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The NHS is a campaigning tool on both sides of the border

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The future of the health service has become a key topic for the Yes campaign in Scotland, and is already being used for leverage by Labour and the Conservatives in England

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It’s only a few days before Scotland’s independence vote and eight months before Britain’s (what’s left of it?) wider general election on May 7 2015 – the date fixed by the coalition partners in 2010 – another constitutional novelty with unsettling possibilities. The NHS is firmly in the front line on both sides of Hadrian’s Wall.

‘Emotion trumps the logic that NHS Scotland has long been in Scottish hands’

I’ve been in Scotland where the formidable Alex Salmond has done well with his late stage “Vote Yes to Save Our NHS” campaign. The No camp’s lead has shrunk by 6 percentage points in a month to 53 per cent versus 47 per cent for Yes. Emotion trumps the logic that NHS Scotland has long been in Scottish hands – or the revelation this week that the Greater Glasgow and Clyde health board has awarded a £300,000 contract to the US firm Weight Watchers.

That may not bother you, as it doesn’t bother me, at least in principle. Glasgow has obesity problems (and I even saw a neon sign for deep fried Mars bars outside a chippy in genteel Edinburgh). On a practical note, Weight Watchers has never done much good for my fatty friends. But Mr Salmond says he’s protecting Scots from “privatisation” – less than 1 per cent of Scottish spending, 6 per cent in England – when life’s usually more complicated.

Wait for the policy

South of the border the health secretary tickled the Daily Mail’s tummy again (two weeks running) by threatening hospitals with fines if they don’t serve patients better food – which the Care Quality Commission will monitor. But it was Labour’s inner struggle to use the NHS for some election leverage – and do so in a credible and reputable way – which caught my eye.

‘The Burnham message remains that fundamental reform is imperative to avoid a crisis’

I should say right away that the “Miliband seeks NHS vote winner” headline you may have seen leading Saturday’s edition of the Financial Times doesn’t have Andy Burnham’s finger prints on it because he seems still to have been on a family holiday in France at the time. In fairness, Ed Miliband’s office tells me it didn’t engage in what policymakers call “kite flying” (“let’s see if the idea flies”) either. “Highly speculative… People will have to wait for our policy,” says my pal.

So it’s a mystery: who said what and why? But it is certainly common ground between Burnham and Eds Miliband and Balls that yes, the NHS will be central, and yes, policies exist but will not be unveiled yet, they are still being tweaked.

What we can say is that Burnham and Balls – who has ruled out Frank Field’s 1p on national insurance idea – agree that Labour can’t promise NHS England extra tax revenue to close the looming fund gap. £5bn? £9bn? £21bn by 2021? You choose.

Heading for a crash

Why not? Because the Tories would say “same old Labour” and even some shadow ministers dismiss it as “Labour’s traditional tax fix”. Also because extra funds would only allow more people – mostly older ones – to be put into hospitals that can’t cope.

‘The temptation to shroud wave is more fun. Ask Alex Salmond’

The Burnham message remains that fundamental reform is imperative to avoid a crisis; and that reform means integration of health and social care so that the system has no incentive to park people in hospital.

We can all see the virtue in that. Burnham has a series of other system changing proposals and thinks the coalition, which can’t decide whether to own/disown the Lansley model, is heading for an NHS train crash as pressure on accident and emergency departments mounts.

Maybe. But Labour saying “there’s no silver bullet” is hardly exciting to the hyperactive media and complicated for voters. The temptation to shroud wave is more fun. Ask Alex Salmond.

Michael White writes about politics for The Guardian

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