Cowper’s Cut is a new weekly column from HSJ’s comment editor Andy Cowper. It will be published every Monday and seeks to serve as an informative and entertaining stimulant for HSJ’s subscribers at the start of the working week.

What fun: an underwhelming general election campaign contested between a pair of main parties trying to market themselves through a cult figure leader.

Mrs May remains the likelier Prime Minister come June 9, although her clunking, comically-denied U-turn over her manifesto promise of no cap on individual social care contributions reveals not a ‘strong and stable’ leader, but one who caves in under moderate pressure. A new Iron Lady she is not.

Should Mrs May prevail as I predict, the NHS’s system leaders and representative organisations face an interesting quandary. How can they influence a May administration which doesn’t seem to listen to them?

The reason Team Theresa doesn’t seem to listen to the NHS is simple: they are really not listening, because they are not very interested. Since their bracing experiment of introducing Andrew Lansley’s reforms (only to see them largely ignored in practice), the Conservative Party tends not to think about the NHS. Instead they outsource that task to Simon Stevens. Stevens is Mr NHS, from the frequent references to his Five-Year Forward View as ‘the NHS’ own plans for itself’.

Team Theresa would like the NHS to shut up and go away. The slight problem with this wish is that the system is under manifest and immense pressure. Those working in and running the service are confused and increasingly irritated by this government’s extreme disengagement with what is going at some point to become a genuine, wide-scale crisis.

So it’s totally understandable that they want their representatives – be they system leaders or membership organisations – to articulate their concerns to the government. The leaders of those organisations have made significant efforts to ‘keep the noise down’ working through back and direct channels to get Team Theresa and the heroically insular Treasury munchkins to acknowledge and understand operational realities.

It hasn’t worked.

The consequence has been an increase in the critical public voice of representative NHS bodies and groups. This obviously raises hackles in the government, whose hermetically-sealed isolation from NHS reality grows stronger as a result.

To have a genuine impact on government policy requires a range of strategies: back and direct channels, as well as public voice with a mixture of critical and helpful messages. It definitely requires the creation and articulation of solutions.

The current situation is that the NHS and its leadership feels the government does everything but listen, and the government feels the service and its leaders does nothing but criticise. This helps neither party; nor, more importantly, is it good for taxpayers, voters and service users present and future.

At some point, NHS leaders are going to have to pivot. The smarter ones will be working out how, where and when … and how they can bring the service with them to reach a new deal.