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

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Brexit is teaching the UK that it needs immigrants

Finally forced to confront the economic consequences of low migration, ministers are abandoning the easy rhetoric of the past.

Why did the UK vote to leave the EU? For conservatives, Brexit was about regaining parliamentary sovereignty. For socialists it was about escaping the single market. For still more it was a chance to punish David Cameron and George Osborne. But supreme among the causes was the desire to reduce immigration.

For years, as the government repeatedly missed its target to limit net migration to "tens of thousands", the EU provided a convenient scapegoat. The free movement of people allegedly made this ambition unachievable (even as non-European migration oustripped that from the continent). When Cameron, the author of the target, was later forced to argue that the price of leaving the EU was nevertheless too great, voters were unsurprisingly unconvinced.

But though the Leave campaign vowed to gain "control" of immigration, it was careful never to set a formal target. As many of its senior figures knew, reducing net migration to "tens of thousands" a year would come at an economic price (immigrants make a net fiscal contribution of £7bn a year). An OBR study found that with zero net migration, public sector debt would rise to 145 per cent of GDP by 2062-63, while with high net migration it would fall to 73 per cent. For the UK, with its poor productivity and sub-par infrastructure, immigration has long been an economic boon. 

When Theresa May became Prime Minister, some cabinet members hoped that she would abolish the net migration target in a "Nixon goes to China" moment. But rather than retreating, the former Home Secretary doubled down. She regards the target as essential on both political and policy grounds (and has rejected pleas to exempt foreign students). But though the same goal endures, Brexit is forcing ministers to reveal a rarely spoken truth: Britain needs immigrants.

Those who boasted during the referendum of their desire to reduce the number of newcomers have been forced to qualify their remarks. On last night's Question Time, Brexit secretary David Davis conceded that immigration woud not invariably fall following Brexit. "I cannot imagine that the policy will be anything other than that which is in the national interest, which means that from time to time we’ll need more, from time to time we’ll need less migrants."

Though Davis insisted that the government would eventually meet its "tens of thousands" target (while sounding rather unconvinced), he added: "The simple truth is that we have to manage this problem. You’ve got industry dependent on migrants. You’ve got social welfare, the national health service. You have to make sure they continue to work."

As my colleague Julia Rampen has charted, Davis's colleagues have inserted similar caveats. Andrea Leadsom, the Environment Secretary, who warned during the referendum that EU immigration could “overwhelm” Britain, has told farmers that she recognises “how important seasonal labour from the EU is to the everyday running of your businesses”. Others, such as the Health Secretary, Jeremy Hunt, the Business Secretary, Greg Clark, and the Communities Secretary, Sajid Javid, have issued similar guarantees to employers. Brexit is fuelling immigration nimbyism: “Fewer migrants, please, but not in my sector.”

The UK’s vote to leave the EU – and May’s decision to pursue a "hard Brexit" – has deprived the government of a convenient alibi for high immigration. Finally forced to confront the economic consequences of low migration, ministers are abandoning the easy rhetoric of the past. Brexit may have been caused by the supposed costs of immigration but it is becoming an education in its benefits.

George Eaton is political editor of the New Statesman.