The new politics of the NHS ring-fence

By Peter Hoskin
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Jeremy Hunt is setting out a “back to basics” approach to care in the NHS today, but he may just want to go back to bed after reading the main editorial in today’s Sun. “The NHS is one of our proudest creations,” it notes half-way through – so far, so positive – but then it continues, “But Cameron’s insistence on ring-fencing its funds creates a climate in which idiocy and incompetence go unchecked.” Ah.

The problems with the NHS ring-fence were clear as soon as it was erected, before the election. There was a mismatch between the Tory Opposition’s insistence that “more” could be achieved for “less,” and their Brown-style argument that only they could be trusted with the health service because only they would shield it from cuts. Sure, they deployed demographic arguments too … but the politics were still inconsistent.

And it looks even more problematic today. Not only has the ring-fence failed to unambiguously achieve what David Cameron intended with it – to convince voters that the Conservatives are the party of the NHS – but it’s also now holding the Tory leadership back. For starters, George Osborne could rather do with some of the money rested in piles behind its bounds. And the attack on Labour over Mid-Staffs was diluted because Mr Cameron couldn’t properly alight on a simple point: that these tragedies happened despite rising and oft-boasted-about spending.

This is why – coupled with the Mid-Staffs scandal itself – it’s unsurprising to see more and more raids on the ring-fence. There’s the Sun today, of course, but the Telegraph also pulled out its power tools in an editorial before the Budget. Liam Fox spoke out against it in his own pre-Budget intervention, and John Baron does likewise in a piece for ConservativeHome today. These are just some examples of many: the mood, which was never exactly kind towards the ring-fence, has become suddenly more unfavourable.

So why doesn’t the Tory leadership just scrap it? Partially, I guess, it’s because they made a “read my lips” – or, rather, read my poster – promise to protect the NHS from cuts, just as they did with pensioner benefits. They’re not going to be quick to abandon so prominent a pledge, having seen what happened to Nick Clegg over tuition fees. And I suspect another part of it is timing: they don’t want to withdraw money from the NHS when the service and the public are still reeling from Mid-Staffs. Their approach is instead to say, “Physician, here’s some cash, heal thyself.”

But whether the ring-fence will hold after 2015 is a different matter entirely. It’s noteworthy that, in his first interview after becoming Health Secretary, Mr Hunt wouldn’t make any promises on that front – not least because he couldn’t foresee the economic future. If austerity is to last, then politics may have to catch up to it.