Chris Ham, Chief Executive of The Kings Fund blogs

The outcome of the general election will mean more of the same for the NHS and social care in the short term and huge uncertainty on two fronts in the medium term. The Conservative government has failed to obtain the mandate it was seeking and now hopes to rely on the support of Democratic Unionist MPs to implement its programme.

Publication: British Medical Journal

Reference: BMJ 2017;357:j2840

The weakness of the minority government will strengthen the hand of NHS England in implementing the Five Year Forward View and continuing its work to achieve financial stability and improvements in performance.

Changes in legislation to support delivery of the forward view, foreshadowed in the Conservative Party manifesto, now seem unlikely, if only because they would act as a lightning rod for opposition parties seeking to attack the government’s stewardship of the NHS. In the absence of legislation, NHS England will continue to promote evolutionary changes to the organisation of the NHS, including collaboration and in some cases mergers between clinical commissioning groups. Accountable care systems in which NHS organisations come together to plan and deliver care will also become more prominent.

Work to achieve financial stability and improvements in performance will remain a high priority as NHS funding increases fail to keep pace with rising demand. The shape of things to come was indicated before the election in reports of NHS England and NHS Improvement tightening their grip on areas with the biggest deficits. Under a new “capped expenditure process,” these areas have been asked to consider a range of radical measures to cut costs. Options under discussion include restricting patient choice, reducing work that is outsourced by NHS trusts, stopping funding for some treatments, closing wards and theatres, and reducing staffing.

All areas of England are working on sustainability and transformation plans (STPs), which are NHS England’s chosen means for implementing the forward view at a local level. Some STPs include plans to reconfigure acute hospital services—for example, by centralising services to tackle workforce shortages and improve patient outcomes. The new government is likely to be sensitive about these changes in the light of public concerns about the downgrading of local hospitals. The election result in Canterbury, where the Labour Party candidate won the seat from the Conservatives on a platform that included opposing plans to reconfigure hospital services in east Kent, will have set alarm bells ringing in Whitehall.

The fate of the Conservatives’ manifesto proposals for social care is in doubt. The mishandling of these proposals during the election was one of the factors that influenced the outcome, and commitments to means test winter fuel payments are unlikely to be acceptable to the Democratic Unionists. Coming forward with specific plans for reforming social care funding and legislating to implement them will be exceptionally difficult in the absence of cross party consensus. Unless the government is willing to provide extra resources, publicly funded social care will be rationed even more severely.

In the medium term, uncertainty derives from the likelihood of a second general election and the impact of the Brexit negotiations and their aftermath. History shows that a minority government is inherently unstable even when it has a pact with another party. By-elections during the coming parliament could further weaken the government’s position, and any deal with the Democratic Unionists could unravel in the face of events. The probability that the prime minister will be challenged from within her own party is a further source of instability. The public will not thank politicians for calling a second election, but there may be little choice in current circumstances.

Brexit negotiations will have a direct effect on the NHS through issues such as the rights of EU nationals working in the UK and an indirect effect from what Brexit means for the economy and public finances. One of the consequences of the election is that the government has no mandate to pursue a hard Brexit. Assuming that a seriously wounded government is able to reach some kind of deal with the EU, and this is by no means certain, this may be less damaging to the NHS and social care than many had feared.

A clear message from the electorate was the need for politicians to listen to and act on its concerns about public services and the effect of further spending cuts. If the government is willing to hear this message, it may loosen the purse strings and find additional funding for the NHS and social care to avoid the harsh restrictions on services now being considered. That at least would be a good outcome.

This article was originally published in the BMJ