Today’s election result has made a fool of Theresa May. But while expectations have been utterly confounded, we continue to have a just about viable Conservative government, with a programme resembling something like status quo for the health service.
Status quo means the NHS remains underfunded, and the economy underpinning it is in a precarious position. This year was always going to be all about the money, and it will continue to be. With the opposition having made gains on a platform of protecting public services, the newly weakened government may be tempted to bung the NHS a bit more cash to make the issue go away for a couple of years. But the economic reality is unchanged – so whether more money can be found for the NHS will depend on a humbled, possibly fractious, Conservative Party’s enthusiasm for raising taxes or borrowing more.
In the meantime, health leaders will continue trying to contain costs. These efforts will become increasingly controversial and hard for everyone to stomach as the squeeze gets tighter.
MPs of all parties will be more wary than ever of backing unpopular proposals for fear of losing their seats
On capital, the Tories’ promise of a massive infrastructure programme will be widely welcomed – until it needs to be funded by selling NHS property, as the Naylor report said it partly would. It seems likely there will be a capital spending programme, but whether it amounts to £10bn will depend on the appetite for land sales. Expect such proposals – especially where the sales relate to wider service change – to be opposed noisily. Local NHS leaders will need to make very compelling arguments for why they are necessary and what the public gets in return.
Likewise, if you’re an STP leader, your job just got harder. One of first things Canterbury’s new Labour MP, Rosie Duffield, said after being elected was that she would oppose reconfiguration in east Kent. Labour has demonstrated its ability to rally large numbers of people to the “save our NHS” cause. Reconfigurations can expect loud, confident opposition. MPs of all parties will be more wary than ever of backing unpopular proposals for fear of losing their seats.
The Conservative manifesto promised “the necessary legislative changes” if the current set-up is found to be slowing reform or preventing clear accountability. National health leaders are understood to want new legislation. But whether they get their way depends on the government’s willingness to take a new health bill through parliament, with the inevitable mud wrestle that will bring. Is the prize worth the risk? Don’t hold your breath.
On the plus side, we won’t have to try to work out what NHS Excellence (Labour’s proposed new regulator) is, which is a relief.
The Tories’ toxic “dementia tax” proposals are utterly discredited, and, having given whoever came up with them the birching of their lives, the prime minister will want to move on
Expect progress on less controversial pledges like replacing the Mental Health Act. But prepare for timidity from ministers on policies that would cause avoidable rows and draw unnecessary attention to their stewardship of the service. Will we see new contracts for dentists or hospital consultants? Once again: ministers will be weighing the potential gain against what could go wrong.
The Tories’ toxic “dementia tax” proposals are utterly discredited, and, having given whoever came up with them the birching of their lives, the prime minister will want to move on. Social care still needs tackling, but the parliamentary numbers are against the Conservatives forcing through anything unpopular in the face of strong opposition. If any progress is to be made on this – and it must be – it will be cross-party, as it always should have been.
This was Brexit election that wasn’t. For the NHS, leaving the EU is bad in two ways: it makes EU staff already in the service uncertain about their right to live and work in the UK; and it threatens the NHS’s ability to source staff from the EU in the long term by potentially restricting freedom of movement.
Ms May’s Brexit strategy has come out of this election as badly as her policy on social care. Today she is doubling down on her existing line and trying to project strength.
But her non-existent majority and torpedoed reputation tell another story. If she was seeking an electoral mandate to pursue her Brexit vision, her failure must make compromise more likely. In the long run, we may dare to hope for a softer line on free movement, and a less catastrophic outcome for the NHS workforce.