David Cameron delivers a speech on NHS reform at University College Hospital on June 7, 2011. Photograph: Getty Images.
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The NHS is becoming an ever-bigger headache for the Tories

Labour stands to gain if the crisis in the health service becomes one of the major election themes. 

One of Labour's priorities for the summer is raising the salience of the NHS, the issue on which it enjoys its largest poll lead. "After living standards, we need it [the NHS] to be voters’ priority," a strategist told me. If one of the defining questions of the election is "which party do I trust to run the health service?" Labour's chances of victory will be improved.  

It is encouraging for the party, then, that both the Sun and the Times splash on the growing NHS crisis today. The former carries an investigation warning of record A&E waiting times and longer waits for GPs, while the latter reports that one in nine people trying to see a doctor cannot get an appointment, with GPs turning patients away more than 40 million times this year.

The Tories have long regarded the NHS as the dog that hasn't barked, boasting that the oft-predicted "winter crisis" never came. But the dog is certainly barking now. Worse, the party's "top-down reorganisation" of the health service (for which, it should not be forgotten, it had no mandate. Indeed, it had a mandate not to introduce one) means Labour can easily lay the blame at the Conservatives' door. 

Having once aspired to establish themselves as "the party of the NHS", the Tories are now narrowly focused on neutralising the issue. As I've previously reported, Lynton Crosby has told ministers not to mention it on the grounds that it helps Labour. 

In his speech at last year's Conservative conference, David Cameron said: "Some people said the NHS wasn't safe in our hands. Well - we knew otherwise. Who protected spending on the NHS? Not Labour - us. Who started the Cancer Drugs Fund? Not Labour - us. And by the way - who presided over Mid Staffs? Patients left for so long without water, they were drinking out of dirty vases...people's grandparents lying filthy and unwashed for days. Who allowed that to happen? Yes, it was Labour...and don't you dare lecture anyone on the NHS again." 

But don't expect to see a similar passage in this year's pre-election address. One of Crosby's most consistent pieces of advice to the Tories is "not to play on Labour's side of the pitch". This means talking about issues on which the party is strong, such as the deficit, immigration and welfare, and avoiding those on which it is weak.

Some Tories believe they can repel the opposition’s assault by deriding the state of the service in Labour-run Wales. But Ed 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 do. 

One of the biggest questions facing Labour before the election, then, is whether, and how, to promise an increase in health spending. 

George Eaton is political editor of the New Statesman.

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How should Labour's disgruntled moderates behave?

The price for loyalty looks like being long-term opposition. Sometimes exiting can be brave.

When Albert O. Hirschman was writing Exit, Voice, Loyalty: Responses to decline in Firms, Organizations, and States he wasn’t thinking of the British Labour Party.  That doesn’t mean, though, that one of the world’s seminal applications of economics to politics can’t help us clarify the options open to the 80 to 90 per cent of Labour MPs who, after another week of utter chaos, are in total despair at what’s happening under Jeremy Corbyn.

According to Hirschman, people in their situation have essentially three choices – all of which stand some chance, although there are no guarantees, of turning things around sooner or later.

The first option is simply to get the hell out: exit, after all, can send a pretty powerful, market-style signal to those at the top that things are going wrong and that something has to change.

The second option is to speak up and shout out: if the leadership’s not listening then complaining loudly might mean they get the message.

The third option is to sit tight and shut up, believing that if the boat isn’t rocked it will somehow eventually make it safely to port.

Most Labour MPs have so far plumped for the third course of action.  They’ve battened down the hatches and are waiting for the storm to pass.  In some ways, that makes sense.  For one thing, Labour’s rules and Corbyn’s famous ‘mandate’ make him difficult to dislodge, and anyone seen to move against him risks deselection by angry activists.

For another, there will be a reckoning – a general election defeat so bad that it will be difficult even for diehards to deny there’s a problem: maybe Labour has to do ‘déjà vu all over again’ and lose like it did in 1983 in order to come to its senses. The problem, however, is that this scenario could still see it stuck in opposition for at least a decade. And that’s presuming that the left hasn’t so effectively consolidated its grip on the party that it can’t get out from under.

That’s presumably why a handful of Labour MPs have gone for option two – voice.  Michael Dugher, John Woodcock, Kevan Jones, Wes Streeting and, of course, John Mann have made it pretty clear they think the whole thing’s a mess and that something – ideally Jeremy Corbyn and those around him – has to give.  They’re joined by others – most recently Stephen Kinnock, who’s talked about the party having to take ‘remedial action’ if its performance in local elections turns out to be as woeful as some are suggesting.  And then of course there are potential leadership challengers making none-too-coded keynote speeches and public appearances (both virtual and real), as well as a whole host of back and frontbenchers prepared to criticise Corbyn and those around him, but only off the record.

So far, however, we’ve seen no-one prepared to take the exit option – or at least to go the whole hog. Admittedly, some, like Emma Reynolds, Chuka Umunna, Dan Jarvis, Yvette Cooper, and Rachel Reeves, have gone halfway by pointedly refusing to serve in Corbyn’s Shadow Cabinet.  But nobody has so far declared their intention to leave politics altogether or to quit the party, either to become an independent or to try to set up something else.

The latter is easily dismissed as a pipe-dream, especially in the light of what happened when Labour moderates tried to do it with the SDP in the eighties.  But maybe it’s time to think again.  After all, in order to refuse even to contemplate it you have to believe that the pendulum will naturally swing back to Labour at a time when, all over Europe, the centre-left looks like being left behind by the march of time and when, in the UK, there seems precious little chance of a now shrunken, predominantly public-sector union movement urging the party back to the centre ground in the same way that its more powerful predecessors did back in the fifties and the late-eighties and nineties. 

Maybe it’s also worth wondering whether those Labour MPs who left for the SDP could and should have done things differently.  Instead of simply jumping ship in relatively small numbers and then staying in parliament, something much bolder and much more dramatic is needed.  What if over one hundred current Labour MPs simultaneously declared they were setting up ‘Real Labour’?  What if they simultaneously resigned from the Commons and then simultaneously fought scores of by-elections under that banner?

To many, even to ask the question is to answer it. The obstacles – political, procedural, and financial – are formidable and forbidding.  The risks are huge and the pay-off massively uncertain.  Indeed, the whole idea can be swiftly written off as a thought-experiment explicitly designed to demonstrate that nothing like it will ever come to pass.

On the other hand, Labour MPs, whether we use Hirschman’s three-way schema or not, are fast running out of options.  The price for loyalty looks like being long-term opposition.  Voice can only do so much when those you’re complaining about seem – in both senses of the word – immovable.  Exit, of course, can easily be made to seem like the coward’s way out. Sometimes, however, it really is the bravest and the best thing to do.

Tim Bale is professor of politics at QMUL. His latest book, Five Year Mission, chronicles Ed Miliband's leadership of the Labour party.