Ambulances are seen at the Accident and Emergency department of St. Thomas' Hospital in London. Photograph: Getty Images.
Show Hide image

We need to talk about the NHS - Cameron must break the Crosby-imposed silence

If the Tories won't face up to the problems in the health service, it's time to make way for a government that will.

David Cameron used to say that his priority could be summed up in three letters: NHS. Now, it seems, he prefers not to talk about it. The word in Westminster is that, on the advice of Lynton Crosby, the Prime Minister has asked his ministers for a period of pre-election silence on the NHS. So the Queen's Speech came and went without even a mention of Mr Cameron's erstwhile priority.

The list of reasons why Mr Cameron no longer wants to talk about the NHS is growing longer by the day. The last week has brought a stream of statistics confirming what many people suspect: the NHS is heading downhill under his government.

First, we learnt that the NHS missed its cancer treatment standard for the first time, leaving a growing number of people waiting longer for the start of treatment and families facing prolonged anguish.

Then, on Wednesday, came news that the deterioration in cancer care was worse than we thought and extended to people with suspected cancers waiting for tests. Waiting times for diagnostic tests are at a six-year high, with 17,000 waiting longer than they should.

Thursday brought the news that the number of people on NHS waiting lists had gone past the three million mark for the first time in six years - highly embarrassing for a Prime Minister who once said that the test of his NHS re-organisation would be its effect on waiting times.

Finally, it was revealed on Friday that A&E departments across the country are in the grip of a summer crisis, with record numbers attending and tens of thousands waiting too long to be seen. The NHS overall has now missed its A&E target for five weeks running; more worryingly, hospital A&Es have not hit it 47 weeks.

A&E is the barometer of the whole health and care system. This barometer is now clearly warning us that there are severe storms ahead for the NHS unless urgent steps are taken to put it back on track. Perhaps this explains why, after a run of negative statistics, there were reports that the government had resorted to panic measures to shore up England's hospitals.

Without any great announcement, or even so much as a press release, it emerged that large amounts of money are to be thrown at the NHS in a bid to keep further bad headlines at bay. It is not clear what the government has decided because of the lack of a clear statement. Some newspaper reports this weekend said £650m in "new money" had been found, while others believe it to be £250m. Whatever the amount, what is clear is that is that is unprecedented for a Prime Minister to have to throw millions at a summer A&E crisis. What is also clear is that, right now, the NHS is in a very dangerous position. All the signs show that it is slipping into a serious condition but it has a government in charge that is not prepared to talk about it. This is not good enough.

Minsters cannot be allowed to take such significant decisions without any explanation of why they are doing it or where the money is coming from. Cameron must order his ministers to come to the Commons early this week to answer these points.

Beyond that, there must now be a proper debate about what is happening in the NHS, why it is going wrong and what must be done to put it right. The reason why David Cameron is so desperate to avoid this debate at all costs is because it brings him back to his biggest misjudgement as Prime Minister: allowing Andrew Lansley to proceed with his ill-considered reorganisation. He was explicitly warned it would damage standards of patient care - and it has. Throwing money at the problems of his own making is no long-term solution for the NHS he has so disastrously destabilised.

David Cameron's great problem is that, though he thinks he can keep things quiet with a few bungs here and there, the public can see for themselves what is happening. They know it has for much harder to get a GP appointments. They are hearing the stories of friends and family being told that they can't have the treatment they need and facing the agonising choice of waiting in discomfort or paying to go private.

The voters are on to Mr Cameron and his damage to the NHS. Worryingly for him, a poll this week found that, for the first time in a long time, the NHS has risen to the top of voters' concerns. Storm clouds are gathering over the NHS, but it is trapped in a situation where the government of the day is not prepared to discuss them. This won't do. If they won't face up to the problems in the NHS, it's time to make way for a government that will.

Andy Burnham is the shadow health secretary

Photo: Getty
Show Hide image

Scotland's vast deficit remains an obstacle to independence

Though the country's financial position has improved, independence would still risk severe austerity. 

For the SNP, the annual Scottish public spending figures bring good and bad news. The good news, such as it is, is that Scotland's deficit fell by £1.3bn in 2016/17. The bad news is that it remains £13.3bn or 8.3 per cent of GDP – three times the UK figure of 2.4 per cent (£46.2bn) and vastly higher than the white paper's worst case scenario of £5.5bn. 

These figures, it's important to note, include Scotland's geographic share of North Sea oil and gas revenue. The "oil bonus" that the SNP once boasted of has withered since the collapse in commodity prices. Though revenue rose from £56m the previous year to £208m, this remains a fraction of the £8bn recorded in 2011/12. Total public sector revenue was £312 per person below the UK average, while expenditure was £1,437 higher. Though the SNP is playing down the figures as "a snapshot", the white paper unambiguously stated: "GERS [Government Expenditure and Revenue Scotland] is the authoritative publication on Scotland’s public finances". 

As before, Nicola Sturgeon has warned of the threat posed by Brexit to the Scottish economy. But the country's black hole means the risks of independence remain immense. As a new state, Scotland would be forced to pay a premium on its debt, resulting in an even greater fiscal gap. Were it to use the pound without permission, with no independent central bank and no lender of last resort, borrowing costs would rise still further. To offset a Greek-style crisis, Scotland would be forced to impose dramatic austerity. 

Sturgeon is undoubtedly right to warn of the risks of Brexit (particularly of the "hard" variety). But for a large number of Scots, this is merely cause to avoid the added turmoil of independence. Though eventual EU membership would benefit Scotland, its UK trade is worth four times as much as that with Europe. 

Of course, for a true nationalist, economics is irrelevant. Independence is a good in itself and sovereignty always trumps prosperity (a point on which Scottish nationalists align with English Brexiteers). But if Scotland is to ever depart the UK, the SNP will need to win over pragmatists, too. In that quest, Scotland's deficit remains a vast obstacle. 

George Eaton is political editor of the New Statesman.