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A clear message

NHS political and system chiefs have made a rare, very blunt, if not quite united, appeal to the top of government for more money – and been clearer than ever that the system faces unprecedented challenges.

At the NHS Providers conference in Birmingham on Wednesday morning, the health secretary Jeremy Hunt and, directly afterwards, NHS England chief executive Simon Stevens both said it was no longer possible to argue that more money was not required.

However, beyond the call for more money ahead of the upcoming budget, unity quickly frayed.

Mr Stevens spelled out more explicitly than ever that poorer standards of care – 5 million people waiting for elective surgery by 2020-21 by one forecast – were unavoidable without more cash.

Along the way, he managed to diverge from the health secretary’s position on several fronts.

Mr Hunt had argued just minutes earlier that the government wasn’t beholden to the Vote Leave campaign’s infamous £350m a week for the NHS promise (although, yes, the money would be nice).

Mr Stevens then said people had voted for Brexit at least partly based on that pledge, which did create obligation given the result (so handover the £18.2bn extra a year please).

Mr Hunt pointed out that while health spending as a portion of GDP might be lower than in France of Germany, it compared well to many other European countries.

Mr Stevens responded, sure – if we compare our spending to “austerity shrunken” countries like Portugal and Greece. But wouldn’t we rather be in the same club as Germany and France?

The £18.2m sum would, handily, bring the NHS pretty much into line with these two.

The SoS was relentlessly focused on the need to improve standards of care further.

The NHS England CEO was blunt that many of gains made in the past decade, particularly around elective waiting times, would be lost without extra cash.

He went far further in his direct challenge to government ahead of the budget on 22 November - although his game will be a longer one going on beyond the budget.

Mr Stevens claimed failure to provide a bigger cash boost next year, perhaps in line with £4bn suggested by several think tanks, would force the government to publicly abolish legally mandated waiting time targets.

In a quieter way, Mr Hunt was also clear “it was now impossible” to argue more money was not needed.

But while he said he was arguing “very hard” for the NHS, he also set about lowering expectations.

Mr Hunt said it was “a mistake if we say the entire future of the NHS rest of the decision that Philip Hammond makes in the budget” and that ask needed to consider the “overall economic context”.

He was also clear that he’d yet to win that argument with the chancellor.

He is running out of time to do so.