There’s only ever been one popular tax rise – and the woman behind it works for Starmer

The last time a Labour government commissioned a landmark report to tell us what we already knew about the NHS, it was to prepare the general public to pay for it, says John Rentoul

Prime minister Keir Starmer with Lord Darzi, author of a ‘reform or die’ report into the NHS (Getty)

We have been here before. In 2002, Tony Blair and Gordon Brown asked Derek Wanless, a banker, to review the NHS. He reported back that the health service needed to be reformed, but that it also really needed more money.

So in the 2002 Budget, Brown announced a rise in national insurance contributions, effective from the following year, to “pay for the NHS”. It remains the only popular tax rise in British history, according to opinion polls.

Deborah Mattinson, the opinion pollster who worked for Brown as chancellor, described the work that went into preparing for that tax rise as her “proudest moment”. She is now working for Keir Starmer, as his director of strategy.

Today, the prime minister echoed Blair’s mantra: more money is conditional on reform. Starmer said in his speech welcoming Lord Darzi’s review of the NHS: “We have to fix the plumbing before turning on the taps, so hear me when I say this: no more money without reform.”

We should not be too cynical about this. There was “reform” in the New Labour period. The big changes were the combination of trusts and targets, and there were also some limited experiments with private provision of NHS services. But the most important change was more money.

After some early expedients during the first two years of spending restraint, including the private finance initiative (PFI), to ease the chronic underfunding of the Tory years, the public spending taps were turned on in 1999. By the end of the Labour government in 2010, the NHS was “basically fixed”, as Blair had promised.

Here we go again. Only today, the NHS starts from a worse position, with huge waiting lists hanging over from the pandemic, and the case for “reform” totally confused by Andrew Lansley’s disastrous re-organisation during the coalition years. There is the added puzzle of what happened to the money that has been pumped into the NHS since the pandemic: large sums have been swallowed up in labour costs, with no improvement in productivity.

No wonder Starmer says this is a “10-year” task. That seems optimistic, given that it took the Blair-Brown government 13 years, and the challenges are greater this time.

There remains the scary question lurking in the background of whether the NHS model can ever be made to work again. But if the principles are the same, it may be that, by taking advice from Alan Milburn, the former health secretary, Wes Streeting can skip the first two years of the last Labour government, when, as Blair later admitted, it had no idea what it was doing.

The Darzi review and Starmer’s speech are part of an accelerated attempt to prepare public opinion – not just for the tax rises that are coming in the Budget next month, but for the length of time that fixing the NHS will take.

There is a third objective of this exercise in managing public opinion, naturally, which is to try to make sure that, over the next few years, the Conservatives get the blame for the inadequate service.

This may be the least successful, which is unfair, because the Conservatives deserve to get the blame. But it may be that public opinion is already growing weary of Labour blaming everything on their “worst inheritance since the Second World War”, the “£22bn black hole” and “they crashed the economy”.

And this rushed attempt to repeat the 2002 exercise in more difficult times is unlikely to be as successful as it was the first time around. Opinion polls suggest that people are prepared to pay more taxes for the NHS, but if these findings are tested, it turns out that few are willing to pay significant amounts – only a quarter say they would pay as much as £100 extra tax per year. (Community note: this is not enough.)

I hope Starmer succeeds – but I fear that this attempt to relive one of New Labour’s finest hours will be a disappointment.