It is unlikely that in the early days of government detailed proposals for organisational and structural reform, proposed by both parties in their manifestos, such as an independent board and elected health boards, will be high on the agenda. More pressing is the need to tackle the government deficit. Decisions and compromises on how quickly and how hard to cut public spending will have much more immediate and significant implications for the NHS. The emergency budget will give an early indication as to whether the coalition will be able to stand by the Conservatives' promise to increase spending on the NHS in real terms each year or whether funding education, which was a Liberal Democrat election priority, will mean that the NHS has to take a hit.
Even if the government is able to maintain health spending at current levels the NHS will not be immune to the need to make significant productivity savings. Locally this will mean changing services, including concentrating hospital-based services in fewer larger centres or moving them out into the community. The consequences of such decisions may mean the closure or downgrading of services including maternity and A&E. With an eye to the next election, which many predict will follow within a year, local MPs will be reluctant to support changes where they are unpopular with local clinicians and the public. The Conservatives' proposed moratorium on politically driven change suggests the government will distance itself from controversial changes, making the job of local leaders within the NHS even harder.
There were some issues on which both parties agreed: the importance of tariffs and allowing any willing provider to deliver services; a desire to get rid of targets; abolishing SHAs and reducing the number of quangos. But before they sweep aside targets and performance management in the NHS the government must put in place other drivers of performance. Cameron promised an information revolution, and both parties were keen on patient choice, but emerging evidence suggests these alone are unlikely to be strong enough to drive quality improvement.
As David Cameron himself admitted coalition politics will throw up challenges. Not least the ability of the two parties to agree on the best way to elect a future government. While the two parties have hammered out a 'deal', there are bound to be new unforeseen challenges. Whether in health or in other areas, deciding how to tackle these issues will require serious debate, compromise and ultimately consensus. This is not the them-and-us politics of Westminster we are used to. It might just provide an opportunity for the NHS to avoid the more damaging swings in political fortune of the past, albeit briefly.