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.

Photo: Getty
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After Richmond Park, Labour MPs are haunted by a familiar ghost

Labour MPs in big cities fear the Liberal Democrats, while in the north, they fear Ukip. 

The Liberal Democrats’ victory in Richmond Park has Conservatives nervous, and rightly so. Not only did Sarah Olney take the votes of soft Conservatives who backed a Remain vote on 23 June, she also benefited from tactical voting from Labour voters.

Although Richmond Park is the fifth most pro-Remain constituency won by a Conservative at the 2015 election, the more significant number – for the Liberal Democrats at least – is 15: that’s the number of Tory-held seats they could win if they reduced the Labour vote by the same amount they managed in Richmond Park.

The Tories have two Brexit headaches, electorally speaking. The first is the direct loss of voters who backed David Cameron in 2015 and a Remain vote in 2016 to the Liberal Democrats. The second is that Brexit appears to have made Liberal Democrat candidates palatable to Labour voters who backed the party as the anti-Conservative option in seats where Labour is generally weak from 1992 to 2010, but stayed at home or voted Labour in 2015.

Although local council by-elections are not as dramatic as parliamentary ones, they offer clues as to how national elections may play out, and it’s worth noting that Richmond Park wasn’t the only place where the Liberal Democrats saw a dramatic surge in the party’s fortunes. They also made a dramatic gain in Chichester, which voted to leave.

(That’s the other factor to remember in the “Leave/Remain” divide. In Liberal-Conservative battlegrounds where the majority of voters opted to leave, the third-placed Labour and Green vote tends to be heavily pro-Remain.)

But it’s not just Conservatives with the Liberal Democrats in second who have cause to be nervous.  Labour MPs outside of England's big cities have long been nervous that Ukip will do to them what the SNP did to their Scottish colleagues in 2015. That Ukip is now in second place in many seats that Labour once considered safe only adds to the sense of unease.

In a lot of seats, the closeness of Ukip is overstated. As one MP, who has the Conservatives in second place observed, “All that’s happened is you used to have five or six no-hopers, and all of that vote has gone to Ukip, so colleagues are nervous”. That’s true, to an extent. But it’s worth noting that the same thing could be said for the Liberal Democrats in Conservative seats in 1992. All they had done was to coagulate most of the “anyone but the Conservative” vote under their banner. In 1997, they took Conservative votes – and with it, picked up 28 formerly Tory seats.

Also nervous are the party’s London MPs, albeit for different reasons. They fear that Remain voters will desert them for the Liberal Democrats. (It’s worth noting that Catherine West, who sits for the most pro-Remain seat in the country, has already told constituents that she will vote against Article 50, as has David Lammy, another North London MP.)

A particular cause for alarm is that most of the party’s high command – Jeremy Corbyn, Emily Thornberry, Diane Abbott, and Keir Starmer – all sit for seats that were heavily pro-Remain. Thornberry, in particular, has the particularly dangerous combination of a seat that voted Remain in June but has flirted with the Liberal Democrats in the past, with the shadow foreign secretary finishing just 484 votes ahead of Bridget Fox, the Liberal Democrat candidate, in 2005.

Are they right to be worried? That the referendum allowed the Liberal Democrats to reconfigure the politics of Richmond Park adds credence to a YouGov poll that showed a pro-Brexit Labour party finishing third behind a pro-second referendum Liberal Democrat party, should Labour go into the next election backing Brexit and the Liberal Democrats opt to oppose it.

The difficulty for Labour is the calculation for the Liberal Democrats is easy. They are an unabashedly pro-European party, from their activists to their MPs, and the 22 per cent of voters who back a referendum re-run are a significantly larger group than the eight per cent of the vote that Nick Clegg’s Liberal Democrats got in 2015.

The calculus is more fraught for Labour. In terms of the straight Conservative battle, their best hope is to put the referendum question to bed and focus on issues which don’t divide their coalition in two, as immigration does. But for separate reasons, neither Ukip nor the Liberal Democrats will be keen to let them.

At every point, the referendum question poses difficulties for Labour. Even when neither Ukip nor the Liberal Democrats take seats from them directly, they can hurt them badly, allowing the Conservatives to come through the middle.

The big problem is that the stance that makes sense in terms of maintaining party unity is to try to run on a ticket of moving past the referendum and focussing on the party’s core issues of social justice, better public services and redistribution.

But the trouble with that approach is that it’s alarmingly similar to the one favoured by Kezia Dugdale and Scottish Labour in 2016, who tried to make the election about public services, not the constitution. They came third, behind a Conservative party that ran on an explicitly pro-Union platform. The possibility of an English sequel should not be ruled out.  

Stephen Bush is special correspondent at the New Statesman. His daily briefing, Morning Call, provides a quick and essential guide to British politics.