Jeremy Laurance: Whoever wins, these will be tough times for the NHS

I cannot remember a general election in which the NHS figured so little. Perhaps that is not surprising – no issue other than the economic crisis and immigration has had much airtime. As a policy-free election, this one breaks all records.

There were a couple of attempts to bring health to the fore with the Tory pledge to fund all cancer drugs (including those not assessed by Nice) and Labour’s promise to shorten the wait for cancer test results to one week. Some newspapers struggled to find a story that, like Jennifer’s ear in the 1992 election, would act as a lightning rod for the electorate. The case of Nikki Phelps, a cancer patient who faced having to sell her house to get the cancer drugs she needed, looked briefly as if it might catch fire. But instead it fizzled out – and now her Primary Care Trust has agreed to fund her treatment.

The key reason for the lack of debate is that nothing substantive divides the parties on the NHS. All agree it must be protected from cuts and none is proposing major reform. But pressure for reform will become irresistible. It is inconceivable that the NHS will weather the next five years of economic freeze without cracks in the cosy consensus over its future appearing. I give it no more than two years before demands for new funds build up and the dam breaks.

Leading doctors wrote to The Guardian this week arguing that decisions on hospital closures must be left to local clinicians in consultation with patients. That is like asking turkeys to vote for Christmas. Only this week the health secretary Andy Burnham executed a remarkable about-turn to appear as saviour of the Whittington hospital’s A&E and maternity departments, which had been earmarked for closure. Is any further proof needed that closing hospitals and departments – necessary in order to raise standards by concentrating expertise in fewer, higher quality units – is electoral suicide?

The NHS cannot continue to do all it has been doing and expect to treat the rising numbers of elderly on a budget that will flatline at best for the foreseeable future. Something will have to give.

Four years ago, the Labour government, fresh from its third consecutive election success, made a determined attempt to confront the issue. Patricia Hewitt, then health secretary, argued that it was no longer safe to carry out all types of specialist emergency medicine in every single hospital and some departments would have to close. She was backed by NHS chief executive David Nicholson, who said there would be up to 60 “reconfigurations”, concentrating key services in fewer hospitals, including paediatrics and maternity care, as well as A&E. Nothing happened. It didn’t have to – there was enough money sloshing around to keep even outdated services going.

That is all about to change – and when it does there will be the mother of rows about the future shape of the NHS. The pity is that we have been denied an opportunity to hear in which direction the parties will want to leap.