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The future would be tough, whoever was in power

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David Cameron has won a famous victory, far more impressive than my tentative eve-of-poll HSJ tip, but do not fear the worst. It would be tough, whoever won.

Before we turn to the prime minister’s first post-victory speech, that 24/7 NHS pledge made in a Midlands GP centre, or to Andy Burnham’s sudden frontrunner status, let’s do the counterintuitive thing.

Let’s track down one of the very few Tory MPs defeated on 7 May, one who may have lost his seat because of Ed Miliband’s doomed “Save Our NHS” mantra.

In 2010 Nick de Bois captured Enfield North on the Hertfordshire stretch of the M25 ring around London, in part because David Cameron and Andrew Lansley visited Chase Farm hospital, promising to stop closure of its accident and emergency without proper local consultation.

‘What will Tory backbenchers let Cameron do with his triumph?’

Of course, the A&E eventually closed as part of a wider restructuring, though not before a High Court battle, leaving de Bois quite cross with ministers as I recall.

On 7 May Labour’s Joan Ryan duly won her old seat back with a majority of 1,086 votes on a swing of 3 per cent. The Chase Farm effect? De Bois isn’t sure what impact it had, though he concedes the trust issue was “at the heart of Labour’s campaign”.

The irony, he tells me, is coalition ministers had just agreed a £270m outline plan to rebuild Chase Farm (admittedly without an A&E).

Labour’s local campaign promptly switched to “you can’t trust people who closed your A&E to keep this promise either”, which makes de Bois cross again. He still thinks the new, kinder Cameron - “Blue Collar Dave” - should adopt less confrontational language when addressing public sector workers. Even more might vote Tory.

Quite so. Cameron has won a famous victory, far more impressive than my tentative eve-of-poll HSJ tip in which I also misjudged the scale of the SNP win, albeit not as badly as all the pollsters.

What will Cameron do with his triumph and what will rightwing Tory backbenchers (less obliging than the discarded Lib Dems) let him do?

In safe hands

Even before making that 24/7 GP speech (which got a “how will you pay for it?” raspberry from many NHS bodies) he tried to reassure voters that the service is safe in his hands by reappointing Jeremy “I am humbled” Hunt.

He is thought by insiders to have had a good, if low key war: focusing on patients and quality; taking the fight to Labour (for once); and seeing off what Tories regard as “dishonest” opposition scares about privatisation and cuts.

Not having liked Labour’s tired NHS themes myself, I have some sympathy.

‘We should take Cameron’s pledge more as an aspiration’

Mr Hunt made a workmanlike job of glossing over the flaws (“where’s the cash? Where will those 5,000 extra GPs come from?”) obvious in the PM’s Monday speech. We should take Cameron’s pledge more as an aspiration. Do not fear the worst. It would be tough, whoever won.

More tangibly, he appointed nice Alistair Burt, a 32-year Commons veteran and moderate, to Norman Lamb’s old job, and brought David Prior (the MP whose Norfolk seat Lamb snatched in 2001) across from the Care Quality Commission to tackle productivity. Freddie Howe (64) and Dan Poulter (36) didn’t make the cut.

Plenty of time later to worry about them, as there is about the Labour leadership which has the rare distinction of now having two health spokespersons in pole position after Chuka Umunna’s sudden withdrawal.

Here goes anyway.

Hard to beat Burnham

Voters’ rejection of Miliband Labour, especially in Scotland, creates the real existential crisis many feared.

Parties do die for want of relevance and Labour is torn between outward looking modernisers and those keen - union leaders like Unite’s noisy Len McCluskey - who think it’s Labour’s job to protect the workers.

Now Tristram Hunt has ruled himself out, Liz Kendall is clearly the modernisers’ best hope, albeit a class of 2010 unknown quantity to most voters, one who says Labour got the economy wrong and Ed took the campaign in the wrong direction.

On current evidence it looks as if Burnham, busy courting both wings, will be hard to beat.

As noted here before, he’s long been positioning himself for a second run after coming fourth out of five in 2010.

‘Parties do die for want of relevance’

Energetic and personable, HSJ readers know he has stepped back from things Labour did in office and he did as a health minister.

Admitting mistakes is fine, but one of my sharpest Labour analysts snaps: “Andy’s on the wrong side of history.”

McCluskey would disagree and will probably throw what union weight he can behind the candidate from the Lancashire working class.

None of the declared candidates have yet persuaded me they are up to the challenge - and what a challenge.

Some say the winner will be on probation for two years and replaced if necessary.

We live in unruly times where the National Health Action Party could only muster 20,210 votes on 7 May. It was double Respect’s tally, five times the Monster Raving Looney Party’s, but nearly 4 million less than UKIP.

Michael White writes about politics for The Guardian

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