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It's 6.30am on the outskirts of Warwick and paramedics Claire Sweet and Kelly Higgerson already have their first call.

The patient - a non-critical case - has been waiting seven hours.

The blue lights of the ambulance illuminate the dark streets as they make their way to the patient, a diabetic person who's been suffering from diarrhoea all night.

It isn't anything life-threatening - but a specialist says the patient should be taken to Warwick Hospital. It all adds to the pressure.

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"It doesn't ever seem to ease off - at all. It puts pressure on us all," Claire tells Sky News.

"We're often waiting outside hospitals and that delays us getting out to help patients."

Winter is always busy for the NHS. But there's another pressure.

A Sky News investigation revealed how integrated care systems - which are responsible for allocating the NHS budget and commissioning services in their area - have been massively overspending.

If current trends continue, our analysis suggests, the NHS may spend £4.9bn more than planned by March 2024.

NHS England says that extra funding has been provided to cover much of the overspend from the first six months of the financial year.

But no further commitment has been made to free up additional funds should that overspend be replicated in the next six months.

Frontline, day to day services must be maintained and paid for. So it means that money that should be spent getting the NHS ready for a more challenging tomorrow - a larger population, a more ageing population - is being spent today.

"Funds that were there to help the NHS become more productive, to see patients quicker, to treat them more efficiently - for example, investing in technology or fixing buildings that are literally crumbling - that money has been diverted to pay to fill the gap in paying for day to day services," Sally Gainsbury, senior policy analyst at the health thinktank, Nuffield Trust, tells me.

I'm riding along in the ambulance with Claire and Kelly, to understand those pressures, how new technology can mitigate them and what that means for future healthcare.

Mid-morning, they get a call to attend a 90-year-old patient who has had a fall.

They make their way upstairs in the house. The patient, Joyce, is lucid and being taken care of her by her daughter when they arrive.

The paramedics suspect she has an infection which has ultimately caused the fall.

Previously, they would have taken her to hospital.

But instead they use an app called Consultant Connect, which lets them speak to a specialist at Warwick Hospital, Dr John Blair.

They describe the situation to him and he recommends Joyce stays at home; a specialist frailty team will come to her house later for a further check-up.

All that means less pressure on the hospital itself. The frailty ward at Warwick Hospital, where patients would usually come, feels relatively quiet, as Rachel Williams, associate chief operating officer, explains.

"We know that if someone rings that frailty phone, 50% of those patients won't come into a hospital setting.

"We haven't opened a surge ward last year in winter because we've been able to keep people in their own homes."

Ms Williams added they know ambulance handover has been kept at a stable level at South Warwickshire by the number of ambulances they've reduced coming to the facility, "even though the demand on urgent and emergency care is going up and up each year".

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So programmes like Consultant Connect help day to day pressures - but they also require initial investment.

And the worry is that overspending means that investment is being squeezed, as Ms Gainsbury points out.

"The NHS had several billion pounds worth of plans this year to invest in new services, to bring in new treatments or improve existing service, improve access for groups of the population who struggle to access healthcare and adopt new technologies - the NHS had plans to improve those areas.

"And in some cases those plans won't be implemented this year because again that money is needed to fill holes."

The work of the West Midlands Ambulance Service crew is high pace and high pressure.

But it's also what the NHS looks like standing still, meeting existing demand.

If money meant for investment is spent on current demand, standing still could become falling behind.