Health gambles could swing the election

With the Conservatives committing the totemic £8bn for the NHS and Labour refusing to match it, politics has seemingly been turned on its head.

‘Outbidding Labour on health spending is a tactic that worked well in 2010’

Yet these commitments say more about the parties’ respective weaknesses than they do about their strengths.

The Conservatives know they cannot hope to win on health, but by making this commitment they hope to neutralise Labour’s strongest issue.

As I wrote in HSJ recently, seeking to outbid Labour on spending is a tactic that worked well in 2010; Conservative strategists have returned to the same playbook.

Cashing in

That they have done so without explicitly finding the money to pay for the commitment shows both the depth of their concern about their position on health and the strength of their confidence about the public’s trust in their financial competence.

‘Labour is borrowing from its NHS credibility to bolster is reputation for fiscal prudence’

They are cashing in some economic credibility to buy some additional confidence from the public on the NHS. Ministers can expect plenty of questions about where the money will come from; “trust us” may not be a strong enough answer.

For Labour, the party of the NHS once again finds itself fighting an election committed to spending less on health than their rivals.

For a party that pledged to make the election all about health, this is an extraordinary position to find itself in.

Shadow ministers can guarantee that every interview they face between now and polling day will start with the money; whether they can get beyond it remains to be seen.

Five year backward view

Labour’s high command will be hoping that a formula of recalling the events of the past five years – combined with long-standing trust on the NHS and spiced up with a few doorstep friendly pledges on issues such as one to one midwifery care and cancer – will be sufficient to score a decisive victory on health, even when they are bringing less money to the table.

‘The forward view has ensured all parties make clear commitments to the money’

This is a gamble. Labour is essentially borrowing from its NHS credibility to bolster is reputation for fiscal prudence. Making a stand on the issue dearest to voters’ hearts will certainly attract attention.

Cutting the deficit requires some political as well as financial pain. Whether some pain on the NHS delivers much gain on economic reputation remains to be seen.

NHS England’s NHS Five Year Forward View has certainly succeeded in setting the parameters of the debate on health, although it appears that it has been successful in ensuring that all parties make clear and unequivocal commitments to the cash.

Money talks

There are, of course, varying interpretations about what signing up to the money actually means.

It is quite possible that the electorate – who are probably less inclined to spend hours interpreting the scripture according to Stevens than health policy watchers – will just see a blizzard of spending commitments from the parties.

‘Both parties have rolled the dice on health in very different ways’

The money is certainly talking, but it might just be creating noise.

With less than four weeks to go to polling day, both parties have rolled the dice on health in very different ways.

They still have some work to do before either gamble can pay off.

Mike Birtwistle is a founding partner of Incisive Health