Analysis

What the election means for the NHS

During the general election on 8 June, polls suggested the NHS was the number one priority on voters' minds, but the result has spread uncertainty and scepticism for the future of the NHS.  

During the general election on 8 June, polls suggested the NHS was the number one priority on voters' minds, but the result has spread uncertainty and scepticism for the future of the NHS

In many ways it is curious that the NHS did not feature more prominently in the election campaign. Polling consistently showed it was the most important issue for the electorate after Brexit.

Yet it did not dominate the debate as many would have expected when the snap election was called. However that does not mean it will not feature heavily now the new parliamentary cycle is under way.

The RCN has already promised to organise a summer of protest, demanding that the government scraps the 1% cap on annual pay rises.

1%

The

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During the general election on 8 June, polls suggested the NHS was the number one priority on voters' minds, but the result has spread uncertainty and scepticism for the future of the NHS 

In many ways it is curious that the NHS did not feature more prominently in the election campaign. Polling consistently showed it was the most important issue for the electorate after Brexit.

Yet it did not dominate the debate as many would have expected when the snap election was called. However that does not mean it will not feature heavily now the new parliamentary cycle is under way.


The election result has spread uncertainty over the future of the NHS. Picture: iStock

The RCN has already promised to organise a ‘summer of protest’, demanding that the government scraps the 1% cap on annual pay rises.

1%

The cap on annual pay rises until 2019

Both Labour and the Liberal Democrats said during the campaign that they would scrap the cap, but the Conservative manifesto made no mention of it.  

As things stand then, the public sector pay cap remains in place until 2019, although health secretary Jeremy Hunt has indicated that, following pressure from the RCN, he will press chancellor Philip Hammond to lift it.

Constructive letter

He told the NHS Confederation annual conference, held a week after the election, that he had received a constructive letter from RCN general secretary Janet Davies and had a ‘great deal of sympathy’ for the plight of nurses.

He told the meeting in Liverpool he would make sure the chancellor considers the arguments being put forward before he makes a decision.

If there is no change, Ms Davies has said she will lead the protests, which will involve demonstrations, the lobbying of MPs and media campaigns, with the threat of industrial action kept in reserve.

‘Hospitals, clinics and communities across the country are short of the nursing staff they need to provide safe care,’ she says. ‘They are being driven out of the NHS by levels of pay that are as damaging to patient care standards as they are to a nurse’s family life.’

1 in 9

The proportion of nursing posts vacant in the NHS

Ms Davies points to the research, which the RCN launched at its annual conference in May, showing that 40,000 nurse posts are vacant: one in nine of the total.

‘It is simple: a pay rise that is deliberately held below inflation is in fact a pay cut.

‘The cap, after years of pay freezes, means that nursing staff are 14% and at least £3,000 a year worse off than they were in 2010. This summer, the government has one last chance to scrap the cap.’

Meeting targets

During the election campaign, the Conservatives were adamant that lifting the cap is unaffordable, claiming that every 1% increase in pay costs £500 million a year.

But, since the shock election result, there has been talk of an easing up on austerity, raising hope of more money for the health service.

Nuffield Trust chief executive Nigel Edwards says the manifesto funding proposals of all the three main parties ‘fell short of the mark’.

The Conservatives promised an extra £8 billion by 2022, but this works out at an annual increase of just over 1% a year. Labour’s offer was a little more generous, around 2%, but still well short of the 4% the NHS historically has received.

Mr Edwards doubts there will be more money for the health service even if the government alters some of its plans. He says there is unlikely to be much scope for ministers, because of the need to make concessions to the Democratic Unionist Party (DUP).

‘The DUP may ask for more funding for projects in Northern Ireland, reducing still further any wriggle room available to the Treasury and further delaying the long-overdue reshaping of the hospital system in Northern Ireland.’

Instead, he predicts there will be more pressure on the health service in England to start meeting targets again. Data released by NHS England on the day after the election show that the three key targets covering emergency care, cancer care and hospital operations all continued to be missed in April.

He fears ‘an ever more desperate push to meet targets’ but adds that, with no extra funding, it is unclear that meeting them is even possible.

5.4%

The percentage of nurses and midwives on the UK register who come from other European Union countries

Capped expenditure

NHS Providers chief executive Chris Hopson agrees the coming months and years will be an ‘enormous challenge’. Alongside funding and the workforce, he cites the need to manage winter safety and the next steps for sustainability and transformation plans (STPs) as the ‘key early priorities’ for the government.

With an unexpected period of purdah during the election, progress on STPs has been slower than expected, with public consultations in many areas still pending.

Already NHS England and NHS Improvement have started intervening in some areas, calling for more stringent measures to tackle deficits by introducing even bigger cuts to services, stopping some treatments and accepting a rise in waiting times for others.

The programme, known as the capped expenditure process, is being deployed in approximately one third of the 44 STP areas.

But Mr Hopson says that what is being proposed in some cases is ‘unrealistic’ and leaves NHS leaders ‘rather uncomfortable’.

He urges vigilance. ‘It’s important that we should all keep a close eye on both of these processes to ensure what’s being put forward is sensible and subject to appropriate public scrutiny.’

Brexit and the nursing workforce

Just a year on from the referendum on whether the UK should remain part of the European Union (EU) or leave, there are already signs that Brexit may be harming a vital supply line of nurses.

Currently, more than 37,000 nurses and midwives from other EU countries are registered with the Nursing and Midwifery Council (NMC) to work in the UK: 5.4% of the total number.

But since last summer the numbers being accepted on the register have slowed to a trickle. From April to July last year, there were on average more than 1,000 joining the register each month. The peak came in July, when 1,304 signed up, but this dropped to just 46 this April.

This decline comes as growing numbers are opting to leave the register; the monthly numbers have nearly doubled in the past year to 406 this April.

Health Foundation director of research and economics Anita Charlesworth says the figures could not be more ‘stark’.

‘The findings should be a wake-up call to politicians and health service leaders.’

But NMC chief executive Jackie Smith urges caution when interpreting the figures: ‘It’s too early to say definitively that this is due to any one reason.’

She says Brexit could be a factor, but so too could be the introduction last year of English language testing for nurses from other EU countries.

 

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