHS with more bureaucracy, waste and inefficiency.

The tentacles of competition law, introduced to the NHS by the Health and Social Care Act on a much wider and more virulent scale, are now preventing hospitals from collaborating to improve services or merging to save money.

Instead they are pulling services apart and forcing local clinical commissioning groups to put ever more services out to tender — wasting valuable management time and money that is being diverted from patient care to employ lawyers and management consultants.

The very creation of clinical commissioning groups as local bodies, nominally controlled by GPs but with no obligation to work with their neighbouring groups or take any wider view of the NHS, indicates the aim of fragmenting the service.

Existing local NHS services are being broken up by clinical commissioning groups and offered up to profiteering private companies.

In Cambridgeshire and Peterborough the main NHS provider of community health services has now been forced to sign up with a consortium led by the rebadged remnants of UnitedHealth, the failed British offshoot of the giant US health insurer, to bid for the £800 million contract to deliver an “integrated pathway” of care for older people.

All of the five remaining bidders involve major private corporations looking to cream profits out of the budget for these services.

Almost three-quarters of the services put out to tender by the NHS since the Act came into force have gone to the private sector.

Whoever wins in Cambridgeshire, the contracting process is likely to leave chaos in its wake as services are wrenched apart and bundled together in the new, confusing “pathway” that spans community services, mental health and hospital care.

Since any profits can only be made from historically underfunded services by screwing more effort from the existing workforce, downbanding and diluting the skill mix of front-line staff, the only ones to gain — at the expense of poorer, less accountable care for patients — will be the private sector.

This is not about saving money, it’s about ideology. It’s about privatising services in a way that allows the private sector to pick off the bits it sees as potentially profitable, while reducing the rest to a minimum safety net of skid-row services.

Cambridgeshire health bosses know this is unpopular, which is why they have gone to great lengths to conceal what they are doing, keeping all the key documents under wraps. Secrecy is a feature of all of these contracting exercises.

They show us the kind of NHS the Tories want — transformed from a public service into a cash cow for the expansion of private-sector cherry-pickers, and from relatively open bodies meeting in public and publishing their papers to the furtive, secretive bodies we have today.

The very reason there is an unprecedented and tightening cash squeeze on the NHS is because the government is cynically exploiting the financial situation to drive home its agenda to slash back the welfare state.

But before we all shrug in despair and give up, remember — the government is still not winning the argument.

Most people are opposed to privatisation of health services. Local campaigns are springing up to resist.

Clause 118 is an admission of abject failure to win any public support for reconfiguration of hospitals.

Many of the high-profile hospital closure plans are stalled. Lewisham Hospital campaigners, with a powerful popular base of support, have successfully defeated Hunt twice in the courts.

In west London, the plans to axe Charing Cross and Ealing hospitals failed to convince the Independent Reconfiguration Panel that there were any viable plans to replace them — and health bosses were told to think again.

In south-west London plans to axe St Helier and Epsom Hospitals in the teeth of opposition have been derailed — by a Tory minister and senior Lib Dems organising ballots of GPs to discredit their clinical commissioning groups.

In north central London the Whittington Hospital lives on another year after again repelling plans to hack it back.

And even where the plans for reconfiguration are still intact, the countdown to the next election is beginning to become a factor.

Don’t be surprised to see fewer confrontations this year than last, as coalition MPs jockey to keep their seats by defending local hospitals.

The real question is whether campaigners can press Labour to take advantage and turn the screw even further, by promising to put more money into the NHS as well as rolling back the Act.

Let’s make Ed Balls cut the subsidies to billionaires and bankers we can’t afford to keep — and step up the fight for funds for an NHS we can’t afford to live without.

John Lister is director of Health Emergency.