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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The rise of the green mayor – Sadiq Khan and the politics of clean energy

At an event at Tate Modern, Sadiq Khan pledged to clean up London's act.

On Thursday night, deep in the bowls of Tate Modern’s turbine hall, London Mayor Sadiq Khan renewed his promise to make the capital a world leader in clean energy and air. Yet his focus was as much on people as power plants – in particular, the need for local authorities to lead where central governments will not.

Khan was there to introduce the screening of a new documentary, From the Ashes, about the demise of the American coal industry. As he noted, Britain continues to battle against the legacy of fossil fuels: “In London today we burn very little coal but we are facing new air pollution challenges brought about for different reasons." 

At a time when the world's leaders are struggling to keep international agreements on climate change afloat, what can mayors do? Khan has pledged to buy only hybrid and zero-emissions buses from next year, and is working towards London becoming a zero carbon city.

Khan has, of course, also gained heroic status for being a bête noire of climate-change-denier-in-chief Donald Trump. On the US president's withdrawal from the Paris Agreement, Khan quipped: “If only he had withdrawn from Twitter.” He had more favourable things to say about the former mayor of New York and climate change activist Michael Bloomberg, who Khan said hailed from “the second greatest city in the world.”

Yet behind his humour was a serious point. Local authorities are having to pick up where both countries' central governments are leaving a void – in improving our air and supporting renewable technology and jobs. Most concerning of all, perhaps, is the way that interest groups representing business are slashing away at the regulations which protect public health, and claiming it as a virtue.

In the UK, documents leaked to Greenpeace’s energy desk show that a government-backed initiative considered proposals for reducing EU rules on fire-safety on the very day of the Grenfell Tower fire. The director of this Red Tape Initiative, Nick Tyrone, told the Guardian that these proposals were rejected. Yet government attempts to water down other EU regulations, such as the energy efficiency directive, still stand.

In America, this blame-game is even more highly charged. Republicans have sworn to replace what they describe as Obama’s “war on coal” with a war on regulation. “I am taking historic steps to lift the restrictions on American energy, to reverse government intrusion, and to cancel job-killing regulations,” Trump announced in March. While he has vowed “to promote clean air and clear water,” he has almost simultaneously signed an order to unravel the Clean Water Rule.

This rhetoric is hurting the very people it claims to protect: miners. From the Ashes shows the many ways that the industry harms wider public health, from water contamination, to air pollution. It also makes a strong case that the American coal industry is in terminal decline, regardless of possibile interventions from government or carbon capture.

Charities like Bloomberg can only do so much to pick up the pieces. The foundation, which helped fund the film, now not only helps support job training programs in coal communities after the Trump administration pulled their funding, but in recent weeks it also promised $15m to UN efforts to tackle climate change – again to help cover Trump's withdrawal from Paris Agreement. “I'm a bit worried about how many cards we're going to have to keep adding to the end of the film”, joked Antha Williams, a Bloomberg representative at the screening, with gallows humour.

Hope also lies with local governments and mayors. The publication of the mayor’s own environment strategy is coming “soon”. Speaking in panel discussion after the film, his deputy mayor for environment and energy, Shirley Rodrigues, described the move to a cleaner future as "an inevitable transition".

Confronting the troubled legacies of our fossil fuel past will not be easy. "We have our own experiences here of our coal mining communities being devastated by the closure of their mines," said Khan. But clean air begins with clean politics; maintaining old ways at the price of health is not one any government must pay. 

'From The Ashes' will premiere on National Geograhpic in the United Kingdom at 9pm on Tuesday, June 27th.

India Bourke is an environment writer and editorial assistant at the New Statesman.

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