Labour leads on health, but it has to be clear that money for the NHS will lead to cuts elsewhere

To achieve economic credibility, Miliband needs to speak the language of priorities. 

To achieve economic credibility, Miliband needs to speak the language of priorities.
Ed Miliband speaks with radiotherapists, during his visit to University College hospital, on April 4, 2011 in London. Photograph: Getty Images.

Scandal follows scandal in Westminster, but David Cameron continues to float above it all. For a period his government appeared dangerously inert in response to allegations of a child abuse cover-up. But the establishment of two inquiries and his vow to leave “no stone unturned” moved him into safer territory.

“Concrete Cameron” is the name some MPs have given the Prime Minister, in tribute to his strange resilience. In short succession, his party finished third in a national election for the first time in its history, his public campaign to block Jean-Claude Juncker’s nomination as European Commission president was comprehensively defeated by EU leaders and his former director of communications Andy Coulson was imprisoned for phone-hacking. But none of these moments was accompanied by the kind of ritual humiliation that Cameron’s opponents hoped for.

It is the enduring strength of the Prime Minister’s brand (he outpolls his party by 7 points; Ed Miliband trails Labour by 13) that gives the Tories hope that they will win next May by framing the general election as a presidential contest. The recent improvement in Cameron’s ratings has surprised those who predicted his reputation would be tarnished irrevocably by now. When he pressed ahead with Andrew Lansley’s National Health Service reforms in 2012, commentators on left and right said that it would prove to be his “poll tax moment”. But the measures have inspired nothing close to that insurrection. Labour focus groups show that voters believe the NHS is struggling but also that they do not connect this with any particular government policy.

The opposition’s aim for the summer is to establish the Prime Minister as the guilty man. After last year’s “cost of living” offensive, it will devote the parliamentary recess to charting the “Cameron effect” on the health service. Leaflets in target seats will focus on the year-long failure to meet the four-hour A&E waiting time target, the lack of GP availability (four in ten people wait more than a week for an appointment) and the missed cancer treatment target. Andy Burnham, the shadow health secretary, and other MPs will join a re-creation of the Jarrow march organised by a group of mothers to protest against the creeping privatisation of the service.

Labour regards raising the salience of the NHS, the issue on which it enjoys its largest poll lead, as essential to its chances of victory next year. “After living standards, we need it [the NHS] to be voters’ priority,” a strategist says. At present, that place is taken by immigration, on which Labour trails the Conservatives by 9 points. To improve its odds, the party needs to force the Tories on to its preferred battleground.

Conservative ministers, who have been ordered by Lynton Crosby, the party’s campaign manager, to avoid mentioning the NHS, believe they can repel the opposition’s assault by deriding the state of the service in Labour-run Wales. But Miliband has adopted a new riposte to this attack: Cameron wants to talk about Wales because he cannot defend his record in England. The disparity in performance between the two countries has narrowed as the health service has deteriorated under the coalition.

But Labour will be able to dwell on this issue for only so long before it is forced to confront a funding gap of £30bn by the end of the next parliament. Stephen Dorrell, the former health secretary, Sarah Wollaston, the new chair of the health select committee, and Frank Field, the former social security minister, all warn that the NHS will not survive in its present form without a real-terms increase in spending. Demographic pressures, the rising cost of technology and the growth in chronic conditions are such that merely ring-fencing the service from cuts will not suffice.

To save the NHS from collapse, Field has proposed a 1 per cent rise in National Insurance, accompanied by the lifting of the floor on contributions and the removal of the ceiling. He told me: “It both deals with the health service and deals with the double Ed problem, which is: does anyone believe them on the fiscal side?”

The plan is partly modelled on Gordon Brown’s 1 per cent increase in NI in his 2002 Budget, a move that proved more popular than almost anyone expected. Miliband, who as a Treasury adviser helped to design the policy, later described this act of social-democratic statecraft as his proudest moment. Yet there is little prospect of a sequel. Shadow cabinet ministers, including Ed Balls, believe that is untenable for the party to speak of a “cost-of-living crisis” and then to argue for a rise in taxation on low- and middle-income earners. “It would be kamikaze politics,” one tells me.

Burnham has long signalled that he does not believe an increase in NHS funding can be justified until health and social care have been integrated and all potential savings have been achieved. He is focused on securing the money needed to support his scheme, potentially through a 10 per cent levy on all estates. But while the long-term savings from integration are estimated to be as high as £6bn, health professionals believe a short-term injection of funds is essential.

“The language of priorities is the religion of socialism,” declared Nye Bevan, the father of the NHS. The only way for Labour to square the fiscal circle may be finally to reveal the austerity it would impose elsewhere in order to release resources for the health service.

Few in Westminster fully comprehend the budgetary horrors that await the next government as ministers, having trimmed Whitehall of fat, are forced to cut into bone. If Miliband is to offer himself as the saviour of the NHS, it is the language of priorities that he will need to speak.

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