This week a joint letter has been published in the Times highlighting the fact that none of the party manifestos suggest that they would meet the expected need for funding over the coming years. Influential groups the Health Foundation, the King’s Fund and the Nuffield Trust highlighted that a real terms funding increase of £30 billion a year could be needed by 2022 to meet projected demand – yet “none of the main political parties have pledged enough in their manifestos to cover even half of that, while the share of our national wealth spent on healthcare would fall under all of their plans.” The organisations urged the next government to improve the NHS’s finances to protect patient care, and establish an independent body to evaluate health and social care funding needs.

General election results and insights

The general election has produced the second hung parliament in seven years. With 649 of the 650 constituencies declared, the Conservatives have emerged with 318 seats, representing 42.4% of the vote, leaving them 8 seats short of a majority and reducing their seat count from before the election. Labour have defied the majority of polls to gain 29 seats, ending on 261 seats and 40% of the vote; and the SNP, Liberal Democrats and DUP have 35, 12 and 10 seats respectively. The Conservatives have increased their vote share by 5.5% while Labour have gained 9.5% of the vote nationally – representing a trend of votes largely converging towards the two main parties, with UKIP’s vote share and the SNP’s seat count both plummeting.

What coalitions could be formed?

As the party with the most seats, the Conservatives will now attempt to form a government with the support of the Democratic Unionist Party (DUP). The DUP previously stated in 2015 that they would not seek cabinet positions as part of a formal coalition with other parties, and would prefer a looser ‘Confidence & Supply’ agreement.

By contrast, even if Labour, the SNP, the Lib Dems, Plaid Cymru and the Greens attempted to form a coalition, this would still be 13 seats short of forming a majority government; the Lib Dems have also seemingly ruled out entering a coalition. As the party with the most seats, the Conservatives possess the royal prerogative to form a government first, and would be in the best position to establish a minority government. However, this could create significant challenges for passing legislation, as all Bills would require extensive negotiation with other parties.

Will Theresa May resign?

At the moment, Theresa May is pressing ahead with forming a minority government and has firmly denied she will resign. However, she ran a highly centralised election campaign, with a focus on her own capability as a leader, and so this result will have caused lasting damage to her credibility within the Conservative Party. It is widely expected that Nick Timothy, the Prime Minister’s Joint Chief of Staff and a key architect of the manifesto, will be sacked.

Conservatives being lined up as potential challengers for the leadership include Boris Johnson, David Davis and Amber Rudd – although the likelihood of Rudd standing is arguably slim, given that she now only has a 346-vote majority and could face the prospect of another general election in the near future.

What happens with Brexit negotiations now?

It is unclear how the Government would proceed with Brexit negotiations if the PM were to stand down at this point – negotiations are currently due to begin on 19th June, yet the EU Budget Commissioner Günther Oettinger has already suggested that the start of talks could be delayed as “With a weak negotiating partner, there’s the danger that the negotiations will turn out badly for both sides.” The European Commission had previously suggested that negotiations could and would be delayed if Labour came to power to allow them time to assemble a Cabinet, and so if there is protracted uncertainty on what form the Government will take, similar delays could be enacted.

The election result also has implications for the UK’s negotiating stance. Theresa May’s decision to call the election was based on the assumption that voters would endorse the Conservatives to “deliver Brexit”, and this would include a mandate for a “hard Brexit”, including withdrawal from the Single Market. The subsequent poor performance from the Conservatives places this assumption into doubt, and would be the most likely factor driving another election later in the year. The indecisive result also somewhat detracts from the UK’s negotiating position with the EU, implying that the Conservatives cannot gain conclusive support for their Brexit agenda at home.

When will MPs return to Parliament?

The Prime Minister will ask the Queen to summon the new Parliament on Tuesday 13th June, as MPs will need to be sworn in and processes such as Select Committee appointments begun. There is not currently any indication that the State Opening of Parliament and Queen’s Speech, scheduled for Monday 19th June, will be postponed – but the Government formed will need to have the greatest confidence possible that its Queen’s Speech would be voted through, so this possibility should not be discounted. Following the 2010 election on 6th May which produced a hung parliament, the Conservatives and Liberal Democrats formed a coalition on 11th May after five days of negotiations, followed by the State Opening of Parliament on 25th May. A similar timeline could see the Queen’s Speech being rescheduled for Monday 26th June.

Who were the winners and losers?

Both Labour and the Conservatives benefitted from a notable decline in support for the SNP in Scotland, while Labour continued its historical dominance in Wales and remained resilient within the north of England. As the polls had been predicting, the Lib Dems failed to substantially capitalise on pro-EU voters, but still gained four seats from their previous position. A number of established politicians lost their seats throughout the night, including former Liberal Democrat leader Nick Clegg; the SNP’s Westminster leader Angus Robertson; and the Cabinet Office minister Ben Gummer, who was heavily involved in producing the Conservative manifesto.

Will there be another election?

Given the potential instability coming from various coalition options, commentators are widely predicting that another election could take place later this year. This would be a historical rarity; the last time two elections took place in one year was 1974.  However, MPs will be aware of the risk of voter fatigue resulting in lower turnout and another uncertain result, and the corresponding disruption to Brexit negotiations while the countdown to leaving the EU continues.

Capped expenditure process could limit NHS procedures

It has been reported in HSJ that health economies are being directed to make further savings as part of a ‘capped expenditure process’ if they are not on track to meet their ‘control total’ budgets for 2017/18, with areas under consideration including limiting the number of procedures carried out by private providers. The process is being considered by NHS England, NHS Improvement and local NHS leaders, and is reportedly being considered for 14 health economies which are threatening to record substantial deficits in 2017/18. These areas largely line up with STP areas and include North Central London; South East London; Bristol, South Gloucestershire and North Somerset; and Surrey and Sussex.

Other options which are being considered to save money in these areas include reducing the number of procedures carried out by non-NHS providers, and the amount of work outsourced from NHS trusts, to ensure that more money for procedures stays within the NHS. A measure which could attract controversy is “systematically drawing out waiting times for planned care” in areas where waiting times are lower than average, and closing or downgrading acute services – although it is noted that this would be unlikely to produce substantial savings during this financial year.

SNP attacked over nurse and midwife shortages

The SNP has been accused of neglecting the nursing and midwifery professions as figures were released showing a record shortage of nurses and midwives in Scotland. 4.5% of posts were empty between March 2016 and March 2017, or 2,919 vacancies, representing an increase of 27.5% from the previous year. The Scottish Government was also criticised for the number of consultant vacancies during that period, which increased by 17.6%.

Responding to the figures, the BMA argued that the Scottish Government is “still not facing up to the problems of medical recruitment”, while the Royal College of Nursing cautioned that there are not enough nurses in Scotland to meet demand for care. The Scottish Conservatives’ Shadow Health Minister, Donald Cameron, accused the SNP of starving the NHS of nurses as the party “places independence at the centre of everything, to the cost of our critical public services like the NHS.”