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Labour can only save the NHS by biting the tax bullet Labour can only save the NHS by biting the tax bullet
(about 2 hours later)
As the hundredth draft of Ed Miliband’s party conference speech is scribbled over and begun again, he and his team face multitudinous dilemmas – not least the pole-axing possibility of Scotland voting yes. Can the trainloads of Labour MPs now heading north persuade the Scots a social democratic future for Britain is possible?As the hundredth draft of Ed Miliband’s party conference speech is scribbled over and begun again, he and his team face multitudinous dilemmas – not least the pole-axing possibility of Scotland voting yes. Can the trainloads of Labour MPs now heading north persuade the Scots a social democratic future for Britain is possible?
It hasn’t escaped Labour’s notice that the yes campaign’s recent surge came when Alex Salmond warned that the NHS in Scotland would be in peril from another privatising Cameron government. Scaremongering, said the other side, since health is devolved. But one thing is certain: Scotland’s block grant is a share of whatever the Treasury allocates across Britain, on health and everything else.It hasn’t escaped Labour’s notice that the yes campaign’s recent surge came when Alex Salmond warned that the NHS in Scotland would be in peril from another privatising Cameron government. Scaremongering, said the other side, since health is devolved. But one thing is certain: Scotland’s block grant is a share of whatever the Treasury allocates across Britain, on health and everything else.
The outlook for health spending is an almost unimaginable cut over the next five years. That’s why Labour plans to put the NHS centre stage at the election, the symbolic heart of its identity. Polls put Labour well ahead as the most trusted to defend it, while the NHS is Cameron’s achilles heel, after his broken promises. The outlook for health spending is an almost unimaginable cut over the next five years. That’s why Labour plans to put the NHS centre stage at the election, the symbolic heart of its identity. Polls put Labour well ahead as the most trusted to defend it, while the NHS is Cameron’s achilles heel, after his broken promises.
So far, Labour has failed to alert the public to what’s afoot for the NHS, though Treasury plans are open for all to see. Every health thinktank has done its best in recent months to sound the alarm. This isn’t shroud-waving – the figures show the NHS about to go into cardiac arrest.So far, Labour has failed to alert the public to what’s afoot for the NHS, though Treasury plans are open for all to see. Every health thinktank has done its best in recent months to sound the alarm. This isn’t shroud-waving – the figures show the NHS about to go into cardiac arrest.
In 15th place, the UK is already low on OECD charts in health spending as a proportion of GDP, lower than in 2009, with even Portugal higher. Yet the plan is to plunge lower – just as the number of people over 80 doubles and the population rises by 3.5 million. The Office for Budget Responsibility figures are the same. The Institute for Fiscal Studies calculates age-adjusted spending on health will fall by 9% per person between 2010 and 2018. For an NHS used to an average 4% increase, a 9% per-capita cut is unthinkable. Look at the charts showing NHS spending falling off a cliff by Anita Charlesworth, as chief economist for the Nuffield Trust, who found the shortfall to be £28bn by 2021. NHS England reckons the sum is £30bn.In 15th place, the UK is already low on OECD charts in health spending as a proportion of GDP, lower than in 2009, with even Portugal higher. Yet the plan is to plunge lower – just as the number of people over 80 doubles and the population rises by 3.5 million. The Office for Budget Responsibility figures are the same. The Institute for Fiscal Studies calculates age-adjusted spending on health will fall by 9% per person between 2010 and 2018. For an NHS used to an average 4% increase, a 9% per-capita cut is unthinkable. Look at the charts showing NHS spending falling off a cliff by Anita Charlesworth, as chief economist for the Nuffield Trust, who found the shortfall to be £28bn by 2021. NHS England reckons the sum is £30bn.
There is no doubt at all that the NHS either needs more money, or it must cut its services beyond what the public would ever accept. Of course there must always be efficiency savings and rationalised hospitals, though integration is now harder: Bournemouth and Poole hospitals were banned by competition law from a sensible merger.There is no doubt at all that the NHS either needs more money, or it must cut its services beyond what the public would ever accept. Of course there must always be efficiency savings and rationalised hospitals, though integration is now harder: Bournemouth and Poole hospitals were banned by competition law from a sensible merger.
Combining health and social care under one budget is essential, but it’s not a cheap answer: Kate Barker’s King’s Fund commission last week said it would cost £5bn a year. Setting up good community care to keep people out of hospital is expensive. Costs will have to increase: an ageing population needs more beds. Merging two bankrupt outfits – NHS and social care – will not magic up one solvent service. So blow a loud raspberry at any politician who pretends efficiency and mergers alone can save enough to fill the gap.Combining health and social care under one budget is essential, but it’s not a cheap answer: Kate Barker’s King’s Fund commission last week said it would cost £5bn a year. Setting up good community care to keep people out of hospital is expensive. Costs will have to increase: an ageing population needs more beds. Merging two bankrupt outfits – NHS and social care – will not magic up one solvent service. So blow a loud raspberry at any politician who pretends efficiency and mergers alone can save enough to fill the gap.
The NHS is near bursting at the seams. Yesterday Cancer Research UK reported diagnostics and treatments under such strain that improvements of recent years risk unravelling. The British Medical Association says GPs are “firefighting to provide services their patients need”. Ambulance times are lengthening and waiting lists growing. Half of trusts are in debt. Social care is even worse, with 15-minute home visits by exhausted care assistants and nursing homes buckling under the low rates paid by councils. Forgetting the whole commissioning process, Jeremy Hunt has begun bunging money at anything politically sensitive – A&E and waiting lists. But it’s just sticking plaster until election day.The NHS is near bursting at the seams. Yesterday Cancer Research UK reported diagnostics and treatments under such strain that improvements of recent years risk unravelling. The British Medical Association says GPs are “firefighting to provide services their patients need”. Ambulance times are lengthening and waiting lists growing. Half of trusts are in debt. Social care is even worse, with 15-minute home visits by exhausted care assistants and nursing homes buckling under the low rates paid by councils. Forgetting the whole commissioning process, Jeremy Hunt has begun bunging money at anything politically sensitive – A&E and waiting lists. But it’s just sticking plaster until election day.
What better ammunition could Labour want for a barnstormer of a campaign than those charts of Cameron’s spending plans? But the first question Miliband will face is: “And what will you do?” Flannelling with small talk of efficiencies and clever wheezes won’t get Labour through the softest interview. You can’t run an attack campaign if you don’t have a defensible answer yourself. Could they say they’ll call a commission after the election? No, Labour insiders think that would never hold water.What better ammunition could Labour want for a barnstormer of a campaign than those charts of Cameron’s spending plans? But the first question Miliband will face is: “And what will you do?” Flannelling with small talk of efficiencies and clever wheezes won’t get Labour through the softest interview. You can’t run an attack campaign if you don’t have a defensible answer yourself. Could they say they’ll call a commission after the election? No, Labour insiders think that would never hold water.
That’s Labour’s dilemma and it needs resolving at the conference before a winter NHS campaign. But all options are frightening. Raising tax while running a “cost of living” campaign looks contradictory, and last week came a foretaste of what’s to come. The Tories sent supporters a message accusing Labour of making £20.8bn in unfunded spending commitments: “After taking Britain’s economy to the brink and opposing every spending reduction we’ve made … all Ed Miliband offers is more spending, higher taxes and more debt than our children could ever hope to repay.” Labour replied tartly: “This is yet another example of the Tory lie machine in action. We have made no unfunded spending commitments.”That’s Labour’s dilemma and it needs resolving at the conference before a winter NHS campaign. But all options are frightening. Raising tax while running a “cost of living” campaign looks contradictory, and last week came a foretaste of what’s to come. The Tories sent supporters a message accusing Labour of making £20.8bn in unfunded spending commitments: “After taking Britain’s economy to the brink and opposing every spending reduction we’ve made … all Ed Miliband offers is more spending, higher taxes and more debt than our children could ever hope to repay.” Labour replied tartly: “This is yet another example of the Tory lie machine in action. We have made no unfunded spending commitments.”
Labour accuses George Osborne of blocking the OBR from auditing all party manifestos: “He wants to carry on spreading lies about Labour while avoiding independent scrutiny of his own manifesto.” That’s all ya-boo, but it shows what Labour’s up against.Labour accuses George Osborne of blocking the OBR from auditing all party manifestos: “He wants to carry on spreading lies about Labour while avoiding independent scrutiny of his own manifesto.” That’s all ya-boo, but it shows what Labour’s up against.
Kate Barker, formerly of the monetary policy committee, launched her report calling on all parties to confront the crisis. Her list of tax rises rightly reaches into the pockets of better-off pensioners. Labour’s last manifesto wanted home-owners to pay a lump sum on retirement (or a lien on their home) for free care. The Tories called it a death tax, and it wrongly went down in history as a blunder. Yet when pollster Deborah Mattinson sampled marginal seats, she found a national care service scored well, with willingness to pay a tax for it.Kate Barker, formerly of the monetary policy committee, launched her report calling on all parties to confront the crisis. Her list of tax rises rightly reaches into the pockets of better-off pensioners. Labour’s last manifesto wanted home-owners to pay a lump sum on retirement (or a lien on their home) for free care. The Tories called it a death tax, and it wrongly went down in history as a blunder. Yet when pollster Deborah Mattinson sampled marginal seats, she found a national care service scored well, with willingness to pay a tax for it.
Dare Labour bite the bullet? It can’t afford not to. Lagging on economic credibility, a promise to raise tax for the NHS would show it can take tough and unpopular decisions. When the Tories shout “Tax Bombshell!” Labour can shoot at their open goal – the NHS funding black hole. Cowering behind a pledge not to raise tax won’t save Labour from Tory bombshell charges anyway. Pretending to defend the NHS without raising the funds will certainly sink them.Dare Labour bite the bullet? It can’t afford not to. Lagging on economic credibility, a promise to raise tax for the NHS would show it can take tough and unpopular decisions. When the Tories shout “Tax Bombshell!” Labour can shoot at their open goal – the NHS funding black hole. Cowering behind a pledge not to raise tax won’t save Labour from Tory bombshell charges anyway. Pretending to defend the NHS without raising the funds will certainly sink them.
Those trusted far more than politicians – the Royal Colleges and weighty medical institutions – this week publish their manifesto demanding all parties are held to account on funding. They need to put the parties’ feet to the fire over the NHS crisis the victor will face the day after the election. Labour has a lot on its mind, but there’s no ducking this one.Those trusted far more than politicians – the Royal Colleges and weighty medical institutions – this week publish their manifesto demanding all parties are held to account on funding. They need to put the parties’ feet to the fire over the NHS crisis the victor will face the day after the election. Labour has a lot on its mind, but there’s no ducking this one.