PMQs review: Cameron rattled by Miliband’s NHS attack

Once again, Cameron struggled to defend the coalition’s health reforms.

Rarely has David Cameron appeared as rattled as he did at today's PMQs. Ed Miliband's decision to lead on the coalition's troubled NHS reforms proved fortuitous as the Prime Minister struggled to offer a coherent defence of his Health Bill.

Asked if he was planning any further amendments, Cameron prattled on about "cutting bureaucracy" and disingenuously claimed that the coalition would prevent "cherry-picking" by the private sector. As is frequently the case, his disregard for detail let him down. Asked if it was true that the NHS would be subject to EU competition law for the first time in its history, the PM appeared either unwilling or unable to answer Miliband's question.

Instead, for the third time in recent months, he selectively quoted from a speech by John Healey in which the shadow health secretary declared that "no one in the House of Commons knows more about the NHS than Andrew Lansley . . . these plans are consistent, coherent and comprehensive. I would expect nothing less from Andrew Lansley."

What Cameron failed to acknowledge is that Healey went on to argue:

They [the Conservatives] believe that competition drives innovation, that price competition brings better value, that profit motivates performance, and that the private sector is better than the public sector. I acknowledge the ambition but I condemn this as the core philosophy being forced into the heart of the NHS. It's wrong for patients. It's wrong for our NHS. It's wrong for Britain.

Miliband, who enjoyed his warmest reception from the Labour benches in months, made easy work of Cameron, but his lengthy questions frequently threatened to turn into speeches. At one point, he reeled off a long list of Labour's achievements on the NHS, a passage that, as Cameron suggested, was remarkably reminiscent of Gordon Brown's machine-gun delivery.

Towards the end, Cameron, visibly angered by the opposition to his reforms from the British Medical Association and Liberal Democrat activists, denounced the BMA as just another "trade union". His willingness to pick a fight with some of the country's most trusted professionals shows how determined he is to push these reforms through. There is no prospect of a forests-style U-turn.

In an attempt to demonstrate that he isn't the only one taking a political gamble, Cameron warned Miliband, whom he humorously referred to as "Son of Roadblock", not to "set his face against reform". Should the coalition's reforms prove unexpectedly popular, it is the Labour leader who will have to change tack. But for now, all the signs are that Cameron is facing a crisis entirely of his own making.

George Eaton is political editor of the New Statesman.

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George Osborne's surplus target is under threat without greater austerity

The IFS exposes the Chancellor's lack of breathing space.

At the end of the last year, I noted how George Osborne's stock, which rose dramatically after the general election, had begun to plummet. His ratings among Tory members and the electorate fell after the tax credits imbroglio and he was booed at the Star Wars premiere (a moment which recalled his past humbling at the Paralympics opening ceremony). 

Matters have improved little since. The Chancellor was isolated by No.10 and cabinet colleagues after describing the Google tax deal, under which the company paid £130m, as a "major success". Today, he is returning from the Super Bowl to a grim prognosis from the IFS. In its Green Budget, the economic oracle warns that Osborne's defining ambition of a budget surplus by 2019-20 may be unachievable without further spending cuts and tax rises. 

Though the OBR's most recent forecast gave him a £10.1bn cushion, reduced earnings growth and lower equity prices could eat up most of that. In addition, the government has pledged to make £8bn of currently unfunded tax cuts by raising the personal allowance and the 40p rate threshold. The problem for Osborne, as his tax credits defeat demonstrated, is that there are few easy cuts left to make. 

Having committed to achieving a surplus by the fixed date of 2019-20, the Chancellor's new fiscal mandate gives him less flexibility than in the past. Indeed, it has been enshrined in law. Osborne's hope is that the UK will achieve its first surplus since 2000-01 just at the moment that he is set to succeed (or has succeeded) David Cameron as prime minister: his political fortunes are aligned with those of the economy. 

There is just one get-out clause. Should GDP growth fall below 1 per cent, the target is suspended. An anaemic economy would hardly be welcome for the Chancellor but it would at least provide him with an alibi for continued borrowing. Osborne may be forced to once more recite his own version of Keynes's maxim: "When the facts change, I change my mind. What do you do, sir?" 

George Eaton is political editor of the New Statesman.