Now the fun and games begin. The predictions of a hung Parliament with the Conservatives holding the most seats proved to be correct and over the next few days the political horse-trading will take place in Whitehall before the puff of white smoke emerges.

A Conservative/ Lib Dem pact (I think they would be loathe to call it the Con-Dem alliance) is not out of the question, nor is a minority Cameron government propped up with support from various shades of Northern Ireland Unionist. Labour will try to woo Nick Clegg, along with the nationalists from Wales, Scotland and Northern Ireland (together with the first Green MP, Caroline Lucas).

What this means for the NHS is anyone’s guess. We know that frontline services would be protected and funding should at least be at the level of inflation, whether Labour or Conservatives are the major players in the new government. And the focus on efficiency and quality will sharpen.

However, some questions spring to mind. Would a minority Tory party be able to push through their planned early public sector savings (remember, they pledged to make savings in the current financial year) in a summer Budget? Would the Lib Dems demand the scalp of strategic health authorities as part of a wider programme of ‘cuts in bureaucracy’, if it enters a formal coalition with Labour or the Conservatives? Is the planned rise in national insurance dead in the water, even if a Labour MP has the keys of Number 10? Would the support of Unionist and nationalist MPs in Northern Ireland, Scotland and Wales have to be bought with better financial deals for those devolved administrations?

What is clear is that it was a bad night for Labour’s health team. Mike O’Brien, Gillian Merron, Phil Hope and Ann Keen all lost their seat to the resurgent Tories, meaning health secretary Andy Burnham is the only member of the team that will return to the Commons. All the shadow health ministers and Liberal Democrat health spokesman Norman Lamb retained their seats.

In Wyre Forest, Independent MP Richard Taylor, the consultant rheumatologist who swept into the Commons in 2001 on the back of a campaign to stop the downgrading of Kidderminster Hospital, lost his seat to the Conservatives.

The dust is settling. Over to you Mr Cameron, Mr Brown and Mr Clegg.

It's all over, bar the shouting. The combatants have criss-crossed the country like manifesto-spouting Tasmanian devils for the last time before arriving at their constituencies.

The last few days of the campaign mean hammering home the message (although Labour did get in a bit of a spin over tactical voting), so Gordon Brown warns of the danger of NHS cuts under a Cameron administration, while Nick Clegg promises to rid the service of waste.

On Tuesday (4 May) David Cameron denies his plans to squeeze spending in the current financial year, should he win power, would lead to cuts in frontline NHS services. Though he acknowledges the scale of the cuts will be greater than seen for many years, he refuses to go into greater detail.

He returns to this theme later in the day as he visits Northern Ireland to give his backing to the electoral pact the Conservatives have made with the Ulster Unionists (who have agreed to take the Tory whip if elected).

Potentially, the Ulster Unionists could give Mr Cameron the majority he seeks in the Commons, and the local party has been criticised by its opponents for being in cahoots with the Conservatives. This is particularly acute when Mr Cameron seems to suggest that Northern Ireland, together with Wales and Scotland, will have to make do with less.

'There is no way Northern Ireland will be singled out over and above any other part of the UK', Mr Cameron says, leaving ample wriggle room.

Bad news for Mr Cameron on the eve of the election (5 May) as X-Factor Svengali and trouser model Simon Cowell backs his campaign (in the interest of balance, it should be pointed out that fellow talent show judge Piers Morgan has voiced his support for Mr Brown).

Visiting Bradford on 5 May, Mr Brown is asked about mental health funding. Reporters are too shocked by the specific nature of the question to record his response

As the parties’ leaders make their way home, they will perhaps be reflecting on the gaffes, the first televised leaders’ debates, the rise of Nick Clegg and how many votes the Zombie party will get (ok, so maybe not the last one).

But will they also be thinking about the health service – the dog that didn't bark in this election campaign. This is my fifth election as a health reporter and I can’t think of one where the NHS has been on the agenda less. Yes, there have been vague promises to 'protect the frontline' and the sport of manager-bashing was pursued for a few minutes in the first televised debate, but little beyond that.

Certainly, Labour has neutralised the NHS issue that has dominated some recent elections – waiting times. But there has been little discussion about the scale and type of efficiencies that will have to be made in the next few years, whoever is in the hot seat at Number 10. Maybe this is intentional as the parties seek to keep their message positive, knowing the electoral can of worms that would be opened by such a debate. And, as noted in previous blogs, the money is not available to fund great swathes of reform.

The polls point to no outright victor, and in the event of a hung Parliament there could be days or even weeks of horse-trading before a government is formed. Of course, Scotland has been getting by well with a minority government in recent times, but history tells us that where there is a hung Parliament at Westminster another election often follows soon after. Happy voting.

Peppa Pig is a firm favourite in our house, but could now be on the list of proscribed viewing for Gordon Brown's children. The cheeky cartoon character, who charms kids and big kids alike in 180 countries, likes nothing better than jumping in muddy puddles and she certainly muddies the water for Labour this week when her appearance at the launch of the party’s family manifesto is cancelled at short notice.

While it was a minor irritant for Labour, and good copy for the papers (according to the Daily Telegraph she didn’t attend because ‘she is unquestionably from a long line of well-bred, well-fed Conservatives’), it is nothing compared to the storm to come. As gaffes go, Gordon Brown’s foot in mouth incident when referring to Gillian Duffy is as public as they come. Whether you view it as a ‘game changer’ or not, hearing the prime minister label a lifelong supporter of his own party a bigot is unedifying and Mr Brown rightly apologised promptly.

The week starts brightly for the prime minister, who earns himself two standing ovations from delegates at the Royal College of Nursing congress in Bournemouth on Monday (26 April). He pays tribute to nurses and their ‘amazing works of care and mercy’ and pledges to protect NHS pensions.

The speech coincides with the launch of Labour’s health manifesto, which reiterates many of the themes the party has already laid out. However, interestingly it pledges capital spending would be ‘refocused’ on primary and community care, while GPs would take on care management responsibilities, designing and purchasing packages of care that meet patients’ needs. Does the latter hint at some form of practice-based commissioning/ payment by results hybrid?

On Tuesday (27 April) it is Liberal Democrat leader Nick Clegg’s turn to go see nurse. On his way to three standing ovations, he tells the RCN Congress that a Lib Dem government would give frontline staff control over their ward or unit budgets. He pledges to save money by capping chief executives’ pay, rather than that of nurses, and target small pay rises (of up to £400 per person) at the lowest-paid staff.

Presumably when David Cameron clocks that his speaker’s ticket is allocating him third billing, he decides to send shadow health Andrew Lansley instead. RCN general secretary and chief executive Peter Carter says it was ‘no way a slur on nurses’ that Mr Cameron (who addressed the Congress the previous year) is the only one of the three main parties’ leaders not to turn up. Yet he still manages to sound like a man who bought an Elvis in Vegas DVD from the market only to find it is actually a dodgy impersonator in Blackpool puffing his way through The wonder of you.

Mr Lansley receives no standing ovation, though he does score points when he talks of reducing bureaucracy and giving nurses greater responsibility. And the nurses welcome his pledge to introduce a one-year preceptorship for all nursing graduates to end the ‘outrageous’ situation where some qualified nurses fail to get a job.

The centre point of the week is again the leaders’ debate on Thursday (29), which focuses on the economy. And for all the talk of new politics over the past few weeks, this one has some very ‘old politics’ messages.

This is particularly true of the clashes between Mr Cameron and Mr Brown over when and how to begin to recover the deficit. The Tory and Labour leaders’ contrasting economic doctrines are laid bare as Mr Cameron essentially calls for a roll-back of the state – cut now, put more money in people’s pockets and hope they spend it to revive the economy – and Mr Brown’s stateism – prop up public services, keep people employed and hope this allows the wider economy some time to recover before you go after the big efficiency savings.

The NHS is mentioned twice, both times in answer to the first question – can you be honest about spending cuts? (Presumably this is a reference to Bank of England governor Mervyn King’s reported claim that the cuts that will have to be inflicted by the next government will leave such scars that the party would be unelectable for a generation).

Mr Brown says there will be cuts in departments other than the NHS and commits to maintaining frontline services. He attacks the Conservative policy of finding £6bn in efficiency savings this year. Mr Cameron says the £6bn represents £1 in every £100 the government spends – quickly relating those cuts to preventing the 7% pay rise received by senior NHS managers in 2008/09.

So, less than a week to go and a Bank Holiday weekend beckons. We’re taking the kids to see Peppa Pig on stage on Monday. No doubt she will rib Daddy Pig about the size of his tummy and urge him to get some exercise. Whatever her political allegiances, her health policy is firmly in favour of illness prevention.

In 1997, Tony Blair was swept to power on a wave of the need for change and his own personal charisma. It didn't hurt that he adopted many of the clothes traditionally woven in Conservative blue. David Cameron is utilising this Blairite tactic – for him, this season’s colour is most definitely red. Not content with claiming the Tories are the party of the NHS (which, of course, will be forever associated with Labour in most minds), he has now adopted co-operatives (the Labour Party sprung from the co-operative movement in the North West of England).

So, if New Labour was the Tories and New Tories are New Labour no wonder voters are confused. Not that it matters of course as the Lib Dems are about to ‘sweep to victory’ – in reality hold the balance of power in a hung Parliament – according to the latest polls, which seem to be based on the fact that Nick Clegg managed to look less shifty than Mr Brown and Mr Cameron in the opening leaders’ debate.

Depending on the number of seats they win, the Cleggies could demand a few cabinet seats – Vince Cable as chancellor would be an obvious (and popular) move, but what about Norman Lamb as health secretary? Would David or Gordon let him carry out the Lib Dems’ manifesto commitment to turn commissioners into locally-elected health boards? Or would they be more likely to acquiesce when he proposed abolishing strategic health authorities, cutting 50% of the Department of Health’s costs and limiting senior managers’ pay?

What happens if current polls are reflected in votes on 6 May is for later. On the campaign trail, if truth be told, we are still waiting for health to become the focus of a landmark battle between the parties (come to think of it, has there been any issue of policy that has defined the differences between the parties and sparked the campaign to life? National insurance did briefly, but in the age of ‘X Factor’ and ‘Britain’s got dancing dogs’ are we focusing too much on personalities and the weekly dose of contrived sound bites in the leaders’ debates?).

In the absence of this year’s Jennifer’s ear, we must make do with what the parties serve up.

On 17 April David Cameron launches the Conservatives’ pubic sector manifesto [download here], setting out how every public sector body can become an employee-owned co-op and promising to deliver fairer pay (presumably the money for fairer pay will be generated by selling cigs and newspapers down at the co-op).

More manifestos are published this week, including the Democratic Unionist Party [download here] in Northern Ireland, which promises increased spending on prevention and early intervention and greater identification of non-cost effective practice. On Wednesday (21), another Northern Irish party, the SDLP, launches its manifesto [here]. It pledges to oppose frontline cuts in health services, invest in hospital construction and start a preventative health fund.

However, the promises from the Northern Irish parties are quickly brought into sharp focus as the local Assembly debates a revised Budget for 2010/11 [see alert]. Though revenue funding is to increase, £16m has been cut from the capital budget and additional savings totalling more than £110m will have to be found.

Some much-needed levity is provided by the Zombie party - no, not a grouping of your favourite ageing politicians, but the Citizens for Undead Rights and Equality. The party’s top health policy – investment in research to find a cure for Zombie bites, naturally. Key slogan – ‘I’m not a Zombie, but one day I might be – let’s find a cure.’ You can find the party’s disappointingly normal looking website via Google.

Once again the focus of the week is the leaders’ debate on Thursday (22 April), which gets feisty at times (nine people are arrested outside, mainly for public order offences, in scenes not seen in Bristol since last Saturday night). Inside, the prime minister chides David Cameron, alleging his opponent would not maintain free prescriptions or eye test for the elderly. Mr Cameron dismisses this as scaremongering.

With the focus of the debate on foreign affairs, it’s not surprising there is little about the NHS. However, earlier in the day the three main parties health spokesmen line up to debate at an event organised by the King’s Fund, BMA, NHS Confederation and RCN.

You can watch a video of the 90-minute debate here. Some of the detail that has been frustratingly absent from the campaign is there, with the spokesmen knowing they cannot get by with vague answers in a room full of clinicians, managers and commentators. But what shows up most is the little difference between the parties – in this economic climate there is little room for grand plans.

Health secretary Andy Burnham criticises his opponents for failing to acknowledge that the tough decisions will mean hospital reorganisation and services moving to other units, but otherwise they are broadly in agreement. Funding will be roughly the same and efficiency and quality are the watchwords of the next few years. And even when shadow health secretary Andrew Lansley raises payment by results (no, this is not going to be a Zombie joke), it is to say that payments should be more closely aligned to quality. But isn't this the road we’re already travelling?

Mixed news for Labour as the campaign swings into its second week. Its manifesto is launched on Monday (12 April) as a King’s Fund assessment that says the NHS has made ‘considerable progress’ since the party took power in 1997. However, there is further controversy on senior NHS managers’ pay.

The manifesto promises no top-down change in primary care trust and strategic health authority structure, stability in the hospital payment system, a greater focus on value for money and quality. There would be greater freedoms for foundation trusts, though failing trusts’ management would be taken over [more].

The King’s Fund report concludes waiting times have fallen, primary care access improved and quality standards set. However, it’s not all positive and it highlights a number of areas, such as variation in access and quality, where improvements could be made [more].

A report from Incomes Data Services [news alert] found chief executives of NHS trusts in England received average pay rises of 7% in 2008/09, compared with the 2.75% given to nurses that year. The opposition parties jump at the chance to criticise Labour’s handling of the issue.

Plaid Cymru launches its manifesto on Tuesday (13 April), pledging to protect hospitals and other public services from ‘Westminster cuts’.

The Conservatives’ manifesto follows [more]. The party promises real-terms increases in health spending and to stop the ‘forced closure’ of maternity wards and A&Es. It vows to widen the use of the tariff and ensure payment by results rewarded quality.

While the Conservative document and the Liberal Democrats’ manifesto [more here] look poles apart (the Tories adopting a retro ‘feel’ and the Lib Dems the functional lines of a TV user manual), they have one major thing in common: manager bashing. The Conservatives no longer refer to NHS ‘managers’ or ‘administrators’ but ‘bureaucrats’ – once a perfectly harmless word in its own right but one that has become pejorative.

The Tories plan to remove ‘expensive layers of NHS bureaucracy’ and cut administration costs by a third. The Lib Dems would take an axe to half of the Department of Health’s costs, scrap strategic health authorities, turn PCTs into elected health boards and ensure no senior NHS manager was paid more than the prime minister (there’s no word on whether they would make an allowance for any perks that go with the job).

There was little surprise in the manifestos, perhaps reflecting the austerity that will be necessary in the years ahead, but top marks for originality in manager-bashing goes to UKIP. Its manifesto [more] says it would: ‘improve NHS management and accountability, and use NHS funds better, by abolishing overlapping layers of bureaucracy such as EU-inspired strategic health authorities and primary care trusts’ (my italics).

Leaving aside the role UKIP punch bag and European Union president Herman van Rompuy may have played in creating les PCTs et SHAs, given the EU’s reputation for financial management PCTs and SHAs might be tempted to sue for libel.

Thursday (15 April) began with a joke – the UK is a no-fly zone thanks to tonnes of ash and dust in the upper atmosphere. Don’t worry it’s just Leeds United cleaning their trophy cabinet (I’m not picking on Leeds particularly – a Leeds fan told me the joke – and could apply to any recently unsuccessful team). It ended in the historic first television debate of the men who would be prime minister.

The format is a little wooden, with no journalistic intervention from the moderator (unlike the US presidential debates). It’s a bit like Question Time but with a more docile studio audience (who were not allowed to boo, cheer, pick their noses or shift uncomfortably in their seat during the 90 minute show under pain of death). With the focus on domestic affairs, the NHS unsurprisingly takes up a good chunk of the time.

On a general question on the economy, Conservative leader David Cameron is so keen to hammer home his view that Labour had wasted taxpayers’ money that he forgot to call managers ‘bureaucrats’. ‘How is a 7% pay rise for NHS managers essential for economic growth?’ he asks, referring to the IDS report from earlier in the week.

The question on the NHS, delivered by a nurse of 12 years’ experience, cuts right to the heart of the matter – how would the leaders address the cost pressures arising from an ageing population and more expensive new treatments? In the initial exchange, David Cameron and Gordon Brown do not address the question of cost pressures head on. Mr Clegg will score points for at least showing he understood the question and saying savings would be needed in the NHS.

Later, the leaders of the two main parties clash over their NHS spending plans. Mr Brown challenges the Conservative leader to match Labour’s pledge of a two-week maximum waiting time to see a specialist where cancer is suspected and the guarantee that patients will be able to see GPs in the evening and at weekends.

Mr Cameron had challenges of his own – why do people have to sell their homes in order to buy cancer drugs and why is Mr Brown preparing to take £200m a year out of the NHS through the planned increase in National Insurance, he asks. He promises to stop the NI rise and use the money to set up a cancer drug fund.

Nick Clegg asks why the government had been closing maternity services and emergency departments, while ‘wasting money on computer systems and bureaucracy’ – ignoring the fact that such closures are not always financially motivated.

As the dust settled (metaphorically – it’s still up there in the atmosphere grounding most flights) on Friday (16 April), all parties claim they have won. Only one will be able to do so on 7 May, unless of course there is a hung Parliament, in which case they will all be able to claim victory once again.