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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Commons Confidential: Smith, selfies and pushy sons

All the best gossip from party conference, including why Dennis Skinner is now the MP for Selfie Central.

Owen Smith discovered the hard way at the Labour party conference in Liverpool that one moment you’re a contender and the next you’re a nobody. The party booked a luxurious suite at the plush Pullman Hotel for Candidate Smith before the leadership result. He was required to return the key card the day after Jeremy Corbyn’s second coming. On the upside, Smith no longer had to watch his defeat replayed endlessly on the apartment’s giant  flat-screen TV.

The Labour back-room boffin Patrick Heneghan, the party’s executive director of elections, had good cause to be startled when a TV crew pounced on him to demand an interview. The human submarine rarely surfaces in public and anonymity is his calling card. It turns out that the bespectacled Heneghan was mistaken for Owen Smith – a risky likeness when vengeful Corbynistas are on rampage. There’s no evidence of Smith being mistaken for Heneghan, though. Yet.

Members of Labour’s governing National Executive Committee are discovering new passions to pass the time during interminable meetings, as the Mods and the Corbs battle over each line of every decision. The shadow cabinet attack dog Jon “Sparkle” Ashworth, son of a casino croupier and a bunny girl, whiles away the hours by reading the poetry of Walt Whitman and W B Yeats on his iPad. Sparkle has learned that, to echo Whitman, to be with those he likes is enough.

I discovered Theresa May’s bit of rough – the grizzled Tory chairman, Patrick McLoughlin, a former Derbyshire coal miner – does his gardening in steel-toecapped wellies stamped “NCB” from his time down the pit thirty years ago. He’ll need his industrial footwear in Birmingham to kick around Tories revolting over grammar schools and Brexit.

Another ex-miner, Dennis Skinner, was the MP for Selfie Central in Liverpool, where a snap with the Beast of Bolsover was a popular memento. Alas, no cameras captured him in the Commons library demonstrating the contorted technique of speed-walkers. His father once inquired, “Why tha’ waddling tha’ bloody arse?” in Skinner’s younger days, when he’d top 7mph. Observers didn’t dare.

The Northern Poorhouse minister Andrew Percy moans that he’s been allocated a broom cupboard masquerading as an office in the old part of parliament. My snout claims that Precious Percy grumbled: “It’s so small, my human rights are violated.” Funny how the only “rights” many Tories shout about are their own.

The son of a very prominent Labour figure was caught trying to smuggle friends without passes into the secure conference zone in Liverpool. “Don’t you know who I am?” The cop didn’t, but he does now.

Kevin Maguire is the associate editor (politics) of the Daily Mirror

Kevin Maguire is Associate Editor (Politics) on the Daily Mirror and author of our Commons Confidential column on the high politics and low life in Westminster. An award-winning journalist, he is in frequent demand on television and radio and co-authored a book on great parliamentary scandals. He was formerly Chief Reporter on the Guardian and Labour Correspondent on the Daily Telegraph.

This article first appeared in the 29 September 2016 issue of the New Statesman, May’s new Tories