Ed Miliband speaks with radiotherapists, during his visit to University College hospital, on April 4, 2011 in London. Photograph: Getty Images.
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A tax rise for the NHS would be good policy and politics for Labour

By promising to save the most popular public service from a funding crisis, Miliband can craft a potent dividing line with the Tories.

If Labour is to win the general election, it will need the NHS to be one of the dominant themes of the campaign. Unlike on issues such as immigration, welfare and the deficit, it enjoys a consistent double-digit lead over the Conservatives and can point to an unambiguous record of success in government (it left office with NHS satisfaction at a record high). As one shadow cabinet minister told me recently: "The more people talk about the NHS, the better Labour does". 

But if the party is to credibly address the future of the health service it will need to confront the looming funding crisis. Contrary to the common view that it has been shielded from austerity, the NHS is currently enduring the toughest spending settlement in its history. Since 1950, health spending has grown at an average annual rate of 4 per cent, but over the current Spending Review it will rise by an average of just 0.5 per cent. 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-terms settlements for the three years from 2015-16, this cut will increase to £34bn or 23 per cent. In the last year, the number of foundation trusts in financial trouble has nearly doubled from 21 to to 39. By the time of the general election, as many as two-thirds could be in the red. 

To date, Labour has emphasised that it will focus on maximising efficiency by ending the dogmatic privatisation of services (which, as former NHS head David Nicholson said, has left the service "bogged down in a morass of competition law") and by integrating health and social care (which Monitor estimates could save up to £6bn).

As Andy Burnham told me when I interviewed him earlier this year: "The reason I’ve outlined the policy that I have is that I can’t make any assumptions about new money, I can’t, I’m just being honest. I’ve got to assume that things are going to be very tight and it’s that reality, that financial outlook, that makes me look at going very deeply into integration. Before anybody asks the public for more money, any politician of any party, you’ve got to be able to look the public in the eye and say 'are we getting the best we possibly can, the most we possibly can, from what the public are already giving us for the health and care system?' I don’t believe we can do that at the moment."

But the question of new funding cannot be indefinitely postponed. It is for this reason, as today's Independent reports, that the shadow cabinet is examining how the party could promise a significant increase in NHS spending at the election. The most popular option is a hypothecated rise in National Insurance (NI). When Gordon Brown increased the tax by 1 per cent in his 2002 Budget to fund higher NHS spending, Tony Blair and others feared the move would be disastrous. But it proved to be a political coup, creating a potent dividing line with the Tories and securing the health service's future for the next decade. Ed Miliband, who helped to design the policy as a special adviser to Brown, later described it as the proudest moment of his career. Recalling this success, Frank Field and others are publicly urging Labour to raise NI again (perhaps rebranding it entirely as an "NHS tax"). 

Field tells the Independent: "I can’t tell you what a good meeting I had with Ed Balls. He knew all the right questions. He was brilliant. I have been discussing this with John Cruddas for some time and he is happy with it...We are not pretending that the NHS can be saved through efficiencies nor that increased funding will not be accompanied by serious reform. By God, it has to be. But there won’t be much left to reform if we don’t do it."

But Labour's past experience of pre-election tax promises (most notably in 1992) and the living standards crisis that it has done so much to draw attention to, means that many are anxious about asking any group other than the very richest to contribute more. A pledge to raise NI would gift the Tories to chance to run a classic 1992-style "tax bombshell" campaign and accuse the party of planning to squeeze "hardworking families". 

Yet this is a political obstacle to be overcome, not to be avoided. As a ComRes poll found last year, health is the most popular spending area among voters. Just 5 per cent believe the NHS budget should be reduced and 71 per cent believe it should be increased. And as Brown's experience in 2002 demonstrated, voters are realistic enough to know that they cannot have something for nothing. By seizing the initiative on tax, Labour will in turn be able to accuse the Tories of planning an "NHS bombshell" under which the service collapses for want of funds. Having made so much of his commitment to our "national religion", Cameron will have no reasonable response. With the polls narrowing as the economy recovers, the time has come to resurrect those dividing lines. 

George Eaton is political editor of the New Statesman.

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The need for responsible investment banking with a strong regional focus

Let’s begin by stating the problem: there’s a lack of long-term investment in the UK economy, both in infrastructure and in the capital needed to run productive businesses.  That counts double at a regional level across the country. This is an old song to be sure, but that doesn’t detract from its reality.  And with the main fallout from Brexit likely to be a decline in foreign direct investment, the investment gap is only going to get worse.

For example, the OECD think tank estimates an annual infrastructure investment of 3.5% of GDP is necessary in developed economies to maintain competitiveness, never mind boost it.  Currently, public sector infrastructure investment in the UK is forecast to reach to be 1.4% of GDP in 2020/21 – and that’s with the increase in capital spending offered in the Autumn Statement.

The curious thing, though, is that there is no actual shortage of capital.  In fact, in the City, there is probably the world’s biggest pot of footloose cash just looking for an investment opportunity. Which suggests that the failure to invest in UK Plc has more to do with the financial plumbing that anything else. Which brings us to investment banks and their role in the economy.

Today’s high street retail banks – the sort you keep your current account with – make their money from mortgage lending and hidden charges on overdraft facilities. The last thing they do is risk lending money to industry or for long-term infrastructure projects. That’s where dedicated investment banks come in.  Their job is to organise the financial plumbing that channels risk capital from its owner through to companies or infrastructure projects, using any means necessary: underwriting share issues, creating consortia to build windfarms, brokering mergers, managing funds, or selling advice.

To cut to the chase: the UK is suffering a blocked financial pipeline.  Our local investment banking system is in crisis.  Post the 2008 Credit Crunch, domestic banks in the UK – Barclays excepted - have been in wholesale flight from investment banking, which is perceived as having been the cause of their ruin. Certainly derivatives trading allied to insane levels of inter-bank lending formed the detonator of the 2008 implosion. And some institutions – notably HBOS – leveraged themselves to unsustainable levels in order to invest in the latter stages of a commercial property bubble whose eventual collapse was obvious to anyone but a banker. 

But the retreat from investment banking activities by UK firms brings problems. First it implies handing over the keys to investment banking and capital supply to Wall Street. Second, if Donald Trump launches his proffered $1trillion infrastructure investment plan for America, there will be a capital flight from the UK and Europe. All of which suggests that Britain needs to make its own arrangements for capital provision through a reformed and expanded domestic investment banking sector or see UK productivity continue to flat-line.

That’s not to say there aren’t questions still to be asked about the ethical behaviour of investment banks. The five biggest global investment banks operating in the UK regularly contrive to pay no corporation tax locally, despite making billions in profits.  Name and shame: I mean JP Morgan, Bank of America Merrill Lynch, Deutsche Bank AG, Nomura Holding and Morgan Stanley.  But without a domestic UK investment banking sector, we are still going to be ripped off.

There is even more of a problem in the regions and nations that make up Britain.  If anything, regional inequality in the UK has worsened since 2010, with London becoming more, not less economically dominant despite the financial crash. The most recent data show that London’s share of Gross Value Added (GVA) increased from 21.5% in 2010 to 22.6% in 2014, while GVA per head also grew quicker in London than elsewhere.  But regional stock exchanges have long since vanished meaning that what capital is available – for growing companies or local infrastructure needs – is stashed in London and won’t go north in a hurry.

There is no single solution to this set of problems so let’s experiment with trying to create various new bits of financial plumbing. First, accept we need an investment banking sector. Next, let’s create some domestic competition in the sector. RBS has spent too much time chasing its tail and downsizing. It’s time RBS recovered its mojo and went back into the investment banking business. Besides, that is probably the only way it is ever going to start generating real profits again.  All it takes is for UKFI, its public owner, to tell CEO Ross McEwan to change course.

We can also unlock domestic capital specifically for safe, long-term infrastructure projects. Here the problem is Solvency II, the new EU regulations governing the capital requirements for the insurance sector and the pension funds they manage. UK pension funds invest an estimated 1% of their total assets in infrastructure. But this is very low compared with funds in Australia and Canada, where 8-15% of assets are invested in infrastructure.  The problem, complain UK insurers, is that the Prudential Conduct Authority is over-interpreting Solvency II and treating the industry as if it were a dodgy bank.  If capital requirements imposed by the PRA on UK insurers were eased, there would be more capital to invest in local infrastructure.

One possible hard solution to the regional investment gap comes from the New Economics Foundation in conjunction with Common Weal, a pro-independence Scottish think tank.  They are pushing the SNP Government at Holyrood to create a Scottish National Investment Bank and have published a detailed blueprint as to how it could work. Using Scottish Government figures for job creation from capital investment, their joint report states that such an investment bank could directly support the creation of 50,000 jobs “within just a few years of being established”.

Investment banking has become a dirty word since 2008. It’s actually a necessary part of the financial furniture.  The trick is to make it work properly. And for that to happen, politicians and regulators have to be pro-active.

Barclays has commissioned a report ‘‘What have the Capital Markets ever done for us? And how could they do it better?’’ by New Financial with the hope to start a debate about the value of capital markets to the economy, especially in the UK. Many thanks go to those who joined us at our events with New Statesman so to examine the report’s findings in detail.

For the previous feature in the series, see Alison McGovern’s Why we must maintain the highest standards in banking in the new political landscape.

George Kerevan is the SNP Member of Parliament for East Lothian.