Why cutting the NHS would be bad policy and bad politics

There is no prospect of David Cameron taking up Liam Fox's suggestion of cutting spending on the health service.

Liam Fox's call for the ring-fence around NHS spending to be removed is one that is likely to attract much sympathy from Conservative activists. There is a common view that the health service, one of just two departments (the other being International Department) to have had its budget protected in real-terms, has been unfairly shielded from austerity, with even some on the left (among them Vince Cable) calling for cuts. 

In reality, the reverse is the case. Owing to the above-average rate of health inflation (most notably the cost of new drugs and medical equipment), the NHS requires real-terms rises just to stand still. As a recent Social Market Foundation paper noted, "A ‘flat real’ settlement for the NHS is mot what it sounds like since it is defined with reference to an irrelevant price index. To keep up with rising input costs, growing demand, and the public’s expectations for an adequate healthcare system, growth in spending on health has historically outstripped GDP growth." 

By historic standards, the NHS is undergoing austerity. Since 1950, health spending has grown at an average annual rate of 4%, but over the current Spending Review it will rise by an average of just 0.5%. As a result, in the words of the SMF, there has been "an effective cut of £16bn from the health budget in terms of what patients expect the NHS to deliver". Should the NHS receive flat real settlements for the three years from 2015-16 (as seems probable), this cut will increase to £34bn or 23%.

If they wish to avoid a significant fall in the quality and quantity of services, this government and future ones are left with three choices: to raise taxes, to cut spending elsewhere, or to impose patient charges. Fox argues that "we’ve tested to destruction the idea that simply throwing lots more money at the health service will make it better", but this ignores the significant improvements that health researchers found to have taken place under Labour (with patient satisfaction rising to a record high as a result). 

If that is reason enough for the Tories to avoid cutting NHS spending, it would also be terrible politics. As a ComRes/ITV News poll found last year, health is the most popular spending area among voters. Just 5% of voters believe the NHS budget should be reduced and 71% believe it should be increased. There is no prospect of Cameron and Osborne handing Labour a pre-election gift by pledging to cut spending.

Incidentally, it's worth correcting the myth, encouraged by Cameron, that Labour would have cut the NHS had it won the last election. In fact, in 2010, then-health secretary Andy Burnham pledged to protect spending, the difference being that the Tories promised to increase it. Burnham helpfully clarified this in an interview with the NS in 2010. 

Why shouldn't NHS spending be ring-fenced?

The ring-fence is what we proposed at the election and, in many ways, it is what I'm still arguing for, which is protection in real terms. Before the election, Labour calculated that if you gave the NHS protection in real terms -- so frozen in inflation -- it would allow you, on the other hand, to give schools inflation in real terms and give police inflation in real terms. Those are the three key services. The health service does not exist in isolation. By taking a more balanced approach to public spending, you can protect the three key services.

So your argument is that ring-fencing it in isolation makes it nonsense?

They're not ring-fencing it. They're increasing it. They're doing two things: they're accelerating the reduction in public spending, which I wouldn't have done, and they are also going to increase the NHS within that. So they went through the whole election campaign boasting that they were going to spend more than me and they're still doing it. Cameron's been saying it every week in the Commons: "Oh, the shadow health secretary wants to spend less on health than us."

As for what Labour's stance will be in 2015, Miliband all but confirmed in an interview with the BBC last year that he would not cut the NHS. He told Nick Robinson: "We're not going to be cutting the health service, I'm very clear about that. We will always be protecting the health service and will always make it a priority."

It's worth remembering that when Ed Balls announced his "zero-based" spending review (one that examines every item of spending), he signalled that health would be a candidate for a "pre-election spending commitment". Expect the Tories to adopt much the same approach. 

Former defence secretary Liam Fox speaks at the Conservative conference in 2011. Photograph: Getty Images.

George Eaton is political editor of the New Statesman.

Photo: Getty Images/AFP
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Why is the government charging more women for selling sex but turning a blind eye to buyers?

Since 2013, the number of women charged for selling sex gone up while the number of men charged for buying it has gone down.

It’s no surprise that prostitution policy is an area rarely visited by our legislators. It’s politically charged - a place where the need to prevent exploitation seemingly clashes head on with notions of liberal freedom; where there are few simple answers, a disputed evidence base, and no votes.

There’s also little evidence to suggest that MPs are different from the rest of the population - where one-in-ten men have purchased sex. It is little wonder therefore that our report on how the law should change, published in 2014, was the first major cross-party intervention on the subject in twenty years.

Some take the view that by removing all legal constraints, it will make the inherently exploitative trade of prostitution, safer. It’s not just me that questions this approach, though I accept that - equally - there’s no consensus that my preferred measure of criminalising the purchase of sex, while decriminalising the sale, would fundamentally change the scale of the problem.

Where all sides come together, however, is in the desire to see women diverted from the law courts. It is still possible for women (and it still is women; prostitution remains highly genderised) to go to prison for offences related to prostitution. Today, in 2015.

The total number of prosecutions for all prostitution offences in England and Wales has been decreasing since 2010, but not in a uniform fashion. This does not reflect a reduction in the size of the trade, or the violent nature of it.

There were once consistently more prosecutions for kerb crawling, profiting, and control of prostitution. But since 2013, there have been more prosecutions for soliciting or loitering than for profit from prostitution and kerb crawling each year.

In simple terms, offences committed by men with choice, freedom and money in their pocket are having a blind eye turned to them, while women are being targeted - and this trend is accelerating. In the law courts, and in prosecutions, it is the most vulnerable party in the transaction, who is taking the burden of criminality.

Take on-street sex buying as an example. In 2013-14 just 237 prosecutions were brought for kerb crawling, but there were 553 - more than twice as many - for loitering and soliciting.

There is a similar pattern in the 2014/15 figures: 227 charges for kerb crawling reached court, while 456 prosecutions were initiated against those who were selling sex. Just 83 prosecutions for control of prostitution, or ‘pimping’, were brought in that same year.

These are men and women on the same street. It takes a high level of liberal delusion to be convinced that prostitution is caused by a surge of women wishing to sell sex, rather than men who wish to buy it. And yet women who sell sex are the ones being targeted in our law courts, not the men that create the demand in the first place.

This situation even goes against the Crown Prosecution Service’s (CPS) own guidance. They say:

“Prostitution is addressed as sexual exploitation within the overall CPS Violence Against Women strategy because of its gendered nature… At the same time, those who abuse and exploit those involved in prostitution should be rigorously investigated and prosecuted, and enforcement activity focused on those who create the demand for on-street sex, such as kerb crawlers.”

Why then, is this happening? For the same reason it always does - in our criminal justice system stigmatised, poor women are valued less than moneyed, professional men.

My debate in Parliament today raises these issues directly with the government ministers responsible. But to be honest, the prosecution-bias against women in the courts isn’t the problem; merely a symptom of it. This bias will only be tackled when the law reflects the inherent harm of the trade to women, rather than sending the mixed signals of today.

That’s why I welcome the work of the End Demand Alliance, composed of over 40 organisations working to end the demand that fuels sex trafficking and prostitution, advocating the adoption of the Sex Buyer Law throughout the UK.

This would criminalise paying for sex, while decriminalising its sale and providing support and exiting services for those exploited by prostitution. Regardless of these big changes in the law, I don’t see how anyone can support the current state of affairs where there are more prosecutions brought against women than men involved in prostitution.

The authorities are targeting women because they're easier to arrest and prosecute. It goes against their own guidance, common sense and natural justice.
And it needs to stop.

Gavin Shuker is MP for Luton South and chair of the All Party Group on Prostitution and the Global Sex Trade.