… or is it?
The election next week was called because of deadlock in Parliament over Brexit and the Prime Minister has framed his campaign around this issue. Of course General Elections are usually more general than one-issue campaigns but whilst the Liberal Democrats are also focusing on stopping Brexit, Labour is doing everything possible to shift the focus to other things. Its key topic is, of course, the NHS and it is beginning to look like that is gaining a grip on many voters who trust the party on this more than they trust the Tories.
Our blog is about the EU and why we should leave it so we are reluctant to take sides on other questions. However, to lose Brexit would be very serious in our view so we need to address the distraction. The Conservatives are the only party offering voters a chance of leaving the EU on half-decent terms, though even they may not do a good job (more on that later). We will simply address the fiction that Labour is the party of the NHS and the Tories will weaken or destroy it by selling it.
All three parties in the wartime coalition (Conservative, Labour and Liberal) approved the Beveridge report they collectively commissioned and their 1945 election manifestos all contained commitments to introduce a welfare state, including a national health service. Labour won and therefore was able to implement its plan and take the credit. A National Insurance tax was introduced to fund the service. NI is not truly an insurance since the revenue is pooled with other general taxation and so has to compete with other demands on government resources. This means that there is always rationing however much is allocated to health but the Service itself decides what to cover and for whom.
In order to gain their acceptance GPs were allowed to remain as private rather than public employees, so from the start the NHS has been part-privatised. Labour governments introduced prescription charges and most opticians and dentists are now private as a result of Labour policies. Using Public Finance Initiatives for the NHS was a novelty introduced under Blair-Brown and has resulted in rip-offs. Rather than using government borrowing (which would have put the costs clearly on the books) private investment was used at high interest, index-linked rates and even services, such as cleaning or changing light bulbs, could be expensive; we will be paying over the odds for decades to come. The same pair did raise NHS spending but used much of it on increased GP remuneration while reducing their home-visit and out-of-hours commitments. In return for this generosity they demanded, through target setting, a method of quantifying the unmeasurable – quality improvement. Cash allocated to hospitals was also spent largely on administrators rather than front-line staff.
Some procedures are carried out by private hospitals on behalf of the NHS while maintaining the ‘free at the point of use’ principle but it is a small percentage, well under 10%. We are (rightly) critical of the American health care system but some of its companies are world class providers; under EU regulations tenders must be open and not restricted to UK providers so why exclude the best if the price and quality matches the need? Most other comparable countries have social insurance schemes and better outcomes (for infant mortality and cancer survival for example). It seems only Labour is willing to privatise aspects of the National Health Service but gets away with what the Conservatives wouldn’t even dare to suggest.
But let’s get back to campaigning about Brexit. Boris talks of “getting Brexit done” and his “oven-ready Brexit” but if he heads the next government and Parliament approves his deal he will simply have committed to pay the EU its divorce alimony and gain permission to start negotiating a trade deal. If he clinches a deal in 2020, as he proposes, it is likely to be a poor one, the EU will continue to play tough. Our future has been compromised by the appalling performance of his predecessor but the alternatives are no Brexit at all or an undefined deal, but one we know will keep us in the major institutions of the Union and under the control of its judges but without representation.
Many of the Conservative manifesto promises are aimed at countering Labour’s challenge rather than those raised by Brexit. However, it is the only party with a chance of governing that offers a glimpse of hope of freedom from the EU’s stranglehold. It may be that a rather compromised Brexit which nevertheless puts the UK out of reach of many areas of Brussels control will help it escape the worst if (or when) the EU reaches its own cliff edge as monetary union in particular collapses. We recommend voting Conservative, if not with our whole hearts.