Will the Budget deliver for the NHS?

The last days and hours before a chancellor gets up in the Commons to deliver a Budget are always full of speculation and uncertainty.

Usually key parts of the public sector get a sense beforehand whether their behind-the-scenes lobbying has been successful and they will be in luck with the Budget handouts.

But that is not so this time at NHS England, which has no idea yet whether a very public plea for more cash will bear fruit.

Simon Stevens, head of NHS England, has pursued a high risk strategy and put his authority on the line by warning openly that health services will deteriorate if there is not a significant cash boost in the Budget.

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He chose a keynote speech at the NHS Providers conference to argue that waiting lists for non-urgent care in England will rise to five million without more money from the Chancellor, Phillip Hammond.

But there are concerns at the highest level of NHS England that the plea may have fallen on deaf ears and that what might be spun in Whitehall as "more money for the NHS" will fall short of what is needed.

Mr Hammond's appearance on the BBC's Andrew Marr programme suggested he was not thrilled by Mr Stevens's intervention.

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The chancellor pointedly said that Mr Stevens had drawn up a five-year plan from 2014, including the resources required, which the government had provided, but the plan was not being delivered.

Mr Hammond added dismissively that in the run-up to Budgets "people running all kinds of services, government departments, come to see us, and they always have very large numbers that are absolutely essential otherwise Armageddon will arrive".

Within a few hours of the chancellor's appearance on the Marr programme, NHS England was tweeting previous comments by Simon Stevens to the effect that he had not got all the money he had asked for and that the settlement for the current financial year and the next two was not adequate to meet rising patient demand.

The spat between the Treasury and NHS England had bubbled up again.

So how are we to judge any Budget boost for the NHS?

The Treasury, under great pressure to curb the deficit and satisfy other spending departments, will not be wanting to throw money at health, which is one of the few to have a ring-fenced budget during the years of public sector austerity.

It's possible that lifting the pay cap for health staff, if it happens, will be dressed up as the government's handout to the NHS.

An extra 1% wage rise, over and above the 1% currently planned for next year, will cost £500m.

The NHS in England will welcome any pay increase for staff at a time of increasing problems over recruitment.

But the fear is that there is not much else from the chancellor to pump into front-line services.

The Department of Health budget, covering England, is set to rise by just 0.4% in real terms next year, hence Mr Stevens's call for extra funding just to maintain existing standards of care.

Health think tanks have said £4bn extra above inflation is required for 2018-19, and NHS England has not denied that is what it has in mind.

Any spending hike announced at Westminster will feed through under the usual formula to the devolved administrations.

NHS leaders have also been calling for more investment funding, known as capital as distinct from revenue spending.

The Department of Health in recent years has switched money from capital budgets to prop up day-to-day services.

Health insiders say an increase in capital spending is now badly needed but are concerned that this may not be fully delivered in the Budget.

A "Budget boost for the NHS", if it happens, will mean different things depending where you sit in Whitehall or over the Thames at NHS England's headquarters.

It could involve more money for health workers and a bit on top for running costs.

NHS England's leadership says nothing less than a pay rise and a significant increase for investment and front-line services will suffice.

The answer, of huge significance to Mr Stevens, will lie in the fine print of the official Treasury documents released on Budget day.