Despite having only been an MP for less than two years it seems that the build up to every Budget and Autumn Statement so far has been dominated by calls for more funding for the NHS and social care. On each occasion campaigners have come away disappointed, but surely, after the worst winter on record and headlines proclaiming a "humanitarian crisis" the Chancellor will now act?
So far the signs have not been good. Despite everyone from the British Medical Association to the Conservative Chair of the Health Select Committee saying otherwise, the mantra from Ministers so far has been that the NHS has got everything it asked for. This claim has been comprehensively refuted and now even the head of the NHS says their funding per patient will decrease over the next few years.
Just about every organisation involved in the health sector believes that social care needs a funding boost as a priority. With an ageing population it was inevitable that removing £4.5 billion from social care would have disastrous consequences.
The calls for a cross party commission into the future of the health service allow politicians to yet again duck the big decisions. Every time there is another crisis, the response will simply be "we have a cross party commission looking into this". At the end of the process there is no guarantee agreement can be reached; Andy Burnham knows from his bitter experience trying to achieve consensus in social care that politicians cannot be trusted to work cross party on issues like this. It would also be an abrogation of our responsibility as the official opposition to outsource such critical work on something that so many of our supporters consider a fundamental element of our party's platform.
The fact is that whatever health and social care service you decide to have, significant political decisions would still need to be made. Continuing with a speedy, safe and free health service is going to cost more money and I am not persuaded that the Conservatives and Liberal Democrats who have repeatedly voted for the tightest funding squeeze in history the sector will all accept that premise. There appears to be a wilful denial by Ministers that the current funding settlement is sufficient. By the end of the decade we could well be spending less per person on health than Costa Rica. I cannot see there being much agreement with that as the direction of travel.
The debate of course isn't just about money but it is an essential prerequisite for the kind of service I want to see. 38 degrees have crowd sourced a whole range of ideas about how extra funding could be found; they are all of course political decisions. Those decisions need to be taken in conjunction with a meaningful conversation about what people are prepared to pay for; how long is it reasonable to expect people to wait for an operation, how easy should it be to see your GP, where is the line drawn between individual and state responsibility in social care? These are questions of priority. At the moment the Government is eroding people's expectations in all these areas with no mandate.
As the official opposition it is the Labour Party's duty to take a lead in beginning the conversations about what the priorities should be and shaping the debate about what the NHS and social care sector should look like in the future. In the past there has been a tendency for politicians of all persuasions to tinker with the structures and believe that is the panacea. I would agree that the current set up is far from perfect but our focus should start with an acceptance that with the inexorable rise in demand we are going to need to make the political case for the health and social care sector to be a priority.
Even if the Chancellor comes up with extra funding in the budget it will only be a sticking plaster so we should not allow the public to be fooled into thinking that's job done. A long term, sustainable approach is needed and history has told us the Labour Party are the only ones who can deliver that.