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I’m not a fan of referendums. But giving the public a chance to voice their opinion could be the only way to improve the NHS

No politician is allowed to pledge a penny of extra spending on any cause

We are living longer. On the whole, longevity should be a cause for celebration. Few would opt to live less long. Yet the political consequences are fraught. The growing numbers of people in their 80s and 90s place a huge demand on the NHS, and make the costly provision of wider elderly care more urgent. Of course, the NHS does not need cash alone to meet the challenge. It must learn to spend every penny efficiently. The familiar demand for “reform” must always accompany taxpayers’ investment. There are many ways of improving delivery, and a debate that goes beyond the banal and simplistic “reform versus anti-reform” is as necessary as the additional cash. But the cash is also required.

Sadly, in Britain’s deranged pre-election debate on “tax and spend”, what Basil Fawlty calls “a statement of the bleedin’ obvious” is almost impossible to advance. No politician is allowed to pledge a penny of additional spending on any significant cause, especially Labour politicians. Commentators deliver stern lectures on the dangers of profligacy. George Osborne warns of a tax bombshell. Powerful newspapers echo the Chancellor. Currently, the Labour leadership is agonising over whether to state the obvious – that the NHS needs more cash to meet the demands upon it, especially if it is to become part of an integrated care service for the elderly. That would require a tax rise.

Ed Miliband has challenged quite a few orthodoxies as leader of the Opposition, but this is one that so far he has not dared to touch. Since 1992, there has been an assumption in Labour’s ranks that they cannot win an election proposing a potentially contentious tax increase. On this issue, Miliband and his shadow Chancellor, Ed Balls, cling closely to New Labour’s approach. Before 1997, Gordon Brown proposed a popular tax rise, a one-off tax on the privatised utilities. Miliband and Balls know they are on safe terrain in proposing a tax on bankers’ bonuses.

Those in the Shadow Cabinet currently urging an additional – and electorally riskier – “NHS tax” point out how popular a similar policy was when introduced by Brown in his 2002 budget. The then-Chancellor announced a substantial tax rise, in the form of higher National Insurance contributions, to pay for NHS improvements and a poll in the following weekend’s Sunday Telegraph found that it was the most popular budget since 1945, to the bewilderment of the Conservative leadership and its newspapers. As Nick Pearce, of the Institute for Public Policy Research think-tank, argued yesterday, a further 1 per cent increase in NI rates would bring in about £4bn each year, and if the proceeds were dedicated to the NHS it could be popular.

There is, though, a very big obstacle, in the form of Britain’s hysterical tax and spend debate. The popular 2002 tax rise was never tested at the 2001 general election. Tony Blair and Brown were careful to avoid ruling out a rise in NI contributions, but even at the height of New Labour’s popularity they did not dare to put the case for a tax increase to pay for the NHS at a general election. In a much closer vote, as the next one will be, Labour would be taking a very big risk to propose an NHS tax that most earners would pay. Yet, as a country, we so obviously need the additional provision.

I am not a fan of referendums. Under the guise of democratic engagement they are devices to get leaders out of a hole. David Cameron did not want to offer an in/out referendum on Europe but had to do so in order to unite his party. Before the 1997 election, Tony Blair offered a range of referendums but most of them were never held. Referendums rarely resolve issues; the last one on Europe, in 1975, has hardly decided Britain’s relationship with the EU. But I can see many virtues in offering a referendum on a tax rise to pay for improvements to the NHS and elderly care. Given that there can be no reasoned debate in an election campaign, and no government in this era of neurotic mistrust will have the authority to increase taxes without a mandate, why not offer a referendum on the issue? There would then be a more considered debate around a theme that affects every single voter, and intense scrutiny over what is being proposed.

Such a move could be part of a revolution in relation to the UK’s archaic tax and spend debate, leading to more earmarked taxes, greater transparency, much more scrutiny of how public money is spent, a wider discussion about what we need as a country, what standards we demand and whether we are willing to pay for them. Of course, it is a big leap to hand over a specific decision on tax and spend to the voters, but even that is much less destabilising than offering plebiscites on the future of Scotland and Britain’s membership of the EU. Forget about referendums on Europe, to be contested in a sprit of incomprehensible hyperbole. Instead, let’s have one on an issue of urgent accessibility that could transform the quality of all our lives.

Axelrod may be talented, but he won’t make a huge difference

Labour’s hiring of President Obama’s election guru, David Axelrod, has commanded the Easter headlines. The symbolism is fleetingly positive for Ed Miliband, reminding a hostile media that his chances of winning are taken seriously by those who have been victorious in US presidential elections, the biggest democratic contests of the lot. But beyond the symbolism, the appointment is likely to make little difference.

Winning elections is to do with composing an overriding message that resonates, linked to policies and values that are coherent and compelling. This is not easy. At the last election, David Cameron sought to be a modernising Tory leader while presenting policies that were similar to his predecessors. There was a clash between tone and specific proposals. Now, Ed Miliband seeks to project pivotal messages on the economy at a time of economic growth and with most voters still blaming his party for the global economic crash in 2008.

But while winning elections is daunting, they do not require superstars from the US. They need clarity of thinking, principled conviction and guile. If such qualities are lacking in British politics, there is something alarmingly inadequate about our political talent.

I suspect such signings are more to do with insecurity across the political parties than a lack of strategic qualities here. A star signing shows that a party is in the game. But winning or losing will be down to those, at the top of a party, that live in the country they seek to rule.

Twitter: @steverichards14