Forget the revelation that hospitals overspent by almost £1bn last year. The figure that really matters is the Nuffield Trust’s estimatethat the true underlying deficit is closer to £4bn.

The magnitude of hospital overspending puts the government in a horrendous bind. It propels ministers towards a substantial spending increase, but one that could be almost entirely consumed in plugging the hospital deficit, with little money left to invest in the community-based services which are crucial to tackling the root causes of galloping demand.

Alarming evidence published this week underscores the growing harm to patients from a system struggling to cope. Nuffield Trust and Health Foundation analysis shows that between 2010 and 2017, the number of patients having to be readmitted to hospitals in England within 30 days rose by more than 19% – from 1.16 million to 1.38 million.

Even more worryingly, they identified a 41% rise in emergency readmissions for potentially preventable problems such as blood clots, pneumonia and pressure sores.

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