Sajid Javid is setting up an "NHS delivery unit" to oversee an efficiency drive in the health service, amid pressure to show that the proceeds of next April's National Insurance hike will not go to waste.

       A team of officials is being established to help ensure that "every penny counts" following the Government's announcement that the health service's budget will rise by ￡33.9 billion a year, The Telegraph understands.

       The disclosure comes as Nikki da Costa, who stepped down as Boris Johnson's head of legislative affairs in August, warns that the Conservatives only have "two final years to set the scene for electoral success". Ms da Costa uses an article in this newspaper to call on the Prime Minister to consider appointing individual senior advisers to oversee major tasks such as NHS reform, in the way that heavyweight figures were given responsibility for areas such as the vaccines programme at the height of the Covid-19 pandemic.

       Senior Tories fear that the Conservatives could face a major backlash at the next election if voters conclude that the 1.25 percentage point increase in National Insurance contributions has been wasted.

       Last month, Conservative MPs expressed fury as it emerged that the Government had failed to secure new commitments from NHS England to demand the increased availability of face-to-face GP appointments in return for the funding settlement.

       Mr Javid used his Conservative Party conference speech last week to declare that there was "a lot of levelling-up to do within the NHS", with a need for a "focus on outcomes not just inputs". He appointed a retired general to lead a review of leadership and management.

       Writing in The Telegraph Ms da Costa states that it is "worth considering whether to replicate the pandemic approach of giving a senior political adviser in Number 10 authority and exclusive competence over an area ... This would need to be thoughtfully done. It should supplement, rather than cut across, existing work in Number 10, ensuring there is absolute focus on a single specific area, such as following through on social care, or making the NHS more efficient. Such a structure would prevent oxygen being sucked away from vital longer-term business."