Where now for the west's mission in Afghanistan?

Cameron meets Obama for talks after US soldier massacres civilians in Kandahar.

David Cameron could not be travelling to Washington in grimmer circumstances. The shocking news that a lone US soldier killed at least 16 civilians, nine of them children, in a shooting spree on Sunday means that US-Afghan relations have reached a new low.

The more one hears about the story the worse it gets. According to the New York Times, "The man gathered 11 bodies, including those of 4 girls younger than 6, and set fire to them". He may have been acting alone but that will not reduce the risk of reprisal attacks. For many, the massacre will confirm their view that the occupation is irredeemably brutal. It was only three weeks ago that US troops were found to have burned copies of the Qur'an at the main Nato base, an act that led to protests in which six American soldiers were killed.

The dry commitment by General John Allen, the commander of US and Nato forces in Afghanistan, to ensure "that anyone who is found to have committed wrongdoing is held fully accountable" is unlikely to dampen tensions. In a statement on its website, the Taliban has vowed to "take revenge from the invaders and the savage murderers for every single martyr".

It declared:

A large number from amongst the victims are innocent children, women and the elderly, martyred by the American barbarians who mercilessly robbed them of their precious lives and drenched their hands with their innocent blood.

The American terrorists want to come up with an excuse for the perpetrator of this inhumane crime by claiming that this immoral culprit was mentally ill.

If the perpetrators of this massacre were in fact mentally ill, then this testifies to yet another moral transgression by the American military because they are arming lunatics in Afghanistan who turn their weapons against the defenceless Afghans without giving a second thought.

Coming so soon after the deaths of six British soldiers last week, there is understandable concern that UK troops may be caught in the fall-out. All of which means that the onus is on Cameron to restate the case for Britain's continued presence. As the shadow foreign secretary, Douglas Alexander, notes in today's Guardian, the PM came to office promising that Afghanistan would be his "number one priority", but it is now eight months since he made a parliamentary statement about it. He writes: "As the prime minister heads to Washington my concern is that he has an end date, but still no end state: no realistic vision of what will be left behind. And in these critical months the scale of military sacrifice does not appear to be being matched by diplomatic effort."

With the fighting likely to intensify in the run-up to the 2014 withdrawal date, the question confronting western leaders is what sort of country they will leave behind. For now, it is likely to be one even more blighted by violence, corruption and the drugs trade. Consequently, a growing number of voices on the left and the right contend that the benefits of remaining are outweighed by the costs. It is up to Cameron to persuade them otherwise.

George Eaton is political editor of the New Statesman.

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Is anyone prepared to solve the NHS funding crisis?

As long as the political taboo on raising taxes endures, the service will be in financial peril. 

It has long been clear that the NHS is in financial ill-health. But today's figures, conveniently delayed until after the Conservative conference, are still stunningly bad. The service ran a deficit of £930m between April and June (greater than the £820m recorded for the whole of the 2014/15 financial year) and is on course for a shortfall of at least £2bn this year - its worst position for a generation. 

Though often described as having been shielded from austerity, owing to its ring-fenced budget, the NHS is enduring the toughest spending settlement in its history. Since 1950, health spending has grown at an average annual rate of 4 per cent, but over the last parliament it rose by just 0.5 per cent. An ageing population, rising treatment costs and the social care crisis all mean that the NHS has to run merely to stand still. The Tories have pledged to provide £10bn more for the service but this still leaves £20bn of efficiency savings required. 

Speculation is now turning to whether George Osborne will provide an emergency injection of funds in the Autumn Statement on 25 November. But the long-term question is whether anyone is prepared to offer a sustainable solution to the crisis. Health experts argue that only a rise in general taxation (income tax, VAT, national insurance), patient charges or a hypothecated "health tax" will secure the future of a universal, high-quality service. But the political taboo against increasing taxes on all but the richest means no politician has ventured into this territory. Shadow health secretary Heidi Alexander has today called for the government to "find money urgently to get through the coming winter months". But the bigger question is whether, under Jeremy Corbyn, Labour is prepared to go beyond sticking-plaster solutions. 

George Eaton is political editor of the New Statesman.