McTernan on politics

The Conservative Party has launched an ambitious health policy.
Last week the opposition health spokesperson, Liam Fox, unveiled a
proposal that promises a “patient passport” – an entitlement to
choose when and where within the NHS you are treated or a cash
equivalent, which you can top up and spend in the private sector.

In effect, he is holding out the prospect of instant choice
available to all – potentially a huge attraction to most patients.
And this is the Tories’ second policy launch in as many months
following their proposal to abolish university tuition fees.

Are we at last seeing the green shoots of political recovery on the
opposition benches? Any such sign of life is to be devoutly desired
by democrats – far better that the government be held to account by
elected opponents than buffeted by the extreme right-wing agendas
of unelected and unaccountable press barons.

There is no doubt that some serious thought has gone into these new
lines of thinking. The higher education policies, in particular,
have a certain cynical brilliance. It is the middle classes who
most oppose higher tuition fees and they will be relieved by the
prospect of a lower financial burden. In addition, they will be
assured that curtailing expansion of places will not affect them or
their children. It is opportunities for working-class children that
are being sacrificed.

The health policy – though initially striking – is, in fact, just
slightly more Blairite than Milburn is. Patients on long waiting
lists already have the freedom to go elsewhere – and it is planned
to extend this over time. The pressing constraint on patient choice
is the lack of capacity. And true choice needs high quality
information on surgical outcomes. Choice without excess capacity
leaves power in the hands of the providers.

The truth is that the Tories are still far from an effective
opposition. First, none of the things they propose is ideologically
distinctive from Labour – this leaves ministers free to cherry-pick
any good ideas that the Conservatives produce. Second, the Tory
electoral base remains extraordinarily insecure. They have still
not shaken off the Liberal Democrats in local government, and their
modest revival in the Scottish parliament looks ominously like a
“dead cat bounce”. They may have won Edinburgh Pentlands from
Labour but that is the only parliamentary seat they hold in any
British city outside London. Third, their party is withering away.
Membership has halved from 40,000 to fewer than 20,000 in 10 years
in Scotland, a pattern repeated across the country. And those that
remain have an average age of 66. So, the verdict remains: a little
done, a lot left to do.

John McTernan is a political analyst.