Suffice to say the result of the election was a shock. Theresa May had a 20-point lead in the polls, and the opposition looked weak. No wonder the Prime Minister called the election, expecting a mandate before the Brexit negotiations, and with success surely assured.
Fast forward six weeks and a disastrous campaign derailed ambitions for a Conservative landslide, and left the credibility of the Prime Minister seriously dented. Parliament looks very different to the start of the year, and the future is anything but certain.
But what does it all mean for the NHS?
1. NHS reform de-prioritised
A hung parliament rarely translates into effective government. Previous experience of minority administrations (under Harold Wilson in 1974 and John Major in 1996) suggests that an alliance with the DUP will be unstable and short lived. The Prime Minister is intent on pursuing a deal, albeit of the ‘confidence and supply’ variety rather than a formal coalition. Such an agreement would enable the Tories to pass the Queen’s Speech and a Budget, but with some Conservative backbenchers harbouring reservations about their new bedfellows, the potential for paralysis and a zombie parliament is very real.
This has significant implications for the NHS. The Conservative manifesto pledged to consult and make the necessary legislative changes if the current landscape was slowing the implementation of STPs –a bold but important step for improving outcomes for patients.
Whilst Simon Stevens has been very effective in navigating around the 2012 Health and Social Care Act to date, there has been a growing realisation that NHS England is running out of room. A large Conservative majority would have created the political opportunity for change, including sounding the death-knell for the internal market and paving the way for the introduction of accountable care. But the lack of cross-party consensus in healthcare, illustrated by Labour’s ardent opposition to the STP process, will now be amplified. It’s hard to see appetite for another painful reform of the NHS, no matter how necessary it may become.
2. Emboldened ministers
Election night was notable for high-profile casualties in healthcare policy. David Mowat and Nicola Blackwood were both swept aside amid Labour’s resurgence in England, leaving a couple of vacancies in Richmond House. The loss of Cabinet Minister Ben Gummer was also significant given his involvement in the Naylor Review and influence across government.
The evidence from the weekend, with the promotion of Damien Green and return of Michael Gove, suggests that May needs to shore up support across the Party. The MPs selected to fill the vacancies at DH – Steve Brine and Jackie Doyle-Price – are both relative unknowns, though Brine has served as a PPS in the Department and Doyle-Price perhaps deserved a promotion after winning three successive elections by the skin of her teeth in Thurrock.
Amid a time of flux in politics, one person remains constant: Jeremy Hunt. The Teflon-like Secretary of State is now an unprecedented five years into one of the most challenging jobs in Whitehall. If the election outcome shifted the axis of power from Theresa May to her cabinet, figures such as Hunt and Chancellor Philip Hammond are likely to be the biggest beneficiaries.
3. Labour re-claims the NHS high ground
Jeremy Corbyn has hailed the Labour manifesto as the star of the Party’s campaign: quite the turnaround after the consternation caused by its premature release less than a month ago. Unsurprisingly, the NHS was a key area of focus as the Party pledged more than £30 billion of additional funding by 2022 – positioned in contrast to the ‘steady as she goes’ approach of the Conservative manifesto, which planned a very slight increase on the current level of investment that many viewed as inadequate.
It seemed inconceivable that, in the midst of the winter crisis, an opinion poll would gave Theresa May a strong lead on managing the NHS – traditionally an area Labour has ‘owned’ politically. Fast-forward to early June, and a string of surveys found normal service resumed, with the public much more likely to trust Labour. The Party’s ambitious funding pledge was aided by a strong campaign for shadow health secretary John Ashworth, who was given the green light to sell his Party’s position and performed strongly in media appearances.
4. Priorities moving forward
During her first months in power, Theresa May was determined not to give special treatment to the Department of Health, and – with the help of Jeremey Hunt – rode out a series of political storms to retain the funding outlined by the 2015 Comprehensive Spending Review. May’s loss of political capital is clear for all to see and the Prime Minister would be wise to moderate her sustainability-first stance towards NHS spending.
A ComRes poll commissioned by the Whitehouse Consultancy found that the public wants the new Government to prioritise investment in improving the longer-term resilience of the NHS, over quick fixes that lower waiting times. More than half of respondents want the government to prioritise further investment in the NHS workforce, whilst upgrades to the quality of primary and community care premises was the second most popular option. Capital investment is one area that the Conservatives trumpeted during the campaign, with Theresa May endorsing the recommendations of the Naylor Review on NHS estates.
While the Review highlights the importance of investing more to improve the state of NHS buildings, it became a political football of sorts in the final week of the campaign, with the Labour Party and health campaigners linking it to privatisation and questioning the sale of surplus hospital buildings. An increased majority would have aided reform, but the Government must now tread lightly and carefully. This slow style of government may be ill-matched to the realities of our fast-moving healthcare system.