The new health secretary will be more hands on than Hunt has ever been

In July last year HSJ and FTI carried out their first poll into public attitudes towards the health service.

In it we asked: “How aware or unaware are you of the structural and financial challenges facing the NHS?”

‘So far, so depressing and predictable’

Seventy per cent described themselves as “aware, but not knowledgeable”, 10 per cent as “knowledgeable” and 20 per cent as “not aware”.

Today we publish the fourth and final poll. The answers to the same question were 70, 12 and 18 respectively.

So far, so depressing and predictable; but why has the election debate been so unenlightening despite the focus on the NHS?

The political pot

Five years ago the talk was of a depoliticised health service, with the plan for an independent NHS board much welcomed.

Andrew Lansley’s inept handling enabled his opponents to claim a conspiracy to allow the health secretary to wash his hands of responsibility. The NHS’s political pot began to simmer.

The post-Lansley period pitched Jeremy Hunt and Andy Burnham into opposition, both unafraid to politicise their arguments.

‘A tight election was unlikely to provide much motivation to focus on the nuance of health policy’

As the heat rose, the NHS Five Year Forward View attempted to give politicians a blueprint they could agree on. Consensus was initially achieved and the document remains hugely influential, but as the health debate reached boiling point Labour made it clear they did not want the future overly defined by a strategy developed under the coalition’s watch, however independent.

So we have had an election that has been defined by airy promises on NHS spending from the Conservatives, which as our polling shows few believe; and a Labour campaign mixing sensible ideas with scare stories which all too often echoed the Neo-Con myth making on radical Islam picked apart byThe Power of Nightmares documentary series in 2004.

A tight election was unlikely to provide much motivation to focus on the nuance of health policy or, indeed, that Labour and Conservatives agree on the majority of how health and social care should be structured, operated and funded.

But this highly politicised environment will affect the NHS for years to come.

Working for every penny

The focus on the NHS will have created an expectation among voters of a significant improvement in performance post-election. The fact politicians have not taken the opportunity to educate the public about the hard times ahead means they are unlikely to be patient.

This expectation is likely to be played out at a local level – by a new generation of energised NHS activists – as well as in the national press and Parliament.

All this will require the new health secretary to be seen to more hands on than even Mr Hunt has been.

This could potentially increase tension between the Department of Health and NHS England.

‘The NHS cannot thrive on flat funding’

Leaders in the service can usually look forward to a lessening in political activity immediately after an election. It will not happen this year, as Labour’s “100 days” plan demonstrates.

With a minority government there will also be the influence of the smaller parties to take into account. Their direct impact on legislation is being overestimated, but their potential ability to cause trouble over performance or policy that concerns them should not be.  

Longer term, the main lesson of the last five years is that the NHS cannot thrive on, effectively, flat funding and any party that tries to do that will suffer at the polls, whatever the mitigating circumstances.

So the NHS will get more money, but every penny will provide more incentive for a cash strapped administration to want to know how it is being spent.   

“No decision about me, without me” was Andrew Lansley’s slogan for patient empowerment. With the sound of bedpans once again deafening all in Westminster, it is more likely to apply to whoever becomes health secretary after May 7.