The election focus has turned north of the border as Labour plays the NHS card in Scotland. But they face an uphill task

The sound of Ed Balls’ latest efforts to chill voters’ spines over “NHS cuts” or NHS charges if the Tories win on 7 May is unlikely to dominate conversation in the Dog and Duck.

I suspect most people tune out of party number crunching efforts, even when underpinned (as Balls’ attack was) by the technocratic analysis of the reputable Institute for Fiscal Studies.

‘Scottish Labour has been hammering away for weeks at the record of NHS Scotland under the SNP since 2007’

By switching this week’s focus to Scotland I won’t pretend the script will change very much, though institute reports are cherry picked north of the border, too.

Scottish Labour has been hammering away for weeks at the record of NHS Scotland under the Scottish National Party since 2007 – the first five under health minister Nicola Sturgeon, now first minister since Alex Salmond stood down.

Tough target

Labour in Scotland is in better shape under the new leadership of ex-cabinet minister Jim Murphy, but that isn’t saying much when the polls predict a near wipeout in its northern heartland, enough to deny Ed Miliband the keys to Number 10 without SNP support.

“We are trying to overcome eight years of neglect in eight weeks,” one Murphy ally told me the other day.

And the SNP is a tough target. When Ed Miliband addressed Labour’s dwindling activist base in Edinburgh at the weekend he warned – as did Balls and Murphy – that George Osborne’s plans would cut £2.7bn from the Holyrood government’s UK block grant.

It was denounced as proof that NHS Scotland is not safe from Tory cuts under devolution.

Balls is almost as austerity minded as Osborne, added SNP Treasury spokesman Stewart Hosie MP. He just happens to be married to Shona Robison, Sturgeon’s student chum and successor but one as cabinet secretary for health, wellbeing and sport.

‘The fact is it is going to be tough, whoever wins’

Er, well up to a point. Holyrood is free to prioritise its spending of the block grant and has chosen to spend 1 per cent less on Scottish health since 2010, as opposed to the modest “ringfenced” increases in England.

Whether it has performed better or worse is a matter of judgement.

It is depressing to read analysis that is predictably skewed by the author’s political outlook: rejecting the market facing health policies first adopted by New Labour has produced better results, say some. And vice versa, insist public sector champions.

Improving outcomes

More dispassionately, you may recall, Nuffield studies suggest outcomes are improving and converging across all four home countries, despite divergent policies.

The fact is it is going to be tough, whoever wins. The saintly Institute for Fiscal Studies points out that Holyrood can raise taxes or cut spending – or both. It also faces sharply falling oil revenues, about which the SNP has been defiantly upbeat.

“It is hard to see how independence could allow Scotland to spend more on the NHS” than inside the UK, the institute said well before oil fell to $50. This week’s Scottish spending figures are gloomy.

‘This week’s Scottish spending figures are gloomy’

Sturgeon has offered SNP support at Westminster in return for economic expansion – ie more borrowing. Balls is wary, David Cameron delighted. Meanwhile Murphy’s new team, including health spokesman Jenny Marra, did manage to score a hit last month when it forced Sturgeon to overrule Robison and promise to publish the weekly performance stats that NHS Scotland delivers to ministers each Tuesday. NHS England does.

This followed a too familiar row over falling performance in Scotland’s A&E departments. The crisis could have been tackled earlier if it had been acknowledged earlier, Marra claimed after freedom of information requests flushed out the facts.

The SNP waved the NHS shroud brilliantly in the referendum. Now it is Labour’s turn again. More heat than light, a bit uninspiring.

Michael White writes about politics for The Guardian