The NHS is toxic for the Tories and they know it

An increasing number of Conservative MPs are starting to think the unloved health reforms ought some

David Cameron was rattled in the Commons today by an attack on his health reforms - and with good reason. The NHS reorganisation is a disaster on many fronts. It is unloved by doctors, poorly understood by the public and, after a series of mangling amendments in parliament, barely even resembles the vision first outlined by Health Secretary Andrew Lansley. The likeliest outcome from the whole thing is protracted chaos and worse services. This time it will be very hard for the Tories to blame the mess on Labour's legacy.

Opinion polls traditionally show Labour well ahead of Conservatives in terms of who is trusted to look after the NHS. Crucially for Ed Miliband, this is also an issue that is personally associated with David Cameron. The pledge to avoid "top down reorganisations" came from Conservative leader's lips. So did the promise to protect health spending in real terms. That will be very hard to achieve even if inflation comes down - at least not without imposing harsher cuts elsewhere. The Labour front bench think the NHS is one policy area where they might be able to puncture Cameron's famous Teflon coating. I have even heard it said by MPs, and not just from Labour ones, that the NHS alone could cost the Tories a majority at the next election

Crucially, Tory MPs are starting to get worried. They are as baffled as anyone else as to how the government got itself into this mess. Questions are increasingly being asked about Lansley's future. It is recognised that he would have to resign if the reforms were shelved. That is hard to do in practice because some of the structural changes are already under way. But as an exercise in political damage limitation it might still be worth slamming on the brakes and, if need be, losing Lansley. Very senior Tories recognise now that the NHS is their point of greatest vulnerability. So much so, in fact, that one source familiar with the Prime Minister's feelings about the subject recently told me Downing Street wished the Lib Dems had killed the thing off last year instead of insisting on a legislative "pause".

Back then Nick Clegg didn't want to be seen to be too obstructive. The Lib Dem priority was still being seen to make coalition work. With hindsight, Clegg's team now say they should have been bolshier and insisted that the NHS reforms be dropped. It is testimony to how politically toxic the whole thing has come that an increasing number of Tories on front and back benches agree.

Rafael Behr is political columnist at the Guardian and former political editor of the New Statesman

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What type of Brexit did we vote for? 150,000 Conservative members will decide

As Michael Gove launches his leadership bid, what Leave looks like will be decided by Conservative activists.

Why did 17 million people vote to the leave the European Union, and what did they want? That’s the question that will shape the direction of British politics and economics for the next half-century, perhaps longer.

Vote Leave triumphed in part because they fought a campaign that combined ruthless precision about what the European Union would do – the illusory £350m a week that could be clawed back with a Brexit vote, the imagined 75 million Turks who would rock up to Britain in the days after a Remain vote – with calculated ambiguity about what exit would look like.

Now that ambiguity will be clarified – by just 150,000 people.

 That’s part of why the initial Brexit losses on the stock market have been clawed back – there is still some expectation that we may end up with a more diluted version of a Leave vote than the version offered by Vote Leave. Within the Treasury, the expectation is that the initial “Brexit shock” has been pushed back until the last quarter of the year, when the election of a new Conservative leader will give markets an idea of what to expect.  

Michael Gove, who kicked off his surprise bid today, is running as the “full-fat” version offered by Vote Leave: exit from not just the European Union but from the single market, a cash bounty for Britain’s public services, more investment in science and education. Make Britain great again!

Although my reading of the Conservative parliamentary party is that Gove’s chances of getting to the top two are receding, with Andrea Leadsom the likely beneficiary. She, too, will offer something close to the unadulterated version of exit that Gove is running on. That is the version that is making officials in Whitehall and the Bank of England most nervous, as they expect it means exit on World Trade Organisation terms, followed by lengthy and severe recession.

Elsewhere, both Stephen Crabb and Theresa May, who supported a Remain vote, have kicked off their campaigns with a promise that “Brexit means Brexit” in the words of May, while Crabb has conceded that, in his view, the Leave vote means that Britain will have to take more control of its borders as part of any exit deal. May has made retaining Britain’s single market access a priority, Crabb has not.

On the Labour side, John McDonnell has set out his red lines in a Brexit negotiation, and again remaining in the single market is a red line, alongside access to the European Investment Bank, and the maintenance of “social Europe”. But he, too, has stated that Brexit means the “end of free movement”.

My reading – and indeed the reading within McDonnell’s circle – is that it is the loyalists who are likely to emerge victorious in Labour’s power struggle, although it could yet be under a different leader. (Serious figures in that camp are thinking about whether Clive Lewis might be the solution to the party’s woes.) Even if they don’t, the rebels’ alternate is likely either to be drawn from the party’s Brownite tendency or to have that faction acting as its guarantors, making an end to free movement a near-certainty on the Labour side.

Why does that matter? Well, the emerging consensus on Whitehall is that, provided you were willing to sacrifice the bulk of Britain’s financial services to Frankfurt and Paris, there is a deal to be struck in which Britain remains subject to only three of the four freedoms – free movement of goods, services, capital and people – but retains access to the single market. 

That means that what Brexit actually looks like remains a matter of conjecture, a subject of considerable consternation for British officials. For staff at the Bank of England,  who have to make a judgement call in their August inflation report as to what the impact of an out vote will be. The Office of Budget Responsibility expects that it will be heavily led by the Bank. Britain's short-term economic future will be driven not by elected politicians but by polls of the Conservative membership. A tense few months await. 

Stephen Bush is special correspondent at the New Statesman. He usually writes about politics.