by David Talbot
“The NHS is on the ballot paper in May” declared the Labour leader at Prime Minister’s Questions as he sought to solidify his party’s clear advantage on this most important, and emotive, of issues. That the NHS is set to be centre stage at the forthcoming general election is partly due to naked politicking, and partly due to the dire forecasts for our health service. Both main combatants are well aware of the financial and demographic peril the NHS is in, but both continue to besmirch the debate with clichéd attacks on how the Tories can’t be trusted on the NHS or, a new variant of the same line, Labour are ruining the NHS in Wales.
It is essential that politicians are honest with the public about the scale of the challenges facing the NHS. This is particularly true of the Labour party who are prone to nostalgia and playing on sentiment, invoking the spirit of Nye Bevan and having a nonagenarian address party conference, for instance, but specifically because the party is making pledges which, deep down, it must know will be difficult or nigh on impossible to deliver. The NHS matters too much for short term electoral considerations; it is better that the party is frank, and dare say unpopular, with the public now rather than risk alienation, anger and a disintegrating NHS later.
Ed Miliband’s flagship announcement at the party conference last month was an eye-catching commitment to establish a new £2.5 billion ‘Time to Care Fund’. This unravelled not long after some fairly rudimentary scrutiny; it will be not be implemented in full until 2017/18 and Labour would need to first pass a Budget and then enact legislation before the mansion tax, levy on tobacco firms and tax avoidance levies would yield any income. And even then there are serious doubts the revenue raised would come anywhere near the £2.5 billion quoted.
It is not to say that the party is not coming up with a better vision for the NHS. Labour’s plan for a combined health and care service is unquestionably the right direction of travel, but it is not a cost or pain-free option. Andy Burnham may deny that there will be large-scale reorganisation, but unavoidably, and undoubtedly, there would be heavy financial and structural costs. A messy structural reorganisation of the administration of healthcare would clearly get in the way of healthcare delivery. What is important, what the public should not be fed, is the idea that it is not a reorganisation. It is exactly that.
The King’s Fund Barker report estimated that even after introducing a combined health and care service, spending would need to rise to around 11% of GDP to meet demand. This would still leave our health spending trailing the highest European spenders – but it would require double the spending increase that Labour is currently proposing.