Right. Let me level with you: I started writing this blog – about what the election result has told us about the shape of future health policy – prior to the polls closing. I’ve since deleted every word I wrote.
From 10pm on Thursday night it was clear that we were likely to get a completely different outcome to what earlier opinion polls had predicted. It’s going to take a while to fully comprehend what the BBC’s Robert Peston has already described as the 'most significant election of my life'.
However there are already some clear implications for health policy – here’s my take and please do give your views in the comments below.
Full speed ahead with the Forward View
Let’s start with the blindingly obvious – we have a Conservative government. What did they promise on health? Tim Gardner’s succinct summary is a good place to start. In short, it boils down to implementing the NHS Five Year Forward View, a pledge to 'increase NHS spending in England in real terms by a minimum of £8 billion over the next five years', and an assortment of relatively micro promises such as same-day GP appointments for the over 75s.
The Conservative backing for the Forward View is significant given Andy Burnham’s open criticism of the strategy; and you would expect whoever is the next Secretary of State for Health to be a firm supporter of Simon Stevens’ plan. However, top of the new ministerial team’s to-do list will be how to get the money to add up this year, let alone in five years’ time. As such, the ability to keep a firm grip on health finances is likely to be the number one criterion in selecting Jeremy Hunt’s successor (presuming Hunt does indeed move on).
The Health and Social Care Act survives
The centrepiece of Labour’s health policy was a pledge to ‘scrap’ the 2012 Health and Social Care Act, and to do so within their first 100 days. Clive Efford MP’s Private Members Bill of late 2014 even gave a blueprint for how Labour would be likely to do it.
Unsurprisingly, given the Act’s unpopularity, the Conservatives chose to say as little as possible about it during the campaign – and it would be a major surprise if they were to announce any significant plans for changing it in this parliament. As such, Andrew Lansley’s legislative framework is likely to at least survive for another five years. By 2020 the complexity of the Act might have caused it to require urgent surgery – or alternatively it may fade into the background and cease to be the polarising issue it is today.
A bad night for mental health
It was a bad night for Labour, but even worse for the Liberal Democrats – its number of MPs being reduced to only a fraction of the number of ministers it held in the last parliament, let alone MPs. The implication for health is that the Lib Dems’ causes – most prominently mental health – have lost their champion in government.
The Conservatives do talk about 'continuing to take your mental health as seriously as your physical health', but this is a weaker commitment than set out by the Lib Dems, and accorded a far lower priority: the Lib Dems put mental health on the cover of their manifesto, the Conservatives put it on page 39. As Felicity Dormon has set out, achieving parity of esteem between mental and physical health is likely to require a fundamental rethinking of mental health services. Without the Lib Dems in government, will mental health simply drop off the Conservatives’ agenda?
Constitutional issues to the fore
At first glance, the two constitutional issues brought to the fore (the SNP takeover in Scotland and the upcoming vote on EU membership) appear to have little to do with the English NHS. However, it’s very likely that the knock on effects of these issues do end up having a significant impact on the NHS – but probably in a number of ways which are currently hard to predict.
For example, if the SNP do succeed in winning greater devolved powers for Scotland, will this impact on the call for greater devolution to English regions in a similar way to Manchester? If the EU referendum does result in the horribly titled 'Brexit', how will this affect the vast international recruitment on which the NHS has come to rely? These are but two questions, and there's bound to be a long list of issues which are suddenly far more relevant to Department of Health mandarins than they were 24 hours ago.
At the Health Foundation we will continue our programme of analysis started pre-election right through the main events of this year – the government’s Queen’s Speech later this month, a spending review, and an updated mandate to the NHS. 2015 has already been eventful, expect that to continue.