How Cameron could ease Tory anger over gay marriage

The Prime Minister could promise to meet his pledge to introduce a married couples' tax allowance in return for support over the issue.

As the government prepares to announce plans to bring forward legislation on gay marriage, the growing divisions within the Conservative Party over the issue are being exposed. Yesterday, David Davies MP described the policy as "barking mad", adding, apropos of nothing, that "most parents would prefer their children not to be gay". Meanwhile, Peter Bone told Sky News: "It was in no party manifesto, there is no mandate for the Prime Minister to do this; he is absolutely wrong to be doing it now, and he's splitting the Conservative Party when we don't need it to be split."

To counterbalance such figures, a group of senior Conservatives, including Michael Gove, Boris Johnson, Transport Secretary Patrick McLoughlin, and former justice minister Nick Herbert, have founded a new group, Freedom to Marry, to campaign for equal marriage. In a letter to the Sunday Telegraph, they wrote: "We recognise that civil partnerships were an important step forward in giving legal recognition to same sex couples. But civil partnerships are not marriages, which express a particular and universally understood commitment."

Today, they are joined by John Major, who declared in a statement released through the group, "The Prime Minister's instinct to support equal marriage is a courageous and genuine attempt to offer security and comfort to people who - at present - may be together, yet feel apart."

That such senior figures feel the need to campaign for what is, after all, already government policy, is an indication of how weak David Cameron's position is. If the PM is forced to rely on the votes of Labour and Liberal Democrat MPs to pass the bill (at least 130 Tory MPs are prepared to vote against it), he will be exposed as the leader of a divided and, in places, bigoted party. Rather than casting the Conservative Party in a positive light, the issue could only serve as a reminder of how unreconstructed parts of it remain. Cameron will lose Conservative votes over the issue, while failing to gain those of liberals.

If the PM wants to limit the extent of the Conservative rebellion, one option would be to fulfil his long-standing pledge to recognise marriage in the tax system (as ConservativeHome editor Tim Montgomerie has argued). The Coalition Agreement (see p. 30) promised to introduce transferable tax allowances for married couples, while guaranteeing Lib Dem MPs the right to abstain, and the measure is reportedly under consideration for next year's Budget. By pledging to bring forward this policy for straight and gay couples alike, Cameron could drain some of the poison from the Tory revolt.

To be clear, he would be wrong to do so (there is no good argument for privileging married couples over others) and such a move may not even succeed in winning the rebels round. In today's Telegraph, demands the introduction of a tax allowance for married couples, while rebuking Cameron for his support for gay marriage. He writes:

The CSJ’s poll, published today, reveals that not just 47 per cent of Conservative supporters feel betrayed by the PM on this omission [Cameron's failure to introduce a tax allowance for married couples] but 35 per cent of all voters. I doubt that the Government will enjoy anything like compensatory approval ratings for announcing in the same week that gay marriage has apparently become a more urgent issue for Government action, despite no similar manifesto commitment to legislate and after a massive consultation exercise that has been overwhelmingly negative.

All the same, it would be surprising if Cameron wasn't considering a grand bargain along these lines.

David Cameron addresses guests at a Gay Pride reception in the garden at 10 Downing Street. Photograph: Getty Images.

George Eaton is political editor of the New Statesman.

Photo: Getty
Show Hide image

The NHS's sustainability is under threat if more isn't done to look after its staff

More work is needed to develop the health service's most precious resource.

As the NHS nears its 70th anniversary, the time is ripe for a workforce rescue plan. Staffing worries, even more than funding pressures, are the biggest cause of concern for NHS trust leaders. There are not enough trained health workers in the UK to meet today’s needs, let alone those of the future.

Demands on hospitals, mental health and community trusts, and ambulance services are growing. More patients need treatment. Increasingly, they require complex care, with specialist expertise. This is not just about numbers. We need a clinical workforce that is skilled and equipped to work in new ways to deal with the changing needs of the population it serves. 

That means improving the supply of people coming to work for the NHS, and doing more to develop and motivate them so they want to stay. These problems are not new but the scale of the challenge has reached a tipping point which threatens the future sustainability of the NHS.

Ministers rightly point out that the NHS in England has more clinical staff than ever before, but numbers have not kept pace with rising demand. The official "shortfall rate" for nurses and midwives across England is close to 10 per cent, and in some places significantly higher. Part of this is down to the recognition, after the events at troubled health trust Mid Staffordshire, of the importance of safe staffing levels. Yet for successive years during the coalition government, the number of nurse training recruits fell.

Far from being a problem just for hospitals, there are major nursing shortages in mental health and community trusts. Between 2009 and 2016 the number of district nurses employed by the NHS in England fell by more than 40 per cent. Just as the health service tries to accelerate plans for more treatment closer to home, in key parts of the workforce the necessary resources are shrinking.

There are also worrying gaps in the supply of doctors. Even as the NHS gears up for what may prove to be its toughest winter yet, we see worrying shortfalls in A&E consultants. The health service is rightly committed to putting mental health on an equal footing with physical health. But many trusts are struggling to fill psychiatry posts. And we do not have enough GPs.

A key part of the problem is retention. Since 2010/11 there has been a worrying rise in “leaver rates” among nurses, midwives, ambulance staff and scientific technical staff. Many blame the pressures of workload, low staffing levels and disillusionment with the quality of care. Seventy per cent of NHS staff stay on for extra hours. Well over a third say they have felt unwell in the past year because of work-related stress.

Add in cuts to real basic pay, year after year, and it is hardly surprising that some are looking to other opportunities and careers outside the public sector. We need a strategy to end pay restraint in the NHS.

There is also a worrying demographic challenge. Almost one in three qualified nurses, midwives and health visitors is aged 50 or older. One in five GPs is at least 55. We have to give them reasons to stay.

NHS trusts have made important strides in engaging with their workforce. Staff ratings on being able to report concerns, feeling trusted to do their jobs, and being able to suggest improvements are encouraging. But there are still cultural problems – for example around discrimination and bullying – which must be addressed locally and nationally.

The NHS can no longer be sure that overseas recruits will step in to fill workforce gaps. In the early 2000s many trusts looked beyond Europe to meet nursing shortages. More recently, as tougher immigration and language rules took hold, a growing proportion came from the EU – though not enough to plug the gap.

Now we have all the uncertainty surrounding Brexit. We need urgent clarity on the status of current EU nationals working in the health and care systems. And we must recognise that for the foreseeable future, NHS trusts will need support to recruit and retain staff from overseas. The government says it will improve the home-grown supply, but that will clearly take time.

These problems have developed in plain sight. But leadership on this has been muddled or trumped by worries over funding. Responsibility for NHS workforce strategy is disjointed. We need a co-ordinated, realistic, long-term strategy to ensure that frontline organisations have the right number of staff with the right skills in the right place to deliver high quality care.

We must act now. This year's long-delayed workforce plan – to be published soon by Health Education England – could be a good place to start. But what we need is a more fundamental approach – with a clear vision of how the NHS must develop its workforce to meet these challenges, and a commitment to make it happen. 

Saffron Cordery is the director of policy and strategy at NHS Providers