Most debates about what the Tories should do are split between what’s right, and what would go down well to win elections. I believe that strong parties start with the former, and work up a way of converting it to the latter. This is why I disagree with James. Refusing to match Labour on health spending in 2010/11 has indeed left the Tories open to the accusation – levelled against Michael Howard in 2005 – that they’ll shut schools and hospitals. James regards this as an unnecessary hostage to fortune.
The Tories should no longer be afraid of this for three reasons. First, it’s a lie. Next, it is Labour that closes schools and hospitals, and Cameron should welcome a chance to remind the electorate of this. Thirdly, I suspect Labour will cut to near-zero NHS expenditure because it’s the easiest way to save money. We need to break away from this idea that health spending is a good in itself. The NHS should be judged by what it does, not how much it costs. Its internal market shows signs of hyperinflation of basic operation prices: is this a yardstick of success? Or too much money chasing a worryingly finite supply?
UK health spending can no longer be described as parsimonious. In 2006 we spent 8.4% of GDP on health v 6.8% in 1997 (detailed ONS study here) and while there is no updated data it’ll be probably be nearer 9% next year. (If I were the Tories, I’d build a 2009/10 figure to make this point. You can do it by taking this pdf and extrapolating NHS forecasts, which are about 80% of total). It’s as much as the average continental European country spends on health, and their tax rates are far higher than ours. Blair’s famous Frost Sofa declaration that he’d take UK health spending to European levels was then seen as so wild a pledge that Alastair Campbell later had to dismiss it as an ambition, not a target (and Brown responded by shouting at Blair “you’ve spent my f***ing budget”). This target has now been reached. Cameron says he’ll keep real-terms increase in NHS spending, which will push its ratio of our (falling) GDP even higher. That’s as much as any responsible government could or should promise. Trees do not grow up to the sky, as Eric Cantona once said. Neither should health spending. That is why Cameron is right.
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