A protest in support of the NHS at last year's Labour conference. Source: Getty
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NHS funding is a taboo topic for all parties

The Tories blew their chance to be trusted on health and Labour doesn't want to talk about where the money will come from.

It is hard to think of a policy that Labour is less likely to adopt for its 2015 manifesto than the flat rate £10-per-month “membership fee” for the NHS proposed by Lord Warner, a Blair-era health minister now sitting in the Lords. Jamie Reed MP, shadow health minister has said “this is not something Labour would ever consider.” He might have added re-introduction of small pox as a health policy  closer to Ed Miliband’s preferred general election offer.

When Labour has a vast lead over the Tories as the party to be trusted with the health service, anything that sounds as if it undermines the founding principle of universal access free at the point of use is out of the question. The problem is that Labour has signed up to tight spending constraint if it forms a government and under those circumstances NHS funding is certain to become a volatile issue. People are living longer, suffering from chronic conditions that are expensive to treat – especially if they result in prolonged hospital stays – and costs in medicine tend to rise faster than inflation. Even without the ongoing fiscal crunch, this would be an issue of existential urgency for the system as it is currently configured.

MPs in all parties know this but it has become hard to say so aloud for fear of facing the follow-up question – what would you do about it? In theory, health spending this parliament has been “ring-fenced” but it doesn’t feel that way in the context of local authority cuts, which have severe consequences for social care, and “efficiency savings” that amount to real terms cuts when imposed in a climate of rising costs. GPs say privately that a growing part of what they do amounts to managing patient expectations downward and rationing.

This model of service erosion is no-one’s preferred policy but it is the inevitable consequence of persistent failure of political courage on all sides. The Tories had their moment to bring public opinion with them in a conversation about reform and they blew it with a vast restructuring that alienated pretty much everyone apart from private healthcare providers. The Lib Dems are desperate to scrub away as much trace of complicity with the Tories’ mangled reforms as they can before polling day, although Nick Clegg was a prominent co-mangler.

Labour, meanwhile, does have a plan to transform the provision of health services – the “whole person care” idea developed by Andy Burnham. This puts the emphasis on public health and investment in prevention to save costs down the line. It also envisages the merger of health and social care.

There are obstacles. First, even if the numbers can be made to add up over the long-term, it looks like a hefty up-front expense and yet another epic re-organisation to boot. Second, Ed Miliband’s office is deeply suspicious of Burnham, believing him to be building a support base in the party machine and manoeuvring into a position to be ready for a leadership contest in the event that Labour loses the next election. With an eye on those ambitions, neither Miliband nor Ed Balls seems in a massive hurry to give the shadow Health Secretary the kind of boost that would come from the adoption of his health plans as a flagship reform proposal going into the general election.

Finally, there is a feeling among some Labour MPs and activists that owning up to the imminent cost crunch in the health service and offering a complicated reform agenda to address it just confuses the message, when all the voters need to know between now and May 2015 is that “you can’t trust the Tories with the NHS.” This school of opposition would gladly build an entire campaign around the anti-Conservative message played on a loop alongside pictures of David Cameron and George Obsorne looking smug interspersed with reminders of their “tax cut for millionaires.”

The reality is that Labour expected problems with the NHS to be more extreme and more salient in political debate than they have proved to be so far. (That isn't meant as a denial of the severity of the problem, only as an observation that they haven't blasted other matters off the front pages.) It is an issue where the opposition has a huge potential advantage but only if voters think it is a matter of such urgency as to trump other questions when weighing up who to vote for – the economy; immigration; crime; education etc. Labour’s dilemma is that the obvious way to make more political noise around the health service is to talk about the funding crisis but doing so invites scrutiny of the opposition’s proposed solution. And that is a conversation the party is not yet ready to have.

Rafael Behr is political columnist at the Guardian and former political editor of the New Statesman

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Labour’s best general election bet is Keir Starmer

The shadow secretary for Brexit has the heart of a Remainer - but head of a pragmatic politician in Brexit Britain. 

In a different election, the shadow Brexit secretary Keir Starmer might have been written off as too quiet a man. Instead - as he set out his plans to scrap the Brexit white paper and offer EU citizens reassurance on “Day One” in the grand hall of the Institute of Civil Engineers - the audience burst into spontaneous applause. 

For voters now torn between their loyalty to Labour and Remain, Starmer is a reassuring figure. Although he says he respects the Brexit vote, the former director of public prosecutions is instinctively in favour of collaborating with Europe. He even wedges phrases like “regulatory alignment” into his speeches. When a journalist asked about the practicality of giving EU citizens right to remain before UK citizens abroad have received similar promises, he retorted: “The way you just described it is to use people as bargaining chips… We would not do that.”

He is also clear about the need for Parliament to vote on a Brexit deal in the autumn of 2018, for a transitional agreement to replace the cliff edge, and for membership of the single market and customs union to be back on the table. When pressed on the option of a second referendum, he said: “The whole point of trying to involve Parliament in the process is that when we get to the final vote, Parliament has had its say.” His main argument against a second referendum idea is that it doesn’t compare like with like, if a transitional deal is already in place. For Remainers, that doesn't sound like a blanket veto of #EUref2. 

Could Leave voters in the provinces warm to the London MP for Holborn and St Pancras? The answer seems to be no – The Daily Express, voice of the blue passport brigade, branded his speech “a plot”. But Starmer is at least respectful of the Brexit vote, as it stands. His speech was introduced by Jenny Chapman, MP for Darlington, who berated Westminster for their attitude to Leave voters, and declared: “I would not be standing here if the Labour Party were in anyway attempting to block Brexit.” Yes, Labour supporters who voted Leave may prefer a Brexiteer like Kate Hoey to Starmer,  but he's in the shadow Cabinet and she's on a boat with Nigel Farage. 

Then there’s the fact Starmer has done his homework. His argument is coherent. His speech was peppered with references to “businesses I spoke to”. He has travelled around the country. He accepts that Brexit means changing freedom of movement rules. Unlike Clive Lewis, often talked about as another leadership contender, he did not resign but voted for the Article 50 Bill. He is one of the rare shadow cabinet members before June 2016 who rejoined the front bench. This also matters as far as Labour members are concerned – a March poll found they disapproved of the way Labour has handled Brexit, but remain loyal to Jeremy Corbyn. 

Finally, for those voters who, like Brenda, reacted to news of a general election by complaining "Not ANOTHER one", Starmer has some of the same appeal as Theresa May - he seems competent and grown-up. While EU regulation may be intensely fascinating to Brexiteers and Brussels correspondents, I suspect that by 2019 most of the British public's overwhelming reaction to Brexit will be boredom. Starmer's willingness to step up to the job matters. 

Starmer may not have the grassroots touch of the Labour leader, nor the charisma of backbench dissidents like Chuka Umunna, but the party should make him the de facto face of the campaign.  In the hysterics of a Brexit election, a quiet man may be just what Labour needs.

What did Keir Starmer say? The key points of his speech

  • An immediate guarantee that all EU nationals currently living in the UK will see no change in their legal status as a result of Brexit, while seeking reciprocal measures for UK citizens in the EU. 
  • Replacing the Tories’ Great Repeal Bill with an EU Rights and Protections Bill which fully protects consumer, worker and environmental rights.
  • A replacement White Paper with a strong emphasis on retaining the benefits of the single market and the customs union. 
  • The devolution of any new powers that are transferred back from Brussels should go straight to the relevant devolved body, whether regional government in England or the devolved administrations in Scotland, Wales and Northern Ireland.
  • Parliament should be fully involved in the Brexit deal, and MPs should be able to vote on the deal in autumn 2018.
  • A commitment to seek to negotiate strong transitional arrangements when leaving the EU and to ensure there is no cliff-edge for the UK economy. 
  • An acceptance that freedom of movement will end with leaving the EU, but a commitment to prioritise jobs and economy in the negotiations.

Julia Rampen is the digital news editor of the New Statesman (previously editor of The Staggers, The New Statesman's online rolling politics blog). She has also been deputy editor at Mirror Money Online and has worked as a financial journalist for several trade magazines. 

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