Viewed over a three to five-year timeframe, the decision by Theresa May to call a snap election on 8 June could prove to be a net positive for the NHS.
If we assume that we are not in for another seismic political shock, the election is likely to return a Conservative government with an increased majority.
This would be good news – when compared to the current situation – for the NHS on four fronts.
The first is that the government is unlikely to continue to tie itself to the pledges made in the 2015 manifesto not to raise taxes and could possibly even abandon its commitment to the triple lock on pensions.
This, in turn, would give them the opportunity to revisit the 2015 spending settlement and provide a 70th birthday present to the NHS during the leanest years stretching from 2018-19 and beyond. In making this case the NHS will have to change its narrative to align with the priorities of a newly strengthened May-led government. Health Foundation chief economist Anita Charlesworth argues persuasively that the NHS must work harder to demonstrate how it contributes to the nation’s wealth as well as its wellbeing.
Less vulnerable to rebellions
In this context, the publication of the Five Year Forward View refresh late last month has turned out to be particularly fortuitous – as the government (and other parties) are all now very clear about the trade-offs the NHS is having to make to stay within budget.
Thirdly, a window opens between the end of the Brexit negotiations and a 2022 election to deal with the remaining structural problems created by the Lansley reforms which stand in the way of the smooth transition to new care models. There was no way, for example, that under the previous timeframes the competition issues which complicate the creation of accountable care organisations or inevitable merger of NHS England and NHS Improvement would have been addressed in the run-up to a 2020 election. The fact that the NHS would start a parliamentary term with a set of, more or less, worked up reform plans also gives the models a better chance of bedding down before the next election and the scrutiny that brings.
Lastly, an increased Conservative majority will mean that the prime minister is less vulnerable to rebellions by her right wing over the Brexit negotiations. Given how important the continuing presence of EU staff are – and will be for the foreseeable future – to the NHS, greater flexibility on their right to remain would be very welcome.
‘The centre fears that the failure to address the health economy deficits early in 2017/18 will leave the service facing a repeat of last summer’s financial reset’
Of course, this scenario depends on some big Ifs. The manifesto pledges on tax may be repeated, significantly reducing the government’s spending power. Even if those pledges do disappear, a returning Conservative administration might well conclude that the just about managing class would not welcome a tax rise - even to fund the NHS.
We already know that the PM and the Chancellor believe their predecessors were very generous to the NHS – especially in comparison to other public services – and could well decide the already-trailed capital boost in the autumn budget is all the service should expect. There will also no longer be the pressure to boost NHS funding in 2018 or 19 to prepare the ground for a 2020 election.
Finally, there is also the continuing danger that a preoccupation with Brexit will simply crowd out all else.
What is not subject to any ‘ifs’ or ‘buts’ is that the forthcoming general election is bad news in the short term for the NHS.
In his most recent interview with HSJ, NHS England chief executive Simon Stevens stressed over and over how the first three months of 2017-18 had to be used to make the hard decisions about “unsustainable services” – especially in areas with the greatest financial challenge.
As HSJ’s analysis yesterday showed, those areas map closely to regions which will constitute the much of the electoral battleground over the next month and a half.
The centre fears that the failure to address gaping financial holes early in 2017-18 will leave the service facing a repeat of last summer’s belated financial reset – and once more losing credibility with a Tory-led Treasury.
The hope is that local organisations facing those difficult decisions will power on, taking heart from the relative brevity of the campaign, the calmness with which the government viewed the NHS reconfiguration issues during the Copeland by-election, and the fact that Jeremy Hunt’s experience and long-term investment in the current reforms reduces the chances of some dramatic U-turn in policy.
It is, of course, recognised that in many places hope is unlikely to triumph over experience.