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The election result podcast

Listen to the HSJ team’s analysis of what Boris Johnson’s big election win might mean for the NHS, on the latest HSJ Health Check podcast — on the webSpotifyApple Podcasts, and elsewhere.

Aside from Brexit, the NHS had top billing in the Conservatives’ election campaign.

It means the Tory majority government we now have in place has some well-aired and much debated promises it will need to start trying to deliver on: 50,000 (net) more nurses over five years, 6,000 more GPs, 50 million extra GP appointments, somewhere between six and 40 new hospital builds, and NHS legislation by March.

A newly emboldened government will seek rapid payback and headlines for its funding commitments; while the NHS will want realistic asks on delivery — and digging out of its current hole, while meeting new asks, if it is to be done, will take some years.

So the deal between government and the service will now be renegotiated in this new political environment, and potentially with a new health and social care secretary, though Matt Hancock could well stay for at least a few more months.

Personality always makes a difference at this level so, if there is to be a change, the NHS’ masters in Whitehall and SE1 will cross their fingers for someone who will keep current relationships stable rather than commence with a lot of meddling.

There is the question of Simon Stevens’ tenure too: the NHS England chief could pick this moment to set an exit date; or could reflect that — with a decent working relationship with the prime minister and a growing funding settlement — he should settle in for the duration.

Either way, NHS leaders will be quick off the mark to ask for rapid confirmation of future budgets, especially on capital and education and training, so they can get on with their “People Plan” for recruiting and retaining staff, and with building hospitals.

The deadline for nursing university applications is in January. If training places are to get a boost at the earliest opportunity, ministers need to move at an unprecedented pace to formalise and shout about paying maintenance grants to students.

There will also be tricky discussions with government on working out how the manifesto’s big-number staffing commitments translate to reality.

On legislation, the Tories’ March target to pass an NHS act is a very ambitious one, even with the Conservatives’ now-substantial Commons majority, but NHS officials will be hopeful that the tight deadline means their proposals will go through relatively intact.

The victorious government has been quick to reiterate its commitment to the NHS and Thursday’s Queen’s Speech will, according to influential Cabinet minister Michael Gove, “ensure there is an NHS funding guarantee”. That may be purely symbolic, but the debate could be important. 

The government will also want the NHS to get on and publish the “long-term plan national implementation plan”, which it has been keen on since the original LTP. National NHS officials will now be updating it to reflect the Tories’ new commitments — and more importantly, thrashing out with ministers what the actual delivery targets are year-by-year, especially for 2020-21.

Meanwhile, there is the increasingly grim reality of winter operations to get through; fast-approaching Brexit deadlines; and an ugly financial reality in the NHS locally heading into 2020-21.

Although NHS funding is now growing quicker than it has been, the pain is not over in most of England. A final overarching question about the new government is whether — as Boris Johnson claimed on Friday morning — it will be a new type of Conservative administration, which could be minded to keep giving decent funding settlements to the health service; or whether, for lack of resource or bandwidth, emerging from NHS austerity will be a very slow business.

Updated for Monday edition.