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.

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Corbyn's supporters loved his principles. But he ditched them in the EU campaign

Jeremy Corbyn never wanted Remain to win, and every gutless performance showed that. Labour voters deserve better. 

“A good and decent man but he is not a leader. That is the problem.” This was just-sacked Hilary Benn’s verdict on Jeremy Corbyn, and he’s two-thirds right. Corbyn is not a leader, and if that wasn’t obvious before the referendum campaign, it should be now. If the Vice documentary didn’t convince you that Corbyn is a man who cannot lead – marked by both insubstantiality and intransigence, both appalling presentation and mortal vanity – then surely his botched efforts for Remain must have.

But so what. Even Corbyn’s greatest supporters don’t rate him as a statesman. They like him because he believes in something. Not just something (after all, Farage believes in something: he believes in a bleached white endless village fete with rifle-toting freemen at the gates) but the right things. Socialist things. Non-Blairite things. The things they believe in. And the one thing that the EU referendum campaign should absolutely put the lie to is any image of Corbyn as a politician of principle – or one who shares his party’s values.

He never supported Remain. He never wanted Remain to win, and every gutless performance showed that. Watching his big centrepiece speech, anyone not explicitly informed that Labour was pro-Remain would have come away with the impression that the EU was a corrupt conglomerate that we’re better off out of. He dedicated more time to attacking the institution he was supposed to be defending, than he did to taking apart his ostensive opposition. And that’s because Leave weren’t his opposition, not really. He has long wanted out of the EU, and he got out.

It is neither good nor decent to lead a bad campaign for a cause you don’t believe in. I don’t think a more committed Corbyn could have swung it for Remain – Labour voters were firmly for Remain, despite his feeble efforts – but giving a serious, passionate account of what what the EU has done for us would at least have established some opposition to the Ukip/Tory carve-up of the nation. Now, there is nothing. No sound, no fury and no party to speak for the half the nation that didn’t want out, or the stragglers who are belatedly realising what out is going to mean.

At a vigil for Jo Cox last Saturday, a Corbyn supporter told me that she hoped the Labour party would now unify behind its leader. It was a noble sentiment, but an entirely misplaced one when the person we are supposed to get behind was busily undermining the cause his members were working for. Corbyn supporters should know this: he has failed you, and will continue to fail you as long as he is party leader.

The longer he stays in office, the further Labour drifts from ever being able to exercise power. The further Labour drifts from power, the more utterly hopeless the prospects for all the things you hoped he would accomplish. He will never end austerity. He will never speak to the nation’s disenfranchised. He will achieve nothing beyond grinding Labour ever further into smallness and irrelevance.

Corbyn does not care about winning, because he does not understand the consequences of losing. That was true of the referendum, and it’s true of his attitude to politics in general. Corbyn isn’t an alternative to right-wing hegemony, he’s a relic – happy to sit in a glass case like a saint’s dead and holy hand, transported from one rapturous crowd of true believers to another, but somehow never able to pull off the miracles he’s credited with.

If you believe the Labour party needs to be more than a rest home for embittered idealists – if you believe the working class must have a political party – if you believe that the job of opposing the government cannot be left to Ukip – if you believe that Britain is better than racism and insularity, and will vote against those vicious principles when given a reason to; if you believe any of those things, then Corbyn must go. Not just because he’s ineffectual, but because he’s untrustworthy too.

Some politicians can get away with being liars. There is a kind of anti-politics that is its own exemplum, whose representatives tell voters that all politicians are on the make, and then prove it by being on the make themselves and posing as the only honest apples in the whole bad barrel. That’s good enough for the right-wing populists who will take us out of Europe but it is not, it never has been, what the Labour Party is. Labour needs better than Corbyn, and the country that needs Labour must not be failed again.

Sarah Ditum is a journalist who writes regularly for the Guardian, New Statesman and others. Her website is here.