At what point does the repeated appearance of the surreal mean that it becomes the new real? Answer: when Donald Trump hits town.
In London for the Nato summit, the US president was taxed with the non-issue that has dominated election discourse for a week. Was the NHS on the table? Trump decided to interpret the question as though he was being asked whether he would like to buy the whole of the NHS, ship it back to America and re-erect it in the Arizona desert. “Never even thought about it,” he replied. Americans already had “private plans that they absolutely love. We wouldn’t want it even if you handed it to us on a silver platter; we want nothing to do with it.”
All we actually have, despite the 450 pages of documents brandished by Labour last week, is the US side of preliminary trade talks in which they say they’d like to discuss drug prices and patents and British civil servants not responding.
The Conservative manifesto shut off any such possibility by slapping down a couple of red lines: “When we are negotiating trade deals,” it said, “the price the NHS pays for drugs will not be on the table. The services the NHS provides will not be on the table.”
Fine. But it means, of course, that something else will be. Back in the summer when this matter came up Theresa May (remember her? Prime minister for a bit. Strong and stable.) stated the bleeding obvious in saying “the point about making trade deals is that, of course, both sides negotiate.” We set red lines, they set red lines. We say no to X, they say, then give us Y. That, and not the NHS being crated up for dispatch to the New World, is the issue.
This, of course, is just one element of Labour’s charge, going back to the days when Andy Burnham claimed the Tories were “privatising” the NHS. Nearly six years ago the shadow health secretary, serving in the catastrophic Ed Miliband team and deprived of the right to promise limitless billions for the NHS, began accusing the Conservatives of having “a privatisation agenda” that would mean the end of universal healthcare, free at the point of use.
If that was so, the Conservatives have manifestly failed. Not only has the basis of the service survived unchanged but, according to the independent health charity The King’s Fund, the share of revenue spent on services delivered by the private sector has stayed more or less static over the past few years. Not, incidentally, that people would be too bothered if it rose. As The King’s Fund puts it, “provided that patients receive care that is timely and free at the point of use, our view is that the provider of a service is less important than the quality and efficiency of the care they deliver.”
Amen. But these days not even Tories dare express such a view, leading to some pitiful denials of past opinions by Conservative spokesmen. Yet this sensible belief, once held by Labour but alas no longer, also turns out to be the conclusion reached by the substantial majority of our 100-voters panel after having the expenditure of the NHS explained to them.
So instead of any sensible discussion about how to improve healthcare in England, all we’ve had in this terrible election is the fraudulent “for sale” row and a bidding war. £20.5 billion in real terms plays £26 billion plays £7 billion per annum. 6,000 more doctors, 50,000 more nurses, 27 million more appointments and on it goes.
The figures are made to stand alone and no one gets to find out what they mean in the context of the real world. We have an ageing population. We need to shift resources into helping the population to age more healthily and to look after those who need care. That takes more money, more carers and new forms of delivery.
But the parties’ bidding war fails to take account even of the impact of their own policies on the requirements of the NHS. The Nuffield Trust think tank published a report this week on how, with NHS job vacancies at over 100,000 and social care worker vacancies at 122,000 and rising, both Conservative and Labour immigration policies to end freedom of movement from the EU are likely to exacerbate chronic staff shortages.
That’s just one. In addition Labour has promised a 5 per cent pay increase for all NHS staff in 2020 and “year on year above inflation increases” after that. This may help ease the recruitment problem a little, of course, but at huge additional cost.
And as if that wasn’t enough Labour has stated its ambition of moving workers, including all of those in the public sector, to a statutory four-day week. When the shadow health secretary, Jonathan Ashworth, attempted to exempt NHS staff from this promise he was effectively repudiated by John McDonnell.
There is a word for having a policy to significantly reduce staff hours at a time of chronic staff shortage. And it isn’t “clever”.
But above all Labour’s concentration of fire on the Conservatives over the false “NHS for Sale” controversy means that it fails to make the true accusation which should really damage the Tories.
For two decades the problem of inadequate social care has grown, and over time become a fug enveloping almost everything we might want to do to make our society that bit better. For almost the whole of the last decade the Conservatives have been in government.
Three years ago the Tories promised a green paper in the summer of 2018. Then in the autumn of 2018. Then April this year. Then as soon as possible.
And here in December 2019, in the manifesto of the great “Just Get It Done” Johnson, is his proposal on arguably the third biggest issue facing the country: “We will build a cross-party consensus to bring forward an answer that solves the problem”. And that is pretty much that.
Now ask yourself these two questions whenever the two prime ministerial candidates declaim on the subject of leadership: first, why have the Tories so cravenly dodged this issue? And then, why has Labour been so happy to let them do it?
Dementia Tax & Theresa May | The King’s Fund