The NHS will need £38bn more a year than planned by the end of the next parliament in order to cut the care backlog and end long treatment delays, political parties have been warned.

Denis Campbell www.theguardian.com 

Labour and Conservative promises on NHS funding “fall well short” of what the beleaguered health service needs to recover from years of underinvestment, according to the Health Foundation.

Politicians are not being honest with the public about the money needed to revive an NHS that is grappling with record numbers awaiting care, inadequate access to GPs and a collapse in public satisfaction, it added.

The NHS will need such huge sums to cope with the rising demand for care that the next government will face “difficult trade-offs” in how it allocates scarce resources, the thinktank said. Failure to give the health service enough money in coming years would mean recent pledges to improve the NHS will not be fulfilled.

The Department of Health and Social Care’s budget will rise by £7.6bn to £196.9bn by 2029/30 under current spending plans. But it will have to increase by £38bn more than that to £235.4bn if whoever is in power after 4 July wants to see “sustained improvement” in its performance, Health Foundation modelling found.

“The health service is in crisis and the main political parties have said they want to fix it. Yet the funding they have so far promised falls well short of the level needed to make improvements,” said Anita Charlesworth, the director of the thinktank’s long-term economic analysis department.

The NHS will need to receive average annual budget rises of 3.8% over the next decade to keep up with the ageing, growing and increasingly sick population, the thinktank calculated.

That 3.8% is significantly above the projected rate of economic growth (1.9%) and planned rise in spending on public services (1.6%) over that time. It also goes well beyond the amount expected if ministers stuck to the Office for Budgetary Responsibility’s 0.8% projected rise in health spending, the thinktank added.

The analysis said: “Addressing the funding required to improve the NHS would mean facing up to difficult trade-offs with the funding needed by other public services and levels of taxation.

“Honesty about these trade-offs has so far been conspicuous by its absence from a general election debate that has been characterised by ‘a conspiracy of silence’ about the choices on public spending and taxation that will confront the next government.”

Whoever is prime minister on 5 July should “level with the public” about the true level of funding the NHS will need to once again deliver key waiting time targets, such as the 18-week wait for hospital care, as well as paying staff more and increasing capital investment.

NHS bosses endorsed the Health Foundation’s analysis. “Put simply, if a new government is going to fulfil campaign promises to tackle NHS backlogs and improve performance, then it will have to invest further,” said Dr Layla McCay, the NHS Confederation’s director of policy. The NHS will need “billions of extra funding”, she added.

Julian Hartley, the chief executive of hospitals group NHS Providers, said health trusts desperately need more capital funding to tackle the effects of “chronic underinvestment in buildings and facilities”, which has left some hospitals so decrepit that they “threaten patient and staff safety”.

As an instant vignette highlighting just how much trouble the Conservatives might face in their English heartlands, Calum Miller’s 10 minutes or so of chats in the neat cul-de-sacs of Langford would be hard to beat.

Peter Walker www.theguardian.com 

Knocking on doors in the community on the fringes of Bicester, just north of Oxford, the Liberal Democrat candidate spoke to locals with all manner of political backstories and motivations, some who had previously voted Tory, Labour or neither, as well as those who had either backed Brexit or wished to remain.

All, however, had arrived at a common conclusion: this time they would vote for him, to try to defeat the Conservatives.

The idea of the “blue wall”, traditionally Conservative seats whose affluent, remain-minded populations were left aghast at the antics of Boris Johnson and Liz Truss, is not new. But on 4 July, a lot of Tory candidates could find out it is a bigger and politically broader phenomenon than anyone guessed.

Miller’s intended seat, Bicester and Woodstock, newly created under the boundary review, would have had a notional Conservative majority of about 15,000 in the 2019 election. However, according to constituency-extrapolated polling, Miller should win it.

If he does, the Oxfordshire councillor and public policy academic, who only entered politics three years ago, would not be lacking in local company. While the Lib Dems are cautious in their predictions and finite in their campaign resources, with a fair electoral wind a swathe of nearby ultra-true blue seats could also turn yellow.

These could include both Witney and Henley, formerly held by David Cameron and Boris Johnson, respectively. There are hopes for the new seat of South Cotswolds, part-formed of the previous Cotswolds constituency, which had a 20,000-plus Tory majority in 2019. There is similar talk that Stratford-on-Avon, the former seat of Nadhim Zahawi, could be in play.

One very clear sign of Bicester and Woodstock’s Tory pedigree is the Conservative candidate chosen to fight it – Rupert Harrison, a former chief of staff to George Osborne, who is now a fund manager and financial commentator. Such people are usually put into safe seats – but for the Tories, it is now a fast-changing landscape.

Striding around the comfortable 1970s and 80s homes of Langford, Miller stresses that his chances remain in flux, not least because he begins many doorstep conversations by telling locals they are no longer in the Banbury constituency, where Labour are the main challengers.

That hurdle cleared, he says, former Conservatives often express disillusionment with the government that is generally connected to the decline of public services.

“I‘ve got voters who have been waiting years for appointments, children whose health has deteriorated while they’ve been on waiting lists, just really awful stories,” he says. “That is sufficiently widespread that is really affecting the confidence and feel about the government.”

There is also anger over the records of Johnson and Truss – and in a slight departure from the blue wall-remainer cliche, this can also be the case for people who voted for Brexit.

June Parry, 74, backed Brexit and then voted Conservative in 2019 in the hope Johnson would finish the job. “I’ll never vote for them again,” she tells Miller. “During Covid, someone was living a nice life at No 10, weren’t they?”

Having previously believed she was still in the Banbury constituency, Parry had planned to spoil her ballot paper in protest. After a chat with Miller, she promises to support him.

A couple of streets away, Roberto Garcia, a 62-year-old retired former car industry worker, recounts being visited by the Conservatives and assured that Labour were the main challengers. He was not fooled. “I’ve got a tactical voting app on my phone,” he says. “I actually felt a bit sorry for him because I hammered him on Brexit.”

A former Labour and Tory voter, Garcia is also backing Miller, or as he puts it: “At the moment I’m a Lib Dem.”

The sheer extent of shifts in voter loyalties in the post-Brexit era means that whatever the polls and door-knocks say, seats like Miller’s are very hard to predict with certainty. It is, however, difficult to escape the sense of a probable political mauling for the Conservatives.

Robert Hayward, the elections expert who is also a Conservative peer, says that anyone who is surprised by this trend has perhaps not been paying attention to a gradual shift in loyalties from about 2015 onwards, as shown by both a cull of Tory councillors in many such places and stagnating parliamentary majorities.

“These areas might be perceived as archetypically Tory, and might have been in yesteryear, but in the last decade they have been anything but,” he says. “They have continued to return Tories, but not with the increased majorities of some other parts of the county.”

One potential risk for the Lib Dems, Hayward warns, could be sheer logistical over-stretch, as they try to fight ever more blue wall-type seats while also battling in the south-west, their more traditional heartland.

Thus far, however, the party’s campaign has been disciplined and seemingly effective, with its leader, Ed Davey, cavorting through a series of fun photo opportunities on paddleboards and waterslides, but also emphasising policy areas like care and sewage.

With postal votes starting to go out this week, a lot of contests will depend on how effectively the party has pushed the tactical voting message, one Lib Dem strategist says.

“The thing we need to do to get it across the line is we need to persuade people that they now live in a Lib Dem-Tory marginal, not a Tory-Labour one,” they say. “That could be the difference between winning or losing a seat.”

Overall, it is hard to find a comparable period in history of the Conservatives which achieved so little, or which left the country at its conclusion in a more troubling state.”

Tory government from 2010 to 2024 worse than any other in postwar history, says study by leading experts.

Andrew Sparrow www.theguardian.com 

As John Stevens reports in a story for the Daily Mirror today, Jeremy Hunt, the chancellor, was complaining at a private Tory dinner earlier this year about the electorate’s “total failure to appreciate our superb record since 2010”.

But just how good is the Conservative party’s record in government over the past 14 years? Thankfully, we now have what is as close as we’re going to get to the authoritative, official verdict. Sir Anthony Seldon, arguably Britain’s leading contemporary political historian, is publishing a collection of essays written by prominent academics and other experts and they have analysed the record of the Conservative government from 2010 to 2024, looking at what it has achieved in every area of policy.

It is called The Conservative Effect 2010-2014: 14 Wasted Years? and it is published by Cambridge University Press.

And its conclusion is damning. It describes this as the worst government in postwar history.

Here is the conclusion of the final chapter, written by Seldon and his co-editor Tom Egerton, which sums up the overall verdict.

“In comparison to the earlier four periods of one-party dominance post-1945, it is hard to see the years since 2010 as anything but disappointing. By 2024, Britain’s standing in the world was lower, the union was less strong, the country less equal, the population less well protected, growth more sluggish with the outlook poor, public services underperforming and largely unreformed, while respect for the institutions of the British state, including the civil service, judiciary and the police, was lower, as it was for external bodies, including the universities and the BBC, repeatedly attacked not least by government, ministers and right-wing commentators.

Do the unusually high number of external shocks to some extent let the governments off the hook? One above all – Brexit – was entirely of its own making and will be seen in history as the defining decision of these years. In 2024, the verdict on Brexit is almost entirely negative, with those who are suffering the most from it, as sceptics at the time predicted, the most vulnerable. The nation was certainly difficult to rule in these fourteen years, the Conservative party still more so. Longstanding problems certainly contributed to the difficulties the prime minister faced in providing clear strategic policy, including the 24-hour news cycle, the rise of social media and AI, and the frequency of scandals and crises. But it was the decision of the prime minister to choose to be distracted by the short term, rather than focusing on the strategic and the long term. The prime minister has agency: the incumbents often overlooked it.

Overall, it is hard to find a comparable period in history of the Conservatives which achieved so little, or which left the country at its conclusion in a more troubling state.”

In their concluding essay, Seldon and Egerton argue that poor leadership was one of the main problems with the 14-year administration. They say that Boris Johnson and Liz Truss were “not up to the job” of being prime minister, and they have a low opinion of most of the other leading figures who have been in government. They say:

“Very few cabinet ministers from 2010 to 2024 could hold a candle to the team who served under Clement Attlee – which included Ernest Bevin, Nye Bevan, Stafford Cripps, Hugh Gaitskell and Herbert Morrison. Or the teams who served under Wilson, Thatcher or Blair. Michael Gove, Jeremy Hunt and Philip Hammond were rare examples of ministers of quality after 2010 …

A strong and capable prime minister is essential to governmental success in the British system. The earlier four periods saw two historic and landmark prime ministers, ie Churchill and Thatcher, with a succession of others who were capable if not agenda-changing PMs, including Macmillan, Wilson, Major and Blair. Since 2010, only Cameron came close to that level, with Sunak the best of the rest. Policy virtually stopped under May as Brexit consumed almost all the machine’s time, while serious policymaking ground to a halt under Johnson’s inept leadership, the worst in modern premiership, and the hapless Truss. Continuity of policy was not helped by each incoming prime minister despising their predecessor, with Truss’s admiration for Johnson the only exception. Thus they took next no time to understand what it was their predecessors were trying to do, and how to build on it rather than destroy it.”

Seldon’s first book, published 40 years ago, was about Churchill’s postwar administration, and he has been editing similar collections of essays studying the record of administrations since Margaret Thatcher’s. He is a fair judge, and not given to making criticisms like this lightly.

The book is officially being published next week, and I’m quoting from a proof copy. In this version, the subtitle still has a question mark after 14 Wasted Years? Judging by the conclusion, that does not seem necessary.

Rishi Sunak had a rare nugget of good news as he arrived at the LBC studios for what was likely to be a tricky phone-in with listeners — inflation has fallen to 2 percent. But now for the hard part: Sunak had to spend a full hour fielding questions from callers, shepherded by veteran hack — and brutally effectively interviewer — Nick Ferrari. ……..(London playbook)

The verdict is now in:

A top politician needs two things to do a successful phone-in. One, convincing sympathy for voter9s who feel their lives are not going well. “I feel your pain,” Bill Clinton once said in a televised town hall meeting, showing other leaders how it is done. The other is a convincing plan for making people’s lives better. Rishi Sunak failed on both counts.

John Rentoul www.independent.co.uk

After four bruising weeks of a six-week election campaign, it seemed to be dawning on the prime minister during this morning’s hour-long radio phone-in that a lot of people dislike him. He tried to sound upbeat and sympathetic to the complaints about how hard life is in Tory Britain – but there was an air of resignation about several of his answers.

“I’m sorry you feel like that,” he said more than once to callers who were cross about his record. “I don’t suppose I will persuade you otherwise.”

Towards the end of the phone-in – presented by Nick Ferrari on LBC – Rishi Sunak said: “We are almost done with this interview and we haven’t talked about migration or security.” Ferrari immediately put Rachel from Bexley through, who wanted to complain that the Rwanda deportation scheme was a waste of money. Sunak wasn’t able to convince her, either.

With time running out the prime minister took a call from Sophie, who was furious about the growth in the number of food banks. His answer was that he wanted to encourage the creation of good jobs. Ferrari made a sceptical noise. Sunak demanded: “You’re sighing – but what do you expect me to say?”

He had, by then, tried several different ways of sounding sympathetic, some of which were less successful than others. His attempt to identify with the joy of home ownership, remembering when he got his first flat, went down badly with callers such as Sophie who told him twice that he was “richer than the King”.

Sunak describes ‘special feeling’ of buying his first home in phone-in grilling

Sunak chafed at questions from callers about “polls and process”, usually with Ferrari following up to press him. He was asked by one caller whether he would stay on as an MP if he was kicked out of No 10. “Of course I’ll do that.”

He was asked by another why he thought he could win a general election “when you couldn’t even win in your own party”. To which his answer was that he was proved right. “I was right in that Liz Truss election and I am right about the economy now.”

But the most revealing exchange was with Theresa from Ladbroke Grove, who said that the NHS had “gone from five stars to one star in 10 to 12 years”, and that she was afraid to go into hospital for her treatment for breast cancer. “If I had known how bad it was going to be, I would have gone private,” she said.

Sunak expressed sympathy, and even on this occasion managed to sound sincere when he said to her: “Stick on the line and we can get your details”, and promised to follow up her case.

But when Ferrari followed up by asking about the front-page story in The Daily Telegraph this morning – about cancer care in Britain being 20 years behind the rest of Europe – the prime minister simply played dumb: “I haven’t seen that.”

Ferrari didn’t let go. Surely someone had brought such an important study, from Macmillan Cancer Support, to his attention? “I haven’t seen the details,” Sunak clarified, and started to recite his standard briefing on cancer care.

Still Ferrari persisted, wanting to know how he responded to this specific report. “It makes me want to work harder to fix it,” Sunak said, reinforcing the impression of him as a bright, well-meaning technocrat whose response to something going wrong is to work harder rather than to solve the underlying problem.

There is the prime minister’s tragedy. Nothing to do with “polls and process”. It is a matter of a public service that was working well 14 years ago and now is not. Sunak had promised at the start of last year to get NHS waiting lists down, and they have continued to go up. He keeps trying to blame NHS staff for going on strike, but most voters think it is his job to settle the strikes and turn the NHS around.

A later caller was Olivia, a striking junior doctor in Newcastle, who pointed out that he hadn’t even definitively settled the dispute with the nurses. It was at this point that Sunak complained that he hadn’t been allowed to talk about migration – another subject on which the overwhelming majority of the voters think he has failed.

A top politician needs two things to do a successful phone-in. One, convincing sympathy for voters who feel their lives are not going well. “I feel your pain,” Bill Clinton once said in a televised town hall meeting, showing other leaders how it is done. The other is a convincing plan for making people’s lives better. Rishi Sunak failed on both counts.