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The people have spoken

With the repercussions of the general election only just beginning to be felt, Community Practitioner takes a look at what it might mean in the longer term for the NHS, healthcare and the people working within it.

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The parties set out their stalls, and the people went to the polls – but the one thing missing from this election was an outright winner.

With no party gaining a majority, and no clear mandate for any one set of manifesto policies, there is a great deal of uncertainty about what the future might hold.

But, as the politicians analyse and absorb what has happened, one thing is already clear – they cannot ignore it. The British public has given them a message – they are not happy with the status quo.

British politics has been on a rollercoaster ride in the past year. Last July the country was still reeling from the result of the Brexit vote and Theresa May entered Number 10 with a parliamentary majority of 12, as Jeremy Corbyn’s approval ratings hit an all-time low.

Just 12 months on, he has increased Labour’s share of the vote by more than any other of the party’s election leaders since 1945, and the Tories have lost their majority in the House of Commons.

If a week is a long time in politics, then a year is an eternity. So where might we be 12 months from now?

A SOFTER BREXIT?

Days after the vote there were already signs that the Conservatives’ rigid stance on austerity was changing and the approach to Brexit softening. Both issues will be crucial to the health service moving forward, in terms of funding, staffing and pay.

Environment secretary Michael Gove told BBC Radio 4’s Today show that while they needed to ‘get on with the job of reducing the deficit’, the Conservatives ‘also need to take account of legitimate public concerns about ensuring that we properly fund public services’.

He also said there now needs to be an ‘open conversation’ about how the UK leaves the EU, adding: ‘We need to recognise we, as Conservatives, were not returned as a majority. That means we need to proceed with the maximum possible consensus.’

Writing in the British Medical Journal, Professor Chris Ham, chief executive of the independent healthcare think tank The King’s Fund, says 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’.

He adds: ‘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.’

He points to ‘a clear message from the electorate’ about 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,’ he says, ‘it may loosen the purse strings and find additional funding for the NHS and social care.’

‘From a union perspective, whatever happens with Brexit, it must resolve the issues of jobs,’ says Sarah Carpenter, head of health at Unite. ‘If the NHS doesn’t have enough people to fill the jobs, that is going to be destructive.’


2500 The number of school nursing staff in England, down 17% from 3000 in 2010


THE HEALTH OF THE NATION

Already the number of European nurses registering to work in the UK has plummeted by 96% since the EU referendum last June, with just 46 nurses from EU countries registered with the NMC in April 2017, compared with 1304 in July 2016, according to figures obtained through a freedom of information request by the Health Foundation. 

Sarah adds: ‘We are going to need to look again at homegrown staff. The Tory manifesto only talks about homegrown medical staff; it doesn’t talk about any other groups of staff.

‘I think one of the things that might happen is the government will have to look again at the student bursary for nurses and midwives, the withdrawal of which has put off a lot of people from going into those professions.

‘Hand in hand with that is the critical issue of pay,’ she adds. ‘I hope there will be a move away from austerity towards a fully funded NHS, with proper pay not constrained by the 1% cap. All the unions are now working together on a joint campaign to end the pay cap, and I hope the election result will help bring that about.’

She says that Unite will also continue to press for the government to take heed of the Labour manifesto pledge to increase the number of health visitors and school nurses, especially in the light of the latest figures that show there are just over 2500 school nursing staff in England, down 17% from 3000 in 2010. And health visitor numbers have fallen in England by 1000 – almost 10% of the workforce – since 2015.

‘There have been some truly shocking figures, and in a year’s time we want to see that turning around,’ adds Sarah. ‘There has got to be a realisation that the health of the nation relies on the public health provision for children.’


The number of European nurses registering to work in the UK has plummeted by 96%


DEEPER ENGAGEMENT

With all parties putting mental health services in their manifestos, and a Tory emphasis on ‘parity of esteem’ in the treatment of mental and physical conditions, there is hope that much needed improvements in provision might be forthcoming.

Sarah also believes NHS Sustainability and Transformation Plans (STPs) could be put under the spotlight, after public sensitivity around downgrading local hospitals became a key issue in some areas during the campaign.

As Professor Ham puts it: ‘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.’

Sarah adds: ‘I think with all the local sensitivity, newly elected MPs aren’t going to want to put themselves in a “Canterbury situation”, and it might cause them to be more critical of the local STP plans.

‘What may happen is more engagement with what is going on, which can only be a good thing. We have been very critical that the STPs have been made behind closed doors and people haven’t been invited in. I think what this election shows is that people want to have more of a say.’

More people having their say could continue to be a powerful force for change, adds Sarah. ‘This election has engaged people who have never been engaged before. With a broader demographic voting, the government will need to take account of the entirety of need. I think there has to be a shift in the agenda as a result.’


The number of health visitors in England has fallen by 1000 – almost 10% of the workforce since 2015


 

Image credit: istock

 

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