Former NHS chief Sir David Nicholson adds to warnings on finances

The former chief executive of NHS England has questioned funding plans for the health service, saying it was still not clear how political parties would fill its "big financial hole".

Sir David Nicholson, who ran the NHS for almost 10 years, told the BBC on Thursday that politicians needed to recognise the urgency of current chief Simon Stevens's call for an extra £8bn a year.

"What politicians [are] talking about [in their plans] is all the extra things they want to do with the £8bn, but actually there is a significant financial hole," he said.

He warned the £22bn a year productivity increase hoped for by Mr Stevens was "theoretical" and relies on funding promises being delivered earlier - as far as possible by 2015-16.

"A precondition for being able to deliver efficiency gain is to have investment upfront," he said.

Bob Kerslake, former head of the civil service, told the Financial Times recently that the NHS would need "an injection of money up front".

All the political parties have signed up to Mr Stevens's five year plan to overhaul the NHS, but manifestos this week revealed differing approaches. The Conservative party agreed to Mr Stevens's £8bn a year, but Labour stopped short of a full commitment.

"You can't fund the NHS with an IOU," Labour leader Ed Miliband said. Labour has promised £2.5bn funding to be paid for by a mansion tax on properties worth more than £2m and a levy on tobacco companies.

Sir David expressed doubt that money could be delivered upfront if targets on the deficit were to be met. "Where is the money going to come from if it needs to be front-loaded?" he asked.

Last week the Financial Times revealed the NHS was facing even deeper financial pressures than Mr Stevens's plan describes.

An analysis of official data for the FT found Mr Stevens's £8bn-a-year gap was much bigger if data for 2013-14 - not taken into account in Mr Stevens's report - were included.

Productivity in 2013-14 fell dramatically after a care scandal at the Mid Staffordshire hospital put pressure on hospitals to hire more temporary staff. Spending on these posts grew by £1bn, almost 28 per cent, in the year.

The Mid Staffs scandal, as it became known, led to campaigns for Sir David's resignation because he had been in charge of the local health authority at the time.

Sir David told the BBC the affair had been "an important moment for the NHS" because it demonstrated that the health service was capable of providing poor care despite its international reputation.

The NHS cannot publish its latest financial report because of the election 'purdah' period.

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