Cameron is sincere in his 'truly seven day' NHS plans - but where is the money?

Those seeking a return to power need to be very careful what they say - during the election the Tories pledged spending increases and tax cuts that were not fully costed

David Cameron has reiterated his pre-election promise to radically improve the NHS (Getty)

The first Prime Ministerial speech of a new term has a powerful symbolic quality. The topic chosen conveys a sense of intent and direction at a point when a leader is at the height of his or her powers. In the aftermath of his unexpected victory, David Cameron chose to highlight his commitment to the NHS, proclaiming in a speech of upbeat optimism that “we can become the first country in the world to deliver a truly seven-day NHS”.

Cameron’s chosen topic and the vision outlined are politically significant, as was George Osborne’s choice for an opening theme last week, when he highlighted in Manchester his plans for a Northern Powerhouse. In both cases their speeches convey a desire to move beyond an arid debate about what government cannot do to a more positive one about what it can.

The contrast with the opening weeks of the Coalition in 2010 is marked. Then, as one of its first acts, the Treasury scrapped a government loan for Forgemasters in Sheffield, signalling an indifference to a Northern Powerhouse, even one in the constituency of the new Deputy Prime Minister. Separately, the Health Secretary, Andrew Lansley, was preparing his plans for a chaotic upheaval of the NHS far removed from a focus on seven-day-a-week provision. Now, with an overall majority, Cameron and Osborne are keen to show they will use their victory as One Nation Conservatives. In 2010, when they had the protective shield of the Liberal Democrats, they leapt impatiently towards the radical right.

Nonetheless, the symbolism of opening speeches is the easy bit. Implementation is far more challenging, not least as Osborne prepares his second Budget of the year. Cameron repeated his pledge to spend an additional £8bn on the NHS by the end of the parliament. At the same time, Osborne seeks £15bn worth of cuts elsewhere. I have no doubt that they are serious about finding the cash. Equally, I have no doubt that they are not sure where to find it. The figure is based on the minimum NHS England regards as necessary to maintain its current wobbly standards. Cameron’s vision sits on top of all the demands it will already be struggling to meet if and when the government finds the minimum investment required.

Privately, the Labour leadership had assumed taxes would have to rise to pay for the increased demands on the NHS – well beyond the Mansion Tax that it proposed. Cameron and Osborne’s tax-raising options are limited after their pledge during the election to make it illegal to increase some taxes. That is proof that Cameron and Osborne did not expect to win by a wide margin. They would not have made such a silly commitment otherwise.

Those seeking power, or a return to it, need to be very careful what they say during a campaign. During the election Cameron and Osborne pledged spending increases and tax cuts that were not fully costed.

In Labour’s latest leadership contest, the noisy Greek chorus of commentators insist that the candidates must accept that the last Labour government overspent, and apologise for the profligacy. Some of the candidates have done so, saying “sorry” to fleeting cheers of approval. The more experienced candidates, Andy Burnham and Yvette Cooper, wisely hold the line as much as they possibly can, even though they know that the media will disapprove, writing them off as backward looking, while hailing other candidates that apologise more fulsomely as farsighted.

Burnham and Cooper are right not to accept the myth about Labour’s overspending, partly because the allegation is not true. As Burnham has pointed out, the spending review before the financial crash was settled below growth projections. After 2001, overall spending increased much more than in equivalent EU countries, but only in order to catch up with those countries after the IMF-imposed cuts of the 1970s and the miserly approach to public spending of the 1980s and 1990s. Such a catch-up was overdue.

But, more importantly, potential leadership candidates need to hold the line to show they have the strength to challenge false orthodoxies about public spending. If Labour’s winning candidate apologises for the past, he or she would soon come under huge pressure from internal and external opponents, and the media, to prove their “modernity” by ruling out any additional public investment in the future.

This has happened in the past. Before the 1997 election, Tony Blair wanted to appease some newspapers by ruling out an increase in the tax burden if he were elected. If he had made such a pledge he would have been hailed in the media as “responsible” and yet paralysed in power, unable to initiate much that he went on to implement.

In the shallow commentaries on the embryonic leadership contest, Burnham is dismissed as “anti-reform” – although he seeks the most sweeping reform since the birth of the NHS: the integration of health and social care – while Cooper is seen as rooted in the past by attempting to explain calmly what the last Labour government got right and wrong in its approach to public spending. Labour needs a leader who can flourish in the media, but if a potential leader appeases the critics too much, power will become close to pointless.

After his own campaign pledges, it is Cameron who faces the gap between vision and the resources to pay for it. Margaret Thatcher responded to her 1987 victory by declaring, counter-intuitively, that more had to be done for inner cities. Not a great deal happened. After his election win Cameron focuses sincerely on the NHS. How will he implement his policies? Where will the money come from? At this early stage I suspect Cameron has as much idea as Thatcher had.

Twitter: @steverichards14