Simon Stevens’s warning to Theresa May and Philip Hammond of the risks they are running by “underfunding our health services by £20bn-£30bn a year” was spectacular for being so public, pointed and premeditated. It was a plea, a protest, a challenge and an attempt at persuasion all rolled into one, though longer on direct threat than his usual diplomatic subtlety.

The NHS England chief executive’s speech at the NHS Providers conference may yield the extra £4bn for the health service next year that he said it needed. Or, depending on its reception in Downing Street and the Treasury, it could lead to the end of his three-and-a-half-year stint as the man trusted – until now – by ministers to run and save the NHS.

It is the second time this year Stevens has publicly contradicted the prime minister over NHS funding. In January he told the Commons public accounts committee that May’s claim that the NHS would receive £10bn extra during this parliament was “stretching it”, given the real sum was £8bn. That went down very badly in No 10.

Now he has upped the ante by giving May a choice: fund the NHS properly – as independent bodies such as the Office for Budget Responsibility, Institute for Fiscal Studies and the National Audit Office would define it – or risk it visibly deteriorating as plans to improve cancer and mental health care (a subject close to May’s heart) are halted, more patients are forced to wait longer for operations in hospital, and GPs, hospitals and community services end up “retrenching and retreating”.

“Some may say: aren’t we spending at the European average? Well, only if you think bundling in austerity-shrunken Greek and Portuguese health spending should help shape the benchmark for Britain,” Stevens said, rebuking the health secretary Jeremy Hunt for making exactly that claim on the same stage minutes earlier.

Stevens urged May to be guided in her view on the NHS budget by the same spirit that helped Britain tackle postwar challenges such as the need for massive housebuilding. “At that point, this country stepped up and took a bold and optimistic view. Not only on a whole range of social topics, but about the need for and benefits from a national health service.”

So what prompted Stevens’s extraordinary explosion? Senior figures in the NHS say it was borne of frustration that he has been close to frozen out of the pre-budget discussions with the chancellor and feels he is not getting the chance to make the NHS’s case. If so, this is an uncomfortable role reversal for Stevens. When David Cameron and George Osborne occupied Nos 10 and 11, Stevens was a welcome visitor and he – not Hunt – did the service’s lobbying himself. “His pride and ego have been hurt”, said one NHS leader with whom he discussed his speech recently.

It was a high-stakes gamble. If Hammond gives the NHS less than £4bn on budget day on Wednesday week, should Stevens resign, his advice having been rejected? And if it is a modest rise and he stays, is his credibility gone? May has never been a fan, and prime ministers don’t like being embarrassed, threatened or handed a back-me-or-sack-me ultimatum. She has troubles aplenty without the boss of the NHS adding to them.

In the Q&A at the end of his speech one delegate asked Stevens whether he would still be in his job in three years’ time. “Three weeks?” Stevens joked gamely. May’s reaction will dictate whether that was a bit of fun or something more prophetic.

Source: TheGuardian