NHS funding matters because you get what you pay for. The level of funding in the NHS has a key role in defining how well we can care for patients: how many staff we can employ, the drugs we can afford and the innovations we can adopt. So it’s no wonder that the debate on future NHS funding has been one of the features of the general election. But there remain five, key, immediate, questions which none of the campaigns have answered.

Most of the focus has been on whether the parties will sign up to the £8 billion of extra funding the NHS says it needs in its Five Year Forward View and how this will be paid for. What’s missing is that the NHS Five year forward view set out a £30 billion NHS funding gap by 2020 with only £8 of the £30 billion coming from extra taxpayer funding. The other £22 billion is intended to come from NHS efficiencies. That £22 billion is 2.75 times more than the £8 billion, but it’s received only a tiny fraction of the public attention. Many in the NHS, including the key independent NHS think tanks, believe that the £22 billion will be very difficult to realise and that, while the oft touted mantra of integrating health and social care will be better for patients, there is no evidence that integration actually saves quick and large amounts of money. So the first question is can the NHS really save £22 billion through proven cash releasing efficiencies and what are these? Without an answer to that question, any extra taxpayer funding won’t go very far.

There remain five, key, immediate questions which none of the general election campaigns have answered

The second is the profile and timing of any extra taxpayer funding. Adding £8 billion by 2020 once the deficit has been eliminated or adding £2.5 billion by 2017/18, once new taxes have been created are all very well, but they won’t solve the large and immediate financial problem facing those who have to deliver care to patients today. Eighty per cent of England’s hospitals and 50% of all provider trusts are now in deficit. Last financial year the overall provider sector deficit was around £900m, and this year it will rise to £2 to £2.5 billion. So how are the parties going to phase any extra funding, with particular emphasis on the funding for this and next financial year?

General election campaigns are often about “retail politics”– guaranteed GP appointments, dedicated personal midwives and the like. Yet none of the desirable offers made so far such as seven day services, 36,000 extra NHS staff and extra mental health services are costed in the existing NHS plans and, most importantly, its budgets. If the NHS needs £8 billion taxpayer funding to close the gap on existing service levels, then new initiatives will need additional funding on top. So we need clarity on how much of the extra funding being pledged is to pay for these service improvements and how much is to plug the existing gap.

The fourth question is about funding transformation. All the political parties, rightly, support the NHS Five year forward view’s vision to transform how the NHS delivers care. But change costs money - £2 billion a year over five years according to one estimate. How and to what extent will the parties fund the transformation which they and we all say is essential?

We need more realism and honesty in the general election campaigns

Lastly, NHS foundation trusts and trusts spend between 65% and 85% of their budgets on staff pay. So if we are to realise efficiencies, we have to either cut or make better use of that pay bill. Yet there seems to be an arms race on raising NHS staff numbers. This is simply not credible financially or from a staff supply perspective since the extra staff do not exist and are not yet trained. The NHS has already added an extra £1 to £1.5 billion of unfunded staff cost over the last two years that it cannot afford – hence the ballooning provider sector deficit. So how do the political parties’ promises on staff numbers match up to the NHS’ financial needs and the availability of people with the training and skills?

And, of course, these five questions ignore the longer term issues flagged in reports like the Barker Commission - the need to raise overall NHS and social care funding longer term and ensure full integration between the two systems.

Our members tell us that they do not believe the current election campaign faces up to the scale of the problem the NHS faces and that none of the pledges will alter the grim reality of the service’s fast-crumbling finances. More realism and honesty please!