Simon Stevens’ funding call ahead of the budget has grabbed headlines, but why was it necessary and how will it go down in Whitehall? 

Tricky negotiations

This month’s budget has clearly been targeted by NHS leaders as an opportunity to extract further spending commitments from the government.

Simon Stevens revival of the now infamous ‘£350m a week’ Brexit promise was a clever way of getting the issue on the news bulletins without having to put a figure on what he wants.

The NHS Confederation and health think tanks have usefully filled in the blanks – they say an extra £4bn of revenue funding is needed just to maintain the current services in each of the next two years, as well as further funds to cover expected pay increases.

We also know the Treasury is looking for “productivity” improvements – perhaps in the form of mass staff contract reform, or “accountable care” – in return for any ground it gives.

On one hand, the need for this intervention suggests that budget negotiations between the NHS and the chancellor/Treasury have not gone well so far.

But on the other, Mr Stevens et al must still feel the door is – to some extent – still open.

Convincing the hawks

The more hawkish Conservatives, including Philip Hammond, will no doubt recall Mr Stevens’ public acceptance of the five-year funding settlement that was agreed in 2015, in which he said the “case for the NHS has been heard and actively supported”.

This was pre-Brexit, when David Cameron and George Osborne, with whom Mr Stevens enjoyed a better relationship, were still in charge and running what appeared a relatively stable government.

There will have been more confidence, on both sides, that further top ups could be secured as the economy improved, so there was no need to point out that most of the conditions set out by NHS England had not been met.

But following Brexit and the new Downing Street arrivals last summer, the promise of further support diminished, and Mr Stevens has repeatedly emphasised that the five-year settlement would be insufficient given that social care, prevention services and capital investment had all diminished.

The referendum has also sparked inflation, which is starting to become a major concern, as well as further workforce difficulties which the NHS is not equipped to cope with.

Far-fetched hopes

The Tory manifesto pledge effectively just extended their existing five-year settlement into the next decade (an additional £8bn over five years), and although it left some wiggle room around phasing, the wording gave the impression of a minimal departure from the previous commitments.

And given the election result scuppered the Tories’ plans to increase taxes, any hopes of a significant increase on the existing revenue budget later this month may be far-fetched. The Treasury will be looking squarely at the thin end of the wedge.

However, we shouldn’t assume in all this that Mr Stevens and Treasury officials are necessarily in serious conflict, or that the lack of a generous Budget settlement would necessitate the NHS England boss jumping ship.

What he has said today is a continuation of, rather than a departure from, the arguments he has made since last July, and he surely has one eye on a more long term persuasion game.

Corrected to state that NHS Confed have called for an increase of £4bn, not £4m.