The coalition’s NHS headache gets bigger

Waiting times reach a three-year high following the decision to relax targets.

Iain Duncan Smith recently caused the government much embarrassment when he admitted that waiting times at his local hospital had increased since last year. Now, a new report by the King's Fund shows that the picture isn't much better elsewhere.

Hospital waiting times are now at their highest since April 2008, with 15 per cent of patients waiting over 18 weeks for treatment. Given the financial pressures on the National Health Service, these figures are hardly disastrous. But the numbers are moving in the wrong direction and cannot be simply explained by seasonal fluctuations.

The news will call into question Andrew Lansley's decision to relax Labour's waiting-time targets last June. As the King's Fund chief economist, Professor John Appleby, a co-author of the report, pointed out: "In the past the two things that kept waiting down were targets and extra money. Managers got sacked for not meeting targets. And of course in the future there won't be the same amount of extra money."

They may not have been fashionable, but Labour's much-derided targets and patient guarantees produced results. Lansley's decision to "relax" targets has had the reverse effect.

One of his first acts as Health Secretary was to pull back on the four-hour Accident and Emergency target, which has since been scrapped entirely. The result is that the number of patients waiting more than four hours has risen from 176,522 to 292,052, a 65 per cent increase and the highest level in five years.

At a time when the coalition is struggling to convince the public that the health service is "safe in its hands", a rise in waiting times is politically toxic. History teaches us that once governments lose trust on the NHS, they rarely win it back.

George Eaton is political editor of the New Statesman.

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Why relations between Theresa May and Philip Hammond became tense so quickly

The political imperative of controlling immigration is clashing with the economic imperative of maintaining growth. 

There is no relationship in government more important than that between the prime minister and the chancellor. When Theresa May entered No.10, she chose Philip Hammond, a dependable technocrat and long-standing ally who she had known since Oxford University. 

But relations between the pair have proved far tenser than anticipated. On Wednesday, Hammond suggested that students could be excluded from the net migration target. "We are having conversations within government about the most appropriate way to record and address net migration," he told the Treasury select committee. The Chancellor, in common with many others, has long regarded the inclusion of students as an obstacle to growth. 

The following day Hammond was publicly rebuked by No.10. "Our position on who is included in the figures has not changed, and we are categorically not reviewing whether or not students are included," a spokesman said (as I reported in advance, May believes that the public would see this move as "a fix"). 

This is not the only clash in May's first 100 days. Hammond was aggrieved by the Prime Minister's criticisms of loose monetary policy (which forced No.10 to state that it "respects the independence of the Bank of England") and is resisting tougher controls on foreign takeovers. The Chancellor has also struck a more sceptical tone on the UK's economic prospects. "It is clear to me that the British people did not vote on June 23 to become poorer," he declared in his conference speech, a signal that national prosperity must come before control of immigration. 

May and Hammond's relationship was never going to match the remarkable bond between David Cameron and George Osborne. But should relations worsen it risks becoming closer to that beween Gordon Brown and Alistair Darling. Like Hammond, Darling entered the Treasury as a calm technocrat and an ally of the PM. But the extraordinary circumstances of the financial crisis transformed him into a far more assertive figure.

In times of turmoil, there is an inevitable clash between political and economic priorities. As prime minister, Brown resisted talk of cuts for fear of the electoral consequences. But as chancellor, Darling was more concerned with the bottom line (backing a rise in VAT). By analogy, May is focused on the political imperative of controlling immigration, while Hammond is focused on the economic imperative of maintaining growth. If their relationship is to endure far tougher times they will soon need to find a middle way. 

George Eaton is political editor of the New Statesman.