Ed Miliband walks with Doctor Tom Coffey at The Brocklehurst Medical Centre in Wandsworth on May 16, 2011 in London. Photograph: Getty Images.
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Miliband puts NHS centre stage with new GP guarantee

Labour leader pledges that all patients will win the right to an appointment within 48 hours. 

Labour laid the ground for Ed Miliband's NHS speech over the weekend by highlighting new figures showing that patients waited more than a week to see their GP on almost 50 million occasions last year. In his address in Manchester this evening, Miliband will offer his antidote.  

He will unveil a "GP guarantee", promising that Labour will give all patients the right to an appointment within 48 hours if they want one - and on the same day if they need one. Under the coalition, the proportion seeing a GP within 48 hours has fallen from 80 per cent to just 40 per cent.

Labour plans to invest an extra £100m a year in family doctor practices, enough to pay for an additional three million GP appointments. One of the central aims of the policy is to reduce the burden on A&E and the number of avoidable hospital admissions. Labour cites studies showing that a 5 per cent increase in patients seeing their preferred GP could reduce emergency admissions by as much as 159,000 a year – saving the NHS £375m. The ambition, as a Labour spokesman told me, is to both "improve the health service and save money". 

Labour plans to pay for the new investment by scrapping government rules which have led to unnecessary administration and legal fees (costing at least £78m) because NHS services are now under threat from EU competition law; and by cutting spending by the three main health quangos: Monitor, the Trust Development Authority and Commissioning Support Units. 

The speech will be followed by an election broadcast tomorow night featuring Miliband volunteering at a hospital.

Miliband will say this evening: 

In the year leading up to the next General Election and beginning in this local and European campaign the National Health Service needs to be on the centre stage of British politics. People remember the promises David Cameron made at the last election: the airbrushed posters and the three letters he said he cared about most: NHS. But we all know the reality now: the broken promises.

David Cameron said there would be moratorium on hospital closures.But he has taken on sweeping new powers to close services over the heads of local people. He said there would be no return to people waiting for hours in A&E. But last year more people waited for over four hours in A&E than for any time for a decade. He promised to protect frontline services. But a quarter of walk-in centres have been closed since 2010.

He promised that people should be able to see their GP '24/7' But a quarter of the public now say they can’t get an appointment in the same week. It’s a scandal that people are waiting that long, it is not how our NHS, the pride of Britain, should work.

And he promised there would be no more top down reorganisations.But he spent billions of pounds on a top-down reorganization that nobody wanted and nobody voted for which has put the principles of markets and competition at the heart of the NHS like never before: Aboost for the private companies and competition lawyers; a burden for everyone else.

Competition, fragmentation, and privatisation - that’s how the Tories see the future of our NHS and that’s why it is going backwards. David Cameron has broken his bond of trust with the British people on the NHS. He has proved the oldest truth in British politics: you can’t trust the Tories with the NHS.

"You can't trust the Tories with the NHS" may be a familiar Labour refrain, but it is no less effective for being so. Even after a concerted Conservative attempt to pin the blame for the Mid-Staffs scandal on the last government, the opposition continues to enjoy a 12-point lead on health. There is every reason for Labour to "bang on" about the NHS. 

But while Miliband can reasonably point to savings that would be achieved by cutting bureaucracy, integrating health and social care, and devolving services, this will not be enough to plug te long-term funding gap. 

At present, despite the common view that it has been shielded from austerity, the NHS is experiencing the toughest spending settlement in its history. 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 a recent Social Market Foundation paper, 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 of the health service, this government and future ones are left with three choices: to raise taxes (my preference), to cut spending elsewhere, or to impose patient charges. With this in mind, Labour figures have begun the tough work of considering which taxes, most obviously National Insurance, they could raise in order to sustain a free, universal NHS. But that remains a battle for another day. 

George Eaton is political editor of the New Statesman.

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Former Irish premier John Bruton on Brexit: "Britain should pay for our border checks"

The former Taoiseach says Brexit has been interpreted as "a profoundly unfriendly act"

At Kapıkule, on the Turkish border with Bulgaria, the queue of lorries awaiting clearance to enter European Union territory can extend as long as 17km. Despite Turkey’s customs union for goods with the bloc, hauliers can spend up to 30 hours clearing a series of demanding administrative hoops. This is the nightmare keeping former Irish premier John Bruton up at night. Only this time, it's the post-Brexit border between Northern Ireland and the Republic, and it's much, much worse.   

Bruton (pictured below), Taoiseach between 1994 and 1997, is an ardent pro-European and was historically so sympathetic to Britain that, while in office, he was pilloried as "John Unionist" by his rivals. But he believes, should she continue her push for a hard Brexit, that Theresa May's promise for a “seamless, frictionless border” is unattainable. 

"A good example of the sort of thing that might arise is what’s happening on the Turkish-Bulgarian border," the former leader of Ireland's centre-right Fine Gael party told me. “The situation would be more severe in Ireland, because the UK proposes to leave the customs union as well."

The outlook for Ireland looks grim – and a world away from the dynamism of the Celtic Tiger days Bruton’s coalition government helped usher in. “There will be all sorts of problems," he said. "Separate permits for truck drivers operating across two jurisdictions, people having to pay for the right to use foreign roads, and a whole range of other issues.” 

Last week, an anti-Brexit protest on the border in Killeen, County Louth, saw mock customs checks bring traffic to a near standstill. But, so far, the discussion around what the future looks like for the 260 border crossings has focused predominantly on its potential effects on Ulster’s fragile peace. Last week Bruton’s successor as Taoiseach, Bertie Ahern, warned “any sort of physical border” would be “bad for the peace process”. 

Bruton does not disagree, and is concerned by what the UK’s withdrawal from the European Convention on Human Rights might mean for the Good Friday Agreement. But he believes the preoccupation with the legacy of violence has distracted British policymakers from the potentially devastating economic impact of Brexit. “I don’t believe that any serious thought was given to the wider impact on the economy of the two islands as a whole," he said. 

The collapse in the pound has already hit Irish exporters, for whom British sales are worth £15bn. Businesses that work across the border could yet face the crippling expense of duplicating their operations after the UK leaves the customs union and single market. This, he says, will “radically disturb” Ireland’s agriculture and food-processing industries – 55 per cent of whose products are sold to the UK. A transitional deal will "anaesthetise" people to the real impact, he says, but when it comes, it will be a more seismic change than many in London are expecting. He even believes it would be “logical” for the UK to cover the Irish government’s costs as it builds new infrastructure and employs new customs officials to deal with the new reality.

Despite his past support for Britain, the government's push for a hard Brexit has clearly tested Bruton's patience. “We’re attempting to unravel more than 40 years of joint work, joint rule-making, to create the largest multinational market in the world," he said. It is not just Bruton who is frustrated. The British decision to "tear that up", he said, "is regarded, particularly by people in Ireland, as a profoundly unfriendly act towards neighbours".

Nor does he think Leave campaigners, among them the former Northern Ireland secretary Theresa Villiers, gave due attention to the issue during the campaign. “The assurances that were given were of the nature of: ‘Well, it’ll be alright on the night!’," he said. "As if the Brexit advocates were in a position to give any assurances on that point.” 

Indeed, some of the more blimpish elements of the British right believe Ireland, wedded to its low corporate tax rates and east-west trade, would sooner follow its neighbour out of the EU than endure the disruption. Recent polling shows they are likely mistaken: some 80 per cent of Irish voters say they would vote to remain in an EU referendum.

Irexit remains a fringe cause and Bruton believes, post-Brexit, Dublin will have no choice but to align itself more closely with the EU27. “The UK is walking away,” he said. “This shift has been imposed upon us by our neighbour. Ireland will have to do the best it can: any EU without Britain is a more difficult EU for Ireland.” 

May, he says, has exacerbated those difficulties. Her appointment of her ally James Brokenshire as secretary of state for Northern Ireland was interpreted as a sign she understood the role’s strategic importance. But Bruton doubts Ireland has figured much in her biggest decisions on Brexit: “I don’t think serious thought was given to this before her conference speech, which insisted on immigration controls and on no jurisdiction for the European Court of Justice. Those two decisions essentially removed the possibility for Ireland and Britain to work together as part of the EEA or customs union – and were not even necessitated by the referendum decision.”

There are several avenues for Britain if it wants to avert the “voluntary injury” it looks set to inflict to Ireland’s economy and its own. One, which Bruton concedes is unlikely, is staying in the single market. He dismisses as “fanciful” the suggestions that Northern Ireland alone could negotiate European Economic Area membership, while a poll on Irish reunification is "only marginally" more likely. 

The other is a variation on the Remoaners’ favourite - a second referendum should Britain look set to crash out on World Trade Organisation terms without a satisfactory deal. “I don’t think a second referendum is going to be accepted by anybody at this stage. It is going to take a number of years,” he said. “I would like to see the negotiation proceed and for the European Union to keep the option of UK membership on 2015 terms on the table. It would be the best available alternative to an agreed outcome.” 

As things stand, however, Bruton is unambiguous. Brexit means the Northern Irish border will change for the worse. “That’s just inherent in the decision the UK electorate was invited to take, and took – or rather, the UK government took in interpreting the referendum.”