NHS leaders are urging Theresa May to give the health service an emergency cash injection of £25bn before 2020 or risk a decline in the quality of care for patients and lengthening delays for treatment.

An influential group representing NHS trusts says that the care provided by hospitals and GP surgeries will suffer over the next few years unless the prime minister provides an £5bn a year for the next three years – and a further £10bn of capital for modernising equipment and buildings.

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NHS Providers is preparing to release its own manifesto next week, calling on the Conservatives and Labour to end what it calls the austerity funding of the health service. Saffron Cordery, the director of policy and strategy , said its analysis showed that there was a “revenue gap” of £4.5bn-£5bn a year in 2017-18 and “each of the subsequent two years as well”.

Hospitals needed that sum, said Cordery, to get rid of their deficits of £800m-£900m a year, fulfil new NHS commitments on cancer and mental health and improve their performance against key waiting time targets.

The NHS also needed a further £10bn for capital spending on building and repairing premises, buying new equipment and modernising how care is provided, she added. That is the sum which a recent report commissioned by the Department of Health said the service needed for those purposes.

May inherited a pledge from David Cameron and George Osborne to provide a £10bn real-terms increase between April 2014 and April 2021. So far in the election campaign, the prime minister has refused to be drawn on how she might fund the health service, telling journalists that they would have to wait for the publication of the party’s manifesto.

A second group, the NHS Confederation, which represents hospitals and ambulance and mental health services, urged May to commit to giving the NHS £8bn-a-year annual budget increases after 2020-21, when the current funding settlement expires. The DH’s budget is due to reach £133.1bn by March 2021.

Niall Dickson, its chief executive, said NHS services were so stretched that it would have to go back to getting at least the 4%-a-year budget increases it enjoyed historically between its creation in 1948 and 2010. After that, the coalition government limited rises to 1% annually.

“It’s quite unsustainable for the shackles to remain on the health and care system and for society to expect the levels of need that will arrive over the next 10-15 years to be met unless it is willing to fund them,” Dickson said. “If we aren’t ready to put significant extra resources into the NHS then difficult choices will need to be made about things that we are going to do.”

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Prof John Appleby, the chief economist of the Nuffield Trust thinktank, said that returning to 4% a year rises “would require a cash increase of around £8bn in 2021-22”.

While Tory backing for such large sums was unlikely, “this could change if the NHS continues to miss its headline performance targets and the concern the public are starting to express about the NHS continues to rise”, he added.

The two interventions put pressure on May on an issue that some polls show is top of voters’ list of priorities in the general election, even ahead of Brexit.

Jeremy Hunt, the health secretary, has said several times that the NHS budget will need to rise by a significant amount after the current funding schedule ends in March 2021. For example, last October he told the Commons health select committee: “It is a given that over coming decades we will need to put more into the health and social care system … if we want a high quality healthcare service, yes, we need to continue investing more.”



Simon Stevens, the chief executive of NHS England, has voiced concern that per capita health funding will decline in 2018-19 and 2019-20. It is due to fall from its current level of £2,223 a head this year by £16 next year and £7 in 2019.

Anita Charlesworth, the director of research at the Health Foundation thinktank, said the NHS could no longer make ends meet by holding down pay and reducing investment in equipment and facilities. “Cracks are evident – access to new drugs is being restricted, waiting times have increased and recruitment and retention are growing problems across the NHS. The health service can always be more efficient but it cannot bridge the gap between pressures rising at 4% and funding at 1% for much longer without quality and access suffering,” she said.



A Conservative spokesman said: “A strong NHS needs a strong economy. Only Theresa May and the Conservatives offer the strong and stable leadership we need to secure our growing economy in future and with it funding for the NHS and its dedicated staff.

“We’ve protected and increased the NHS budget and got thousands more staff in hospitals – but we know that progress is on the ballot paper at this election.”