NHS leaders are urging Rishi Sunak to fulfil his pledge to give the service “whatever it needs” to respond to the coronavirus crisis, by boosting its budget by £4bn next year. NHS services need the money to tackle the huge backlog of patients waiting for surgery and the sharp increase in people needing mental health care as a direct result of the pandemic. Patients will suffer if the money for those problems does not arrive, they claim. NHS Providers, which represents trusts in England, wants the chancellor to unveil a major financial boost for the service in his comprehensive spending review on 25 November. It will set departmental budgets across Whitehall for 2021-22 at a time when the government has committed to spend at least £210bn to deal with the Covid public health emergency. The plea comes amid fears at high levels of the NHS that, with public finances under intense pressure because of the huge costs of the pandemic, it will not get as much money as it has been seeking. “We’re hearing that it’s not going to be as much as we need,” said one NHS source. The letter to Sunak reminds him that on 11 March, as the pandemic was unfolding, he told the House of Commons that “whatever extra resources our NHS needs to cope with coronavirus, it will get … whether it’s millions of pounds or billions of pounds … whatever it needs, whatever it costs, we stand behind our NHS”. NHS Providers’ letter acknowledges that “the current public expenditure position is difficult” and that the Treasury does not want to revisit the five-year funding deal which the then prime minister, Theresa May, unveiled in 2018 to mark the service’s 70th birthday. However, it warns that two “urgent, new problems” – the many people unable to access care in the spring and the extra pressure on mental health services – require a rethink and the provision of an extra £3bn-4bn. Acute hospitals need to pay for more diagnostic equipment, such as scanners, while mental health trusts need to increase their capacity to treat those in need, says the letter from Chris Hopson, the chief executive of NHS Providers, and Saffron Cordery, his deputy. “Trust leaders are deeply concerned that if the spending review fails to allocate the extra money to fund this capacity in 2021-22, the health and wellbeing of hundreds of thousands of patients is at risk,” they add. As a result of May’s deal, the budget for the Department of Health and Social Care was due to rise to £139.8bn this year, with NHS England getting £129.9bn of that. However, since then, the Treasury has had to spend £31.9bn more on the NHS than planned. Of that money, more than £15bn went on personal protective equipment for NHS staff, £10bn was earmarked for the controversy-mired test-and-trace programme and more than £1bn on extra ventilators. It has also allocated another £5.5bn to pay private hospitals to treat NHS patients. A government spokesperson said: “This government has put never-before-seen levels of investment into our NHS, both before and during the pandemic. “We confirmed £31.9bn extra in July for health services to tackle coronavirus, with £3bn specifically to support the NHS during winter and to upgrade A&E facilities. “Alongside this we have provided £2.3bn of extra mental health investment a year by 2023-24 as part of the NHS long-term plan and £10.2m in funding to mental health charities to support adults and children affected by the pandemic.”