Warning comes after financial regulator warned NHS ‘could pop’ without an emergency cash injection in budget

The NHS will need up to £24bn more by 2022 than Theresa May plans to give it or patient care will worsen and treatment waiting times grow even longer, experts have said.

Rising demand for care means the NHS budget in England will have to jump to £152.6bn by the end of this parliament, which could be as much as £24.2bn more than ministers have pledged.

At least £4bn of that will have to come next year alone just to keep the NHS functioning well, three leading health thinktanks have said.

The estimates come a day after the boss of the service’s financial regulator warned that the NHS could “pop” unless it receives an emergency cash injection in the budget later this month.

Jim Mackey, the chief executive of NHS Improvement, said the NHS would have to scale back the range of services it provides in ways that would damage patient care if chancellor Philip Hammond does not announce an increase on the sums already planned on 22 November.



The chief executive of the King’s Fund, Prof Chris Ham, said the NHS is in danger of going backwards as a result of its unprecedented budget squeeze.

The King’s Fund – a health thinktank – produced the pre-budget analysis of health spending alongside the Nuffield Trust and the Health Foundation, two independent charities.

Annual rises in health spending have averaged 1% since 2010, when the David Cameron-led coalition took over power from Labour, compared with the 4% a year that had occurred until then.

“After seven years of austerity, the dramatic improvements made in healthcare over the last 20 years are at risk of slipping away,” said Ham.

“The message is clear – unless the government finds the money the NHS and social care need, patients, service users and their families will suffer the consequences.”

The analysis found that: “The amount the government currently plans to spend is not enough to maintain standards of care and meet the rising demand for health services. Throughout this parliament, there will be a significant and growing gap between the resources given to the NHS and the demands it faces.”

The £8bn more by 2022 pledged by the Conservatives “will not be enough, however, to close a projected funding gap of at least £20bn by 2022/23 based on the government’s projected current spending plans”.

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How wide the gap proves to be depends on how much of the £8bn extra pledged for the NHS turns out to be genuinely new money and how much is recycled from the wider health budget, the thinktanks say. But even the full £8bn would still leave a substantial gap, they point out.

Mackey, hired by the government two years ago to improve the service’s disastrous finances, warned that the NHS’s already poor performance against key targets for A&E care, cancer treatment and planned operations could deteriorate even further if ministers do not provide more cash.

Speaking to the annual conference of NHS Providers in Birmingham, Mackey said the service’s finances and its ability to do everything expected of it were still on a knife-edge, even though more than half of the 233 health trusts are likely to balance their books this year.

“More than half are managing the money, a much smaller proportion are managing in a sustainable way. It is far too tight, it is far too finely balanced. At what point does this pop?

“The worst thing is that it just pops in performance and the money deteriorates and we get back to where we were when we no longer have an investable proposition.”

Although the government recognises that the NHS’s budget is tight, significant extra money is unlikely to arrive when Hammond delivers his budget, he suggested.

Critics say the £8bn is far less than the service needs given that demand for care is rising at 4% a year and staff are quitting, partly in frustration at seeing their income fall as a result of seven years of pay freezes or 1% pay rises.

Simon Stevens, the chief executive of NHS England, is likely to air his views on how much the NHS needs when he addresses the conference on Wednesday in a speech on how the service is faring as it approaches its 70th birthday next July.

Mackey added: “I hope it [extra money] comes in this budget but at some point it needs to come. If it’s not this budget, it needs to be a budget in the future, hopefully before things pop.”

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The exact scope of what care the NHS can be expected to provide would need to be “reset” and some forms of care “deprioritised” unless its budget goes up beyond the small increases ministers have already planned, Mackey said.

“If there is no more money in the budget, honestly I think we need to be sitting down and agreeing publicly and as a collective what’s actually possible to deliver within that resource. We can’t do everything.”

There would need to be a public debate about the limits of NHS care – “a reset discussion that recalibrates and matches money and expectations”, added Mackey.

The Department of Health said that health spending was close to that in other EU nations.

“As research shows, spending on the NHS is in line with most other European countries, and the public can be reassured that the government is committed to continued investment in the health service – including an extra £8bn over the next five years,” a spokesman said.

“Despite being busy, the NHS has been ranked by the independent Commonwealth Fund as the best and safest healthcare system out of 11 wealthy nations.”