When John Healey stood at the despatch box in 2016 and condemned a Budget for cutting disability benefits by more than £4bn, he was making an argument that will sound familiar to anyone who has sat through an NHS board meeting this year. The argument was that some claims on the public purse matter more than others, and that stripping support from people who are sick or disabled to fund tax relief elsewhere gets the priorities backwards. Nine years on, Healey holds the Treasury, and the department finalising a fresh round of Personal Independence Payment reforms sits inside the same fiscal envelope as the NHS. The health service now finds itself hoping that the man who once made its argument for it will still believe it now that he is the one signing off the cuts.

The timing sharpens the point. The Timms review into PIP eligibility is due to report in November, alongside a Budget in which Healey will have to reconcile Andy Burnham's spending instincts with fiscal rules he has pledged to keep. Disability and incapacity benefits overlap with NHS priorities more than Whitehall likes to admit. Long-term sickness drives both the welfare bill and waiting list pressure, and the government's own workforce strategy depends on getting people well enough to return to work rather than simply narrowing who qualifies for support while they are ill. A chancellor who previously condemned stricter eligibility as an assault on the weak must now choose whether PIP reform qualifies as fiscal restraint or the type of "regressive" decision he used to criticise in the Commons.

What makes Healey harder to read than his predecessor is that his one demonstrated act of rebellion against Treasury orthodoxy was over defence, not health or welfare. He resigned as defence secretary rather than accept spending plans he judged inadequate, and told colleagues afterwards that the Treasury operated as "a dead hand on dynamic government." That is a instructive data point for NHS leaders preparing their submissions for the next spending review, due to be confirmed later this parliament. It shows a politician capable of overriding fiscal caution for a cause he believes in, which is precisely the treatment health leaders have spent years trying to secure. Defence got there through Healey's personal conviction and a hostile international backdrop. The NHS has no equivalent lever, and no similar champion inside the Treasury with a proven willingness to walk.

The health service enters this Budget cycle with its settlement for day-to-day spending already locked in at close to 3 per cent real growth, agreed under Rachel Reeves and unlikely to be revisited wholesale. Capital funding is a different matter. It was left flat in real terms for the rest of the review period, at a moment when the maintenance backlog across NHS estates has climbed past £13bn and trusts are still raiding capital budgets to cover daily running costs. Healey's history as a Treasury minister under Gordon Brown, when public capital investment was treated as an economic tool rather than a discretionary extra, may matter more here than his welfare record. If he is genuinely sympathetic to the argument that crumbling buildings and outdated equipment constrain growth as much as any other form of underinvestment, NHS capital could be where his instincts translate into something usable. If not, the health service joins welfare and everything else competing for headroom against debt approaching £3tn.

None of this guarantees a favourable outcome for the NHS. It does mean the usual assumption, that a chancellor with a left-wing tax record will be soft on public service spending, does not automatically extend to health. Healey's welfare sympathies are well documented and now inconvenient to him. His sympathies on the NHS specifically have never been tested in office. NHS leaders drafting their case for the next fiscal event would do well to remember that the last time this Chancellor broke ranks with the Treasury, it was for a different department entirely.