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.

ELLIE FOREMAN-PECK FOR NEW STATESMAN
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The triumph of Misbah-ul-Haq, the quiet grafter

How Misbah redeemed Pakistani cricket.

It was an incongruous sight: the entire Pakistani cricket team doing press-ups on the revered pitch at Lord’s, led by its captain, Misbah-ul-Haq. This unusual celebration marked not merely a Test match victory over England on Sunday but something greater: the rehabilitation of Pakistani cricket.

Seven years earlier, the Sri Lankan team bus was en route to the cricket stadium in Lahore for the third day of a Test match against Pakistan when it was attacked by Islamist militants. Gunfire killed six police officers and a driver; several Sri Lankan cricketers were also injured. That was the last Test match played in Pakistan, which, despite protestations, opponents consider too dangerous to visit.

A year later, Pakistan toured England for a Test series. The News of the World alleged that in the final match at Lord’s three Pakistani cricketers had conspired to bowl no-balls in exchange for money. All three received bans of five years or more for corruption. The entire squad was lampooned; police had to shield its members from abuse as they arrived home.

Misbah was on the periphery of all of this. Aged 36 at the time, he was dropped from the squad before the English tour and seemed unlikely to play international cricket again. But the turbulence engulfing Pakistani cricket forced the selectors to reassess. Not only was Misbah recalled but he was made captain. “You have to ask yourself,” he later said: “‘Have I been the captain because they supported me, or because they had no alternatives?’”

Pakistani cricket prizes and mythologises teenage talent plucked from obscurity and brought into the international side. During his decade as captain, Imran Khan picked 11 teenagers to make their debuts, often simply on the basis of being wowed by their performance in the nets. Misbah shows that another way is possible. He grew up in Mianwali, a city that was so remote that: “The culture there wasn’t such that you thought about playing for Pakistan.”

At the behest of his parents, he devoted his early twenties not to his promising batting but to gaining an MBA. Only at 24 did he make his first-class debut, strikingly late in an age when professional sportsmen are expected to dedicate all their energy to the game from their teenage years.

Pakistani cricket has always been “a little blip of chaos to the straight lines of order”, Osman Samiuddin writes in The Unquiet Ones. Misbah has created order out of chaos. He is unflappable and methodical, both as a captain and as a batsman. His mood seems impervious to results. More than anything, he is resilient.

He has led Pakistan to 21 Test victories – seven more than any other captain. He has done this with a bowling attack ravaged by the 2010 corruption scandal and without playing a single match at home. Because of security concerns, Pakistan now play in the United Arab Emirates, sometimes in front of fewer than a hundred supporters.

Misbah has developed a team that marries professionalism with the self-expression and flair for which his country’s cricket is renowned. And he has scored runs – lots of them. Over his 43 Tests as captain, he has averaged at 56.68. Few have been so empowered by responsibility, or as selfless. He often fields at short leg, the most dangerous position in the game and one usually reserved for the team’s junior player.

Misbah has retained his capacity to surprise. As a batsman, he has a reputation for stoic defence. Yet, in November 2014 he reached a century against Australia in just 56 balls, equalling the previous record for the fastest ever Test innings, held by Viv Richards. The tuk-tuk had become a Ferrari.

Late in 2015, Misbah tried to retire. He was 41 and had helped to keep Pakistani cricket alive during some of its darkest days. But the selectors pressured him to stay on, arguing that the team would need him during its arduous tours to England and Australia.

They were right. His crowning glory was still to come. The team arrived in England following weeks of training with the national army in Abbottabad. “The army people are not getting much salaries, but for this flag and for the Pakistani nation, they want to sacrifice their lives,” Misbah said. “That’s a big motivation for all of us. Everyone is really putting effort in for that flag and the nation.”

Now 42, almost a decade older than any cricketer in England’s side, Misbah fulfilled a lifetime’s ambition by playing in a Test match at Lord’s. In Pakistan’s first innings, he scored a century and celebrated with push-ups on the outfield, in homage to the army’s fitness regime and those who had had the temerity to mock his age.

When Pakistan secured victory a little after 6pm on the fourth evening of the game, the entire team imitated the captain’s push-ups, then saluted the national flag. The applause for them reverberated far beyond St John’s Wood.

“It’s been a remarkable turnaround after the 2010 incident,” Misbah-ul-Haq said, ever undemonstrative.

He would never say as much, but he has done more than anyone else to lead Pakistan back to glory. 

Tim Wigmore is a contributing writer to the New Statesman and the author of Second XI: Cricket In Its Outposts.

This article first appeared in the 21 July 2016 issue of the New Statesman, The English Revolt