“I worry about everything,” the prime minister told the BBC’s Andrew Marr yesterday. “That’s my job.” And so it is, I suppose. But there are times when “everything” is less burdensome than it might be; when, for instance, the main party of opposition decides, for no immediately obvious reason, to depart the stage, to take a sabbatical, to disappear up its own ideological fundament.
Though they dare not say as much in public – Tory smugness being a vote-loser if ever there was one – the PM and his colleagues cannot quite believe their good fortune, less than a year after a general election a fair few of them believed they would lose. Jeremy Corbyn, a senior cabinet member told me last week, is “the happiest piece of good luck that has ever happened”.
Yet politics abhors a vacuum. As Labour retreats to work out what it wants to be, the political battlefield is no less bloody, its contours no less jagged. Britain’s membership of the EU is now a matter of daily contestation, before even the rules of engagement have been declared and the referendum campaign whistle blown.
Last week George Osborne delivered a speech drawing bleak attention to the “dangerous cocktail” of geopolitical and economic forces bearing down on UK plc and its recovery. On one level this was part of what, in private, he calls “chancellor 101” – intermittent snapshots of the global economy to help voters understand why the government is adopting this or that series of measures. In this case, Osborne was describing a context dominated by the Chinese slowdown, the low oil price and the worldwide expectation of higher interest rates.
Much less significant than the difference between the chancellor’s tone last week and in November, when he delivered the autumn statement, is the broader political consistency of the message he and Cameron have pressed home over the past decade: “Stability first”, or “Don’t jeopardise these hard-won gains.”
In November 2014, for instance, Cameron cautioned that “red warning lights are once again flashing on the dashboard of the global economy”. Like Osborne’s “dangerous cocktail”, the image of the pulsing red lights was not meant to inspire fatalism but electoral caution. These carefully calibrated warnings – the basis of last year’s general election victory – remain the irreducible core of the Conservatives’ political strategy.
It is a cliche that Cameron is a pragmatist rather than an ideologue, an assertion that tends to obscure his ambitions as a social reformer. He was shaken to the core by the 2011 riots: though his immediate public response was to categorise the disorder as no more than an outburst of criminality, he was deeply troubled by the discontent and despair that tore through England’s inner cities.
In today’s Sunday Times, accordingly, he promised to bulldoze the worst sink estates and to replace them with decent housing. “The riots of 2011 didn’t emerge from within terraced streets or low-rise apartment buildings,” the PM wrote. “The rioters came overwhelmingly from these postwar estates. That’s not a coincidence.”
Nor is it coincidence that he has marched yet again into the centre ground once occupied so confidently by New Labour. There are Blairites who hope, privately, that his avowedly centrist Tory caucus will leave intact, and perhaps even entrench, the public service reforms they initiated.
For this and other reasons, much the most pressing political challenge facing the government is the junior doctors’ strike that begins with a 24-hour stoppage on Tuesday, during which time only emergency cover will be provided. If no settlement is reached, there will be a 48-hour strike on 26 January – and then a walkout from 8am to 5pm on 10 February in which, for the first time, emergency care will also be withheld.
The stakes in this confrontation are vertiginously high. Cameron and the health secretary Jeremy Hunt find themselves ranged against the medical profession – the government’s argument being, in brief, that junior doctors’ contracts are absurdly old-fashioned, drafted as if disease goes into remission and accidents never happen at the weekend.
The police and fire brigades operate as normal on Saturdays and Sundays, as do employees in all manner of trades and professions. Why should doctors be paid on an antiquated basis that encourages them to work absurdly long hours on weekdays rather than to make themselves available for weekend shifts?
One of Cameron’s early modernising achievements was to reassure voters by ditching proposals to subsidise patients who went private and ringfencing the health service budget, that the NHS was indeed safe in his hands. Much of this goodwill, however, was squandered by Andrew Lansley’s NHS plan – which was precisely the sort of monstrous bureaucratic upheaval Cameron had promised not to implement. The question, to which we will shortly learn the answer, is how much of this goodwill endures.
Those who believe the NHS is never secure under a Tory government accuse Lansley, Hunt and their Major-era predecessors of pursuing what Orwell called “catastrophic gradualism”: through a series of radical interventions (the charge sheet reads) Conservative health secretaries are seeking to dismantle or privatise the NHS, or both.
For those unburdened by anti-Tory prejudice, another interpretation is possible: that the greatest threat to the NHS is not the Conservative party but its own failure to respond to modernity. How can a state-run health service, free at the point of use, keep up with the wonders of medical technology, the radical advance of pharmaceutical science, and the marvel of 21st-century longevity?
How indeed. The King’s Fund warns that spending on health as a share of GDP is declining. But in England alone expenditure on health in 2015-16 is expected to reach £116.6bn. Could more be spent? Of course, limitlessly so. But that’s the point. The custodian of the NHS who truly seeks to safeguard its future must fight for internal efficiency, restless reform and the changing needs of patients, as well as for extra cash.
This is how Hunt has to frame the public debate over the strikes. Not as a battle between capricious Tory austerity and noble doctors, but a fight between a patient-centred NHS and a creaking, old-fashioned system designed to match the inherited habits of the profession – possibly supported in their action by pickets from the Corbynite grassroots movement Momentum.
He has his work cut out – but he also knows he has to win. While Labour takes compassionate leave, the real battles rage on.
