No promises to keep the NHS fully funded

Stephen Dorrell and Chris Smith both admit they will not be allowed to spend what is needed on health
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Usually the NHS is Labour's Big Issue at election time. But there is surprisingly little sign of it as yet. Remember the War of Jennifer's Ear over a Labour party political broadcast last time? Remember how Robin Cook used to jump up and down like Rumpelstiltskin proclaiming that the Tories were out to privatise the NHS - which no one quite believed? Well, where is the noise now? Only an eerie silence.

Last week Jack O'Sullivan spelt out on these pages the scale of the crisis facing the NHS. It needs close to 3 per cent above inflation each year to keep up with the ageing population (40 per cent of NHS money is spent on the over-65s) added to unstoppable demands for new drugs and treatments. Under the Tories, the NHS has survived adequately on 2.6 per cent extra a year. Occasionally it dipped down, but loud shrieks of pain ensured that the following year it caught up. Easing in the NHS reforms, the Government greased the wheels: when things got tight the NHS got a bung. It happened this year - the NHS was due no real increase but Dorrell stole an extra pounds 400m from the capital account to put into the current account. (The capital account is cut by a third, a serious problem for next year.)

Times are hard again with a familiar end-of-year squeeze - surgery lists closed, 50-hour waits on trolleys in A & E and accelerated hospital closures. Trusts are also borrowing heavily from next year's budget and delaying paying creditors, sanctioned centrally with glee at mounting debts for incoming Labour. (There are signs of this kind of scorched earth policy in other departments as well.)

But it is the spending plans for the next few years that are truly alarming. Next year the NHS is allotted only a 0.9 per cent increase. In 1998-99, it faces a disastrous cut of -0.6 per cent, and the following year, a calamitous zero increase. Never, ever, in the patchy financial history of the NHS, have there been four years in a row like these. The figures in the Treasury's Red Book would mean a mass flight to private insurance and the end of the NHS as anything but a safety net for the poor. The NHS for once is not waving shrouds but drowning.

Now that is the doomsday scenario and Labour's Iron shadow Chancellor has signed his name in blood to it. So both parties are apparently committed, (on paper), to killing off the NHS. Could this explain their eerie silence? Neither can fight the other effectively on this shifting quicksand.

Do we really believe they will stick to those figures? I went to see both Stephen Dorrell, the Health Secretary, and Chris Smith, Labour's shadow, to divine their true intent. Of course they both say the NHS is safest in their hands - but the hands of both of them are tied. It's a no-win arm-wrestle.

Stephen Dorrell can get away with more winks and nods on the spending front (not that he is a winking or nodding sort of man). What he in fact said was: "I'm not going to be drawn on what the Budget settlement may be for future years, beyond what's spelled out in the Red Book. But if the case does have to be made for substantial growth, then it will have to be justified on its merits." In other words, he would fight for more.

He adds his campaign speech: "The difference between us and Labour is that we are committing ourselves to real terms growth year on year. We certainly aren't committing ourselves to large growth, but it does commit us not to cut." His features are deadpan, but next comes what passes for that wink and nod: "Judge us by our track record. Over the last 18 years we have delivered real growth to the Health Service. If there are special pressures in later years they will have to be examined. I hope I will advance the best case for a growing budget for the NHS, as the most cost- and quality-effective health service in the world."

Now poor old Chris Smith would be garrotted by Gordon Brown if he went as far as even Dorrell's Minimalist nudge-nudge. If he said the money would be there, the hyena Mawhinney would have him up on a billboard the next day. No, Smith has to spell out exactly how Labour will save money within the NHS budget through clever wheezes in order to plug the horrendous spending gap. Such as saving pounds 100m on management, by cutting to one-tenth the number of contracts exchanged. No doubt money can be saved, maybe pounds 100m - but it's chickenfeed.

Chris Smith makes a convincing case for managing the NHS better - but where's the money? "I will argue my case for a fair share at the cabinet table" he promises. "I will show that every pound is wisely spent. The NHS will also get its share of money cascading in as the unemployed go back to work, financed by the windfall tax. It can be done."

There is not a shred of ideology in either man's view of the NHS; no flags to wave or battle cries. Both men are deeply absorbed by the NHS' vexing intellectual conundrums. Both quote new research on effectiveness - the treatments and drugs that really work - as the key to wiser spending. Smith is right in saying that the contracting system could be streamlined, but this is not really the stuff of election politics.

Out there on the doorstep, every candidate says the NHS is the Big Issue. The irony is that in the real world, it is probably now the least political issue. All that matters is who will fund it best. The best guess is that both men would fight valiantly for more money and both governments would strain every muscle to bung in enough money to keep it creaking and groaning along as it always has done.

The figures are nonsense, and what they accuse one another of is half- hearted nonsense too. And everyone knows it. The one unshakeable electoral fact is that the whole nation supports the NHS passionately and will not tolerate its demise. The party that seriously damages it will be a dead party - and the Tories have always known that.

What of the future? In power, Chris Smith may have the hot breath of Rodney Bickerstaffe's low-paid Unison members upon his neck. In opposition, Dorrell may be plagued by some fruitcake ideologue such as Redwood for a leader full of clever ideas for selling off the NHS. Each has his nightmare scenario. Dorrell says perceptively that what he really fears is an NHS that stops changing - by which I take him to warn that Labour may simply offer stasis; new health developments gallop apace and need constant revolution, challenge and response. But Chris Smith is not short of radical ideas: NHS staff can expect jolting new reforms from him, too.

As for this election campaign, an honest and decent man like Chris Smith may choke on promises that Labour would save the NHS while the wicked Tories would privatise it. Every time he tries to make political capital out of scandalous cuts and lengthening waiting lists the other side will bellow back at him: "What would you do, then?" If Labour wants to play the NHS card effectively then Gordon Brown will have to come up with a better story for Chris Smith to tell - and that means more money up front before the election. (It will certainly be there after it.) The NHS is a winner for Labour - but not without visible, credible cash on the table to expose the Tories' killer Red Book plans.