Will Dave sign the shortest suicide note in history today?

Strategy with Sue Marsh

“David Cameron will today invite the public to vote against him at the next general election if he fails to keep his promises to protect the National Health Service”

Now there’s an invitation. Whichever strategy guru came up with that line must be at least a little twitchy today.

“Trust-me Dave” has come up with a list of 5 “pledges” to protect our NHS :

“that the government will not endanger universal coverage; will not break up or hinder efficient and integrated care; will keep waiting times low; will increase spending on the NHS; and will not “sell-off” the NHS to create a US-style private system, but will ensure competition benefits patients.”

Clearly, they don’t actually pledge anything. Waiting times “low” is very woolly, “universal coverage” and “efficient, integrated care” don’t really mean anything to most people.

The message is clearly supposed to be, “The NHS is safe with us, we won’t privatise it and standards won’t fall” Quite the gauntlet when you look at it that way.

So far, Cameron’s style is to promise the earth and actually deliver a kind of hell. Time and time and time again he makes a “pledge” only to break it. But as I’ve argued endlessly, the NHS is different. The public will now judge him on the NHS and for all the spin and fudging, they will judge it on their own standards, not his.

They will look very closely indeed at the funding. A penny less than promised and he’s in a whole heap of trouble. They will be fed scrutinised waiting times by every media outlet in the country. They will decide for themselves how much “competition” equates to a kind of back-door privatisation.

So how likely is Dave to be able to deliver? Did he spend the last few weeks poring endlessly over budgets, projections, forecasts and Trust plans? Or did he soak up the rays in Ibiza and sketch out a few reassuring soundbites?

Initially, we were told that the NHS would need to find £20 billion in efficiency savings. It’s clear that no-one – including Dave it seems – has a clue what that really means. It means fewer nurses, doctors, beds, paramedics, physios, radiographers. It means cancer provision is being cut, hospices closed, hospitals “merged” and specialist services are being axed.

Recently, NHS Trusts were told that actually, they needed to find more savings. Monitor, the independent regulator of NHS foundation trusts now claims that rather than 4% per year savings, trusts need to look to save closer to 6 or 7% per year.

Targets were axed with the first wave of Osborne’s scythe and already waiting times have risen both for procedures and for A&E.

But most of all, social care, independent living, disability provision, carer’s support, mental health services and community programmes are all being axed. The extra burden that will now fall on the NHS is eye watering and I’m not sure the coalition even realise.

The NHS needs something like 6% extra every year to cope with increased demand and rising prices. Mr Cameron is “protecting” the budget, not increasing it, hence the “efficiency savings” that need to be found.

As a Prime Minister who believes in the Policy Fairy, Cameron struggles with joined up-thinking at the best of times. His government may have the best of intentions within specific departments, but rarely seems to consider how the actions of one will impact on another.

Yet again, we see an attempt to feed the five thousand with a loaf and some fishes. If Cameron can protect the NHS as he claims during the worst squeeze on NHS budgets in living memory, then I’ll have to start believing that he can walk on water.

If not, he says we can vote him out. I’m sure many, many people will be holding him to that.