The die has been cast and the 2017 General Election is firmly underway – so what now lies ahead for health and social care?

The UK’s decision to leave the EU has monopolised public and political debate in the ten months since the referendum. At the moment, it’s hard to imagine the election being dominated by anything but Brexit: not least because strengthening the UK’s negotiating position was the reason given by the Prime Minister for having the election in the first place.

However, elections always involve an element of uncertainty: personalities and politics will have at least as much of an influence as policies, and who knows what damage a rogue bacon sandwich could do between now and 8 June?

The NHS will definitely feature. If nothing else, growing public concern should mean no major party can avoid talking about health care. But will party manifestos converge on backing the Five Year Forward View – as per the 2015 election – or will anyone offer the public a distinctly different vision for health and social care?

The election campaign may well restrict itself to an arms race over which party will offer the NHS the most resource – people and money – and arguments about how those plans will be paid for.

Sure enough, this week Labour announced new pledges focusing on NHS staff: more people, pay rises and investment in training. The Liberal Democrats questioned how Labour was intending to pay for its pledges, but were in full agreement with the argument that the pay cap is unsustainable. The Government’s position may have been less forthcoming, but didn’t appear to rule out changing their existing position in the upcoming Conservative manifesto.

Equally however, the campaign could go beyond a relatively straightforward bidding war about funding the system we have and get into changing the system in more fundamental ways.

That should be positive if that means a long overdue conversation with the public about the long-term solution for social care: something that the main parties now seem to agree is necessary, albeit without agreeing what that solution looks like.

But the debate could also stray into major changes in NHS structures, or even moving away from the principles of a tax-funded, free at point of use comprehensive health system.

Admittedly, if public opinion is anything to go by, minor tinkering with the NHS currently seems more likely than major reform. Our own analysis of the 2014 British Social Attitudes survey found strong support across all sections of British society for a national health system that is tax funded, free at the point of use and provides comprehensive care for all citizens.

Likewise, the fallout from the Health and Social Care Act 2012 should also deter our political leaders from committing to major change. As Donald Trump would attest, health care is complicated.

But it’s hard to escape the feeling that the EU referendum was symptomatic of a much bigger shift in the political landscape. An unpredictable election may mean that tinkering with structures (or even principles) becomes too great a temptation to resist.

Major changes may seem unlikely, though a recent House of Lords report highlighted a lack of political consensus. Moreover, just as there are those on the left who claim the NHS is already being dismantled, a small but vocal minority on the right argues the NHS is fundamentally broken and needs to be replaced. And unlikely does not mean impossible.

After all, at the time of the last general election in 2015, the idea that the UK would shortly vote to leave the EU was widely seen as unlikely, even by some of those pushing to leave. But just two years on that’s exactly where we are.

The health service is, of course, struggling to meet continuing growth in demand within limited growth in resources. But those challenges are common to virtually every other comparable country, and no other type of health system is immune from the pressures they bring.

Although we can and should debate whether we allocate enough resource to health care, ultimately we have a health system that – when given the tools needed to deliver – is as capable as any other of delivering access to high-quality care for an entire population. This should be clear by looking at progress over time and international comparisons.

No one can deny that there are areas where improvement is needed, but root and branch reform would simply be an unnecessary distraction from the real challenge work of delivering on the vision set out for the English NHS in the Five Year Forward View.

Whether the NHS plays a leading role in the campaign or just a bit part is unknowable at this stage. Either way, there’s no space for complacency about the future.

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