Brothers in arms: Ed Balls and Jim Murphy on the campaign trail. Photo:Getty
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The coming election will decide the future of the NHS, and with it, the United Kingdom

The National Health Service will be on the ballot paper in May, and its continued survival is vital to the preservation of the Union.

In September 2014 the Scottish independence referendum brought the United Kingdom perilously close to splitting apart. From that moment on those elements that we share, that help create a sense of common purpose need to become ever more precious as we try to unify our nation.

As always, constitutional change should be evolutionary and never more so than for that complex and flexible instrument of our democracy, the House of Commons. It must also, even in the shadow of the referendum in Scotland, go with the grain of English nature. I detect no wish for a separate English parliament, nor for regional government in England. But there is an English dimension which those of us whose origins are from other parts of the UK must respect. The tragedy of today is that our Prime Minister, David Cameron, cannot seem to embrace the broadminded generosity of spirit that almost all of his predecessors have been able to summon up.

Ours is at this moment in our history a hesitant and fragile Union. We all need to respect and value, whatever political parties we support, those elements which bind the citizens of the UK together. David Cameron needs to understand that to play the ‘English card’ on Scottish devolution in the way he did outside 10 Downing Street on the day after the Scottish referendum vote was a grave mistake which has already had far-reaching constitutional consequences.

He has started to do this again in his depiction of the SNP MPs likely to be elected in large numbers to the House of Commons as an illegitimate force merely because they advocate separation through the democratic mechanism of another referendum. The former Conservative Secretary of State for Scotland, Michael Forsyth, taking a different angle was correct to warn David Cameron against bolstering the SNP chances over Labour as "a short-term and dangerous view." These issues are too serious for ‘Flashman’ politics and Ed Miliband is wise to adopt a longer term and steadier view.

The closest analogy I can find to such irresponsible behaviour on the Constitution is when David Lloyd George on 5 December 1921 infamously threatened “war within three days”, if all the members of the Irish delegation did not sign the Anglo-Irish Treaty. It was, as it turned out, a very dangerous bluff. At 2.20 a.m. the treaty was signed but not by all. Lord Birkenhead in the British government delegation commented, ‘I may have signed my political death warrant,’ to which Michael Collins, leading the Irish delegation, perceptively replied, ‘I may have signed my actual death warrant.’ Lloyd George’s intervention when revealed to the Dáil damaged Collins and though the vote went through it was despite of not because of it. Collins was at that stage despite Éamon de Valera’s opposition recognised as a brave farsighted man. Weakening him was weakening the Union.  Cameron should learn this lesson from history: holding the UK together is still a task that requires courage, holding to the long view.

We need elements other than the most obvious one of the defence of the realm to bind the UK together and even on defence in relation to Trident, there are deep differences that need addressing. The aftermath of the referendum in Scotland has not lifted the threat of separation but given the UK a little more time to achieve the correct balance between its constituent parts.

David Cameron, as Prime Minister, must also take the main responsibility for deceiving the people over the Health and Social Care Act 2012 and the incompetent implementation of that legislation.

Cameron told NHS audiences – the royal colleges of surgeons, nurses and pathologists among others – throughout 2009 that “there will be no more of these pointless re-organisations that aim for change but instead bring chaos”. Or that “we will not persist with the top-down restructures and reorganisations of the NHS that have dominated the last decade in the NHS”, causing “terrible disruption, demoralisation and waste”. Vain attempts have been made since to claim the 2012 legislation as being “bottom up” but these were soon shown to be demonstrably false.

The major consequence of the 2012 Health and Social Care Act has been how it views health care in England as a business rather than a service. Along with Scotland, Wales and Northern Ireland have retained an undoubtedly recognisable NHS, albeit in slightly different forms. Only in England does the threat exist that the NHS will be unrecognisable by 2020 if the 2012 legislation is not repealed in substance after the May 2015 general election. This has profound implications for the UK for the underlying reasons that make the original concept of the NHS worth fighting for are clear, but not often stated, perhaps because they go to the ethical and moral basis of the way many UK citizens wish to live their lives.

In this general election there is a settled wish emerging from the great bulk of voters for the original NHS to be available in all parts of the UK in a recognisable form. It would be a unifying theme for the next UK government to reinstate the NHS, at a time when the UK needs to revive a sense of unity.

There is another aspect to the Scottish referendum, the wish it has inspired for England to devolve more decisions to its bigger cities: London, Birmingham, Manchester, Leeds, Liverpool and Newcastle. In part this follows the success story of the gradual introduction of powerful mayors. There is a strong case for considering a strategic health and caring role for such cities. It would need to be introduced carefully on the basis of proven experience, not all happening at once, and would stem from a well-considered proposal from a city put to the Secretary of State for Health, who would have the enabling power to introduce it.

Constitutional changes in a democracy usually are the result of political trade-offs and changes for Scotland impact on Wales and Northern Ireland and of course by far the largest component of the UK, England.

Two other vital reforms could reinforce the structure of UK unity. First, an elected Senate representing the four elements of the UK. The House of Lords has become an absurdity in size and composition. It reeks of patronage.

The second reform comes from the McKay Commission on the consequences of devolution published in March 2013.  They propose that “decisions at the United Kingdom level with a separate and distinct effect for England (or for England and Wales) should normally be taken only with the consent of a majority of MPs for constituencies in England (or England and Wales)” while ensuring that “the right of the House of Commons as a whole to make the final decision should remain”. They have carved out a mechanism allowing that some English legislation would not have to be part of the normal procedure on all occasions. The commissioners assert: “We would expect departures from the norm to occur only rarely in practice” and “The apparent fragility of the declaratory resolution approach can also be seen as flexibility. A government, after consideration, may decide that it is necessary in the interests of the UK as a whole, or an affected part of it, to invoke the exception implicit in the word ‘normally”.

The report preserves the present position in the House of Commons that there should not be two different kinds of MPs, so all MPs would vote on whether to grant a second reading for all Bills and finally whether a Bill should become law with a single vote on third reading. If some English legislation has from time to time so great an implication for the UK as a whole that it does not fit with only English MPs amending it at committee and report stages, then Parliament can decide to make it UK legislation.           

NHS reinstatement legislation in 2015 will be a classic case of the sort of legislative exception that the McKay commissioners had in mind. Ed Miliband should indicate in advance during this election that he would so regard it. He should also indicate that he would not endorse legislation for another referendum as Prime Minister of the UK in the lifetime of the next Parliament.

The social history of the NHS makes clear that it would be ‘an error to regard the NHS as a spontaneous creation’. The cumbersome National Health Insurance (NHI) administration established in 1911 supplied minimum financial relief during sickness and a ‘panel doctor’ service for the low paid on the basis of weekly deductions of income for the so-called health stamp. But many were not covered by this insurance. There was nothing for those excluded other than the charity of the doctor or a hospital. The Dawson report of 1920 pointed the way but many slum dwellers had totally inadequate healthcare, if any, and lived in conditions of Dickensian squalor. The Second World War brought the Emergency Medical Service, the Beveridge report and the 1944 White Paper outlining the provisions of the projected NHS: a resolve emerged in wartime within the British people that when peace came there would be a different and better system of healthcare for everyone.

At the heart of all marketisation and commercialisation of the NHS, David Marquand has written, lies the “totemic term “choice”: free choice by unconnected individuals, satisfying individual wants through market competition”. Healthcare, whether public or private, in a very real sense is infinite: money can be – and in many countries is – poured into healthcare by those who can afford it. Money for the NHS is a public choice, but it is all relative to what we choose to spend on education, housing, welfare, defence, all legitimate demands.

Healthcare, if publicly provided, inevitably has to be constrained. That rationing process within the NHS is flexible, professional and democratically accountable. It is decided by Parliament through the Chancellor of the Exchequer, the Secretary of State for Health and Cabinet. By democratic choice it is not done by a market or by insurance premiums or an appointed QUANGO like NHS England.

Voters could have chosen a different system – they exist in many parts of the world – but no major political party has ever felt brave or foolish enough to put that choice to them. It was not a choice put to the electorate in 2010 by either the Conservatives or Liberal Democrats. Both parties are fudging this choice again in 2015 though at least now the Liberal Democrats have admitted some changes are needed to the existing legislation. 

Politics cannot be an ideology-free zone but it should not resound with zealotry. No one should be Prime Minister for England alone. We saw in the Scottish referendum how powerful a vote swinger the NHS became in the closing stages of the campaign. Despite the fact that health is fully devolved to the Scottish Parliament, the spectre of an English-controlled Treasury being able to use financial allocations to bring marketisation to Scotland's NHS carried sufficient weight with voters that the ‘yes’ campaign exploited it and the ‘no’ campaign feared it. It also served to remind some voters, not just in Scotland, that the NHS as we have known it since 1948 was under threat. The English voters in this General Election are becoming evermore aware of this threat in England.

Before 7 May 2015 many MPs and candidates – Conservative, Labour, Liberal Democrat, Ukip, Green, SNP, Plaid Cymru – will be systematically challenged to indicate whether they will support the NHS Reinstatement Bill in England. In Scotland, Wales and Northern Ireland, candidates are being urged to commit to vote, if elected as an MP, for reinstatement of the NHS in England. Allow marketisation and commercialisation to continue in England and it will not be long before it affects the NHS throughout the United Kingdom. The NHS in one part of the UK means the NHS in all of the UK. They will never be exactly the same for they are part of devolved government but they need to be inextricably linked in a truly united UK.

The end of the NHS as we have known and understood it in England will take place before 2020 if whichever party or parties that win the 2015 general election does not change the 2012 NHS legislation. Social historians may not be agreed as to when the exact moment of its passing will be. As endings go, it will be, in the words of T. S. Eliot, “not with a bang but a whimper” and around that moment the issue of Scottish independence will be back on the political agenda with a vengeance. The two are linked in more ways than have yet been fully recognised.  The NHS is not a religion, as it has been likened to, nor is it the preserve of one political party, nor one country within our United Kingdom. It belongs to all of us.


Lord Owen was Foreign Secretary 1977-79, a founder-member of the SDP and is now a crossbench peer.

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North Yorkshire has approved the UK’s first fracking tests in five years. What does this mean?

Is fracking the answer to the UK's energy future? Or a serious risk to the environment?

Shale gas operation has been approved in North Yorkshire, the first since a ban introduced after two minor earthquakes in 2011 were shown to be caused by fracking in the area. On Tuesday night, after two days of heated debate, North Yorkshire councillors finally granted an application to frack in the North York Moors National Park.

The vote by the Tory-dominated council was passed by seven votes to four, and sets an important precedent for the scores of other applications still awaiting decision across the country. It also gives a much-needed boost to David Cameron’s 2014 promise to “go all out for shale”. But with regional authorities pitted against local communities, and national government in dispute with global NGOs, what is the wider verdict on the industry?

What is fracking?

Fracking, or “hydraulic fracturing”, is the extraction of shale gas from deep underground. A mixture of water, sand and chemicals is pumped into the earth at such high pressure that it literally fractures the rocks and releases the gas trapped inside.

Opponents claim that the side effects include earthquakes, polluted ground water, and noise and traffic pollution. The image the industry would least like you to associate with the process is this clip of a man setting fire to a running tap, from the 2010 US documentary Gasland

Advocates dispute the above criticisms, and instead argue that shale gas extraction will create jobs, help the UK transition to a carbon-neutral world, reduce reliance on imports and boost tax revenues.

So do these claims stands up? Let’s take each in turn...

Will it create jobs? Yes, but mostly in the short-term.

Industry experts imply that job creation in the UK could reflect that seen in the US, while the medium-sized production company Cuadrilla claims that shale gas production would create 1,700 jobs in Lancashire alone.

But claims about employment may be exaggerated. A US study overseen by Penn State University showed that only one in seven of the jobs projected in an industry forecast actually materialised. In the UK, a Friends of the Earth report contends that the majority of jobs to be created by fracking in Lancashire would only be short-term – with under 200 surviving the initial construction burst.

Environmentalists, in contrast, point to evidence that green energy creates more jobs than similar-sized fossil fuel investments.  And it’s not just climate campaigners who don’t buy the employment promise. Trade union members also have their doubts. Ian Gallagher, Secretary of Blackburn and District Trade Unions Council, told Friends of the Earth that: “Investment in the areas identified by the Million Climate Jobs Campaign [...] is a far more certain way of addressing both climate change and economic growth than drilling for shale gas.”

Will it deliver cleaner energy? Not as completely as renewables would.

America’s “shale revolution” has been credited with reversing the country’s reliance on dirty coal and helping them lead the world in carbon-emissions reduction. Thanks to the relatively low carbon dioxide content of natural gas (emitting half the amount of coal to generate the same amount of electricity), fracking helped the US reduce its annual emissions of carbon dioxide by 556 million metric tons between 2007 and 2014. Banning it, advocates argue, would “immediately increase the use of coal”.

Yet a new report from the Royal Society for the Protection of Birds (previously known for its opposition to wind farm applications), has laid out a number of ways that the UK government can meet its target of 80 per cent emissions reduction by 2050 without necessarily introducing fracking and without harming the natural world. Renewable, home-produced, energy, they argue, could in theory cover the UK’s energy needs three times over. They’ve even included some handy maps:

Map of UK land available for renewable technologies. Source: RSPB’s 2050 Energy Vision.

Will it deliver secure energy? Yes, up to a point.

For energy to be “sustainable” it also has to be secure; it has to be available on demand and not threatened by international upheaval. Gas-fired “peaking” plants can be used to even-out input into the electricity grid when the sun doesn’t shine or the wind is not so blowy. The government thus claims that natural gas is an essential part of the UK’s future “energy mix”, which, if produced domestically through fracking, will also free us from reliance on imports tarnished by volatile Russian politics.

But, time is running out. Recent analysis by Carbon Brief suggests that we only have five years left of current CO2 emission levels before we blow the carbon budget and risk breaching the climate’s crucial 1.5°C tipping point. Whichever energy choices we make now need to starting brining down the carbon over-spend immediately.

Will it help stablise the wider economy? Yes, but not forever.

With so many “Yes, buts...” in the above list, you might wonder why the government is still pressing so hard for fracking’s expansion? Part of the answer may lie in their vested interest in supporting the wider industry.

Tax revenues from UK oil and gas generate a large portion of the government’s income. In 2013-14, the revenue from license fees, petroleum revenue tax, corporation tax and the supplementary charge accounted for nearly £5bn of UK exchequer receipts. The Treasury cannot afford to lose these, as evidenced in the last budget when George Osborne further subsidied North Sea oil operations through increased tax breaks.

The more that the Conservatives support the industry, the more they can tax it. In 2012 DECC said it wanted to “guarantee... every last economic drop of oil and gas is produced for the benefit of the UK”. This sentiment was repeated yesterday by energy minister Andrea Leadsom, when she welcomed the North Yorkshire decision and described fracking as a “fantastic opportunity”.

Dependence on finite domestic fuel reserves, however, is not a long-term economic solution. Not least because they will either run out or force us to exceed international emissions treaties: “Pensions already have enough stranded assets as they are,” says Danielle Pafford from

Is it worth it? Most European countries have decided it’s not.

There is currently no commercial shale-gas drilling in Europe. Sustained protests against the industry in Romania, combined with poor exploration results, have already caused energy giant Chevron to pull out of the country. Total has also abandonned explorations in Denmark, Poland is being referred to the European Court of Justice for failing to adequately assess fracking’s impact, and, in Germany, brewers have launched special bottle-caps with the slogan “Nein! Zu Fracking” to warn against the threat to their water supply.

Back in the UK, the government's latest survey of public attitudes to fracking found that 44 per cent neither supported nor opposed the practice, but also that opinion is gradually shifting out of favour. If the government doesn't come up with arguments that hold water soon, it seems likely that the UK's fracking future could still be blasted apart.

India Bourke is the New Statesman's editorial assistant.