With the Conservative Party confounding polls and expectations to win a majority in the Commons, many will already be working to revise their expectations of what the next five years might hold for the health service.
The new government is only hours old, and David Cameron is yet to name his health secretary. But with that caveat, here are HSJ’s five observations on what the election result will mean for the NHS.
1. Simon Stevens’ forward view vision is cemented as the NHS’s top priority
The NHS England chief executive already has the backing of Mr Cameron and chancellor George Osborne, and the main message from the Tory manifesto’s health pages was support for Simon Stevens to get on with the NHS Five Year Forward View, his reform plans as laid out last autumn.
HSJ editor Alastair McLellan tweets: “#GE2015 result GOOD for Simon Stevens. Has strong working relationship w/ Tories. Full speed ahead on 5 Yr Forward View.”
2. Service change
Backing the forward view means the NHS will be pressing on with big changes to health services aimed at dramatically increasing productivity. Work will be accelerated on a wide spectrum of projects, from replacing traditional primary care with “multispecialty community providers”, to centralising acute hospital services, and using technology to cut workforce costs.
A single party government with a majority - even a small one - means national and local officials will be able to start making important decisions a lot quicker than would have been the case under drawn out hung Parliament negotiations.
3. More money – but with questions and strings attached
The Conservatives committed to increasing annual NHS spending by at least £8bn in real terms by 2020, on top of the existing plan for this financial year. This broadly meets what national NHS leaders identified, as the minimum the service would need to keep its head above water.
But this is only the start of the funding debate. The Conservatives have not detailed how they will raise the money or how much will arrive in each year and have been quiet on the scope for a separate “transformation fund”, which was also called for in the forward view.
Ensuring the promised funding arrives, and at the right time, will be the subject of lobbying and negotiation from now and through the spending review expected to culminate in the autumn.
We can also expect the government, in particular the Treasury, to seek specific changes from the NHS in return for growth. One possibility could be measures to cut staff costs; the Tory manifesto hints at reviewing performance linked pay, as an example.
In the meantime, it will be less straightforward for a Conservative government than it would have been for Labour to increase NHS spending in this financial year, as many believe will be needed. Labour specifically said it would do this. Jeremy Hunt has told HSJ he did not expect it to be needed, as the 2015-16 funding increase that the last government delivered in the autumn statement was in line with what Mr Stevens said was required. This doesn’t mean no in-year increase will come, but it is not certain. This situation will put pressure on the health service – and Mr Stevens personally – to show it is moving quickly to bear down on inefficiency.
4. Less chance of swift structure or legislation change
The Health Act 2012 will be staying on the statute books for time being at least. We will not see a rapid repeal of the 2012 competition rules, or the rush to reorganise commissioning that some had expected from Labour. That said, the act created practical problems in several areas, which the Tory government might seek to tidy up with new law or structures. A wish list might include a revamp to create a more powerful provider regulation regime overseen by Monitor.
Another key ask could be making it easier to devolve and pool health and social care budgets – for example, to build on the devo Manc project. This Greater Manchester work will now keep its national political momentum and may spread – the chancellor made clear this morning his “northern powerhouse” work would be prioritised.
5. Bad news for local government and social care
Our editor observes: “#GE2015 result BAD for local gov. Less involvement in health than under Labour AND social care cuts.”
Tory fiscal plans suggest larger reductions in local authority social care and related budgets. This could have both direct and indirect effects on the NHS. Jeremy Hunt told HSJ before the election that the better care fund would be “extended and accelerated” under a Conservative government, and that this would allow the benefits of the promised £8bn increase in health spending to be “shared across the health and social care system”.