It’s hard to think of any Prime Minister who has entered office surrounded by such low expectations. Liz Truss was backed by just over half of Conservative party members and secured barely an eighth of MPs in the first ballot. Her critics dismiss her as a lightweight, wholly unsuited to tackling the problems now facing the country. The presumption is not just for trouble, but calamity: the fastest drop in living standards in living memory, followed by prolonged recession and worse.

So if Truss manages to send inflation into reverse and makes a noticeable cut to taxes by Easter, it will be seen as quite an achievement. She has also been helped by Rishi Sunak’s somewhat wild exaggeration of the risk her tax cuts posed to the public finances. Her proposed reduction of National Insurance by 1.25 percentage points, while welcome, is rather small – and was priced in by the markets some time ago. If they were going to baulk at Trussonomics, they’d have done so already.

Perhaps the biggest threat to Truss’s survival is the state of the National Health Service. It’s striking that her long-standing ally Thérèse Coffey, now her deputy, was asked to become Health Secretary. The new Prime Minister must deal with an organisation in deep crisis.

Some 29,317 patients had to wait more than 12 hours to be admitted to hospital after being seen in A&E in July, up from a few hundred before the pandemic. The average ambulance wait time for illnesses such as strokes was just under an hour, three times as long as was normal in 2019. There are 356,000 people who have waited more than 52 weeks for an operation or other procedure – such waits had been eliminated prior to Covid. Traditionally the summer has seen a lull in NHS demand before cold weather and winter viruses set in. There’s been no such lull this year. In a sign of what might be to follow, Australia has just seen its biggest flu spike in five years.

Chris Whitty, the chief medical officer,is concerned that low temperatures will lead to thousands of extra deaths. This fear is well-founded. Every winter, Britain suffers at least 20,000 excess deaths – a figure that would cause much more controversy if those affected did not tend to be in their eighties and over. Studies show that when home temperatures dip below 17°C, the likelihood of blood clots, strokes and death goes up dramatically. Official guidance is to keep living rooms at 21°C for the elderly, but how many can afford to do that this winter? Britain’s poorly insulated homes mean our winter excess deaths are far worse than those of, say, Norway. Combine this with an NHS that is already toppling over and the picture is stark.

It is ironic that the NHS overload is down to the panicked decision to impose lock-downs, which were justified by the prospect of an overwhelmed NHS. The public answered calls to ‘protect the NHS’ by not using it – a message health chiefs deeply resented because they knew the failure to deal with smaller health issues leads to a build-up of bigger issues further down the line.

In all, there seem to have been eight million fewer NHS appointments during the lockdowns. The original assumption was that half of these people would seek healthcare eventually, which is why waiting lists – six million at the end of lockdown – were expected to surpass nine million next year. It now seems that far fewer patients are coming forward. The number of people being diagnosed with illnesses such as cancer has fallen sharply, while the number of people dying at home has risen.

Eventually, Truss will have to reckon with the question of whether lockdown cost more lives than it saved. This is about the future, not the past. The NHS’s fragility means we can expect more calls to lock down in the event that a new pathogen should strike. We need to be in a better position to assess the health risks of doing so. What are the consequences? Which interventions save the most lives? As more data emerges, answers must be found before new panic sets in.

The NHS in its current form is unlikely to survive the effects of lockdown. More capacity is badly needed, and pouring cash into the unreformed system has not worked. There was a time, before Tony Blair’s premiership, when a government presiding over a struggling NHS could have been accused of starving it of money. Britain once lagged behind other developed countries in health spending. But it is no longer possible to argue this point. At the last count, Britain spent 13 per cent of its GDP on healthcare, more than any developed country other than the United States, itself often accused of running a very financially inefficient health system. Too many lives are at stake to ignore the need for reform.

For now Truss will have to get through this winter as best she can. As far as possible, her energy-bill bailout should be aimed at protecting the most vulnerable: that is to say, the over-eighties and those most likely to die of the cold. The economic issues she faces are huge, but so too are the risks of a collapsing health service. Protecting the old and infirm should be the first priority in whatever plan she has for the next few months.