There’s little doubt that many find the nature of political discourse in the UK entirely contrived. Politicians, with few noteworthy exceptions, can look as if they’re not taking issues seriously, mouthing words from a script given to them, and appear utterly self-serving.

The King’s Fund have given their view on what might happen in the general election of 2015, with an increasing number of people interested in the NHS. But the fundamental issue remains that many people do not feel as if they voted in any sense for the policy changes in the NHS just coming to an end. Various campaigners, including these two, have tried their best to articulate a general unease amongst various voters, but it seems as if Ed Miliband is much more keen to mention repeatedly ‘the cost of living crisis’, rather than refer to what is happening to the NHS.

It wasn’t that long ago since we heard there were ’24 hours to save the NHS’, in a charge that ended up taking on a rather cartoonish character some non-Labour supporters allege.

By definition, all crises must come to an end. Labour’s difficulty with the current ‘cost of living crisis’ is that many feel that the causes of the ‘crisis’ have been a slow burn for ages, including changes in the energy market under a previous Labour administration. So Labour can attempt an argument that ‘not the right people are benefiting from the recovery’, in much the same way there’s been the wrong type of snow on some train lines. But the massive problem with this argument is that the people who might be benefiting from the economic recovery might be exactly the same people whom Labour tried to woo in the Blair-Brown years.

Yes, that’s right.

These are the same people Lord Mandelson has been ‘intensely relaxed’ about. Labour over its dead body would not like to bring in a whopping property tax to clobber very wealthy people. Polly Toynbee in a Guardian podcast recently remarked that it was possible that a person could see an increase in the price of his own house more than the net profit of going out to work (deducting presumably transport) expenses. And yet this is the sort of stuff which Piketty is interested in, and which Labour would rather not touch with a bargepole. So one has to enquire casually does Labour actually know what a crisis is?

“I don’t think other people in the world would share the view [that] there is mounting chaos” were in fact the precise words of the then Labour Prime Minister, Jim Callaghan.

Some have mooted that the three words, “Crisis – what crisis?” helped bring down the last Labour government in 1979, even though the man generally thought to have uttered them – Jim Callaghan – did not in fact do so. And yet the Sun journalist who fashioned that headline caught the popular impression of a government unaware of a very serious state of affairs which had sneaked up on it. Indeed, much politics is about image – and certainly Labour want to implant in people’s minds an impression of an out-of-touch incompetent administration not ‘fit for purpose’.

Crises in medicine are though interesting and precisely defined. An “Addisonian crisis” or “adrenal crisis” is a constellation of symptoms that indicates severe adrenal insufficiency. This may be the result of either previously undiagnosed Addison’s disease, a disease process suddenly affecting adrenal function (such as adrenal haemorrhage), or an intercurrent problem (e.g. infection, trauma) in someone known to have Addison’s disease (the latter is therefore ‘acute on chronic’). It is a medical emergency and potentially life-threatening situation requiring immediate emergency treatment. Characteristic symptoms can include a sudden penetrating pain in the legs, lower back or abdomen, severe vomiting and diarrhea, resulting in dehydration, a low blood pressure, a reduced level of blood glucose, and confusion.

Ed Miliband also feels his crisis is very real, if not as such ‘life threatening’. Miliband has previously promised to rescue Britain’s struggling middle classes by boosting their living standards as he warns that the “cost-of-living crisis” will last for at least another five years. He that living standards are “the greatest challenge of our age” and will be at the heart of his party’s general election campaign next year. He has rejected calls from within his own party for him to change his strategy because the economy is improving.

But there may be trouble ahead for Miliband. The “cost of living crisis” is about to turn around, according to a forecast from the Institute for Fiscal Studies (IFS). In its so-called green budget, the IFS predicted that wages will start to rise faster than inflation in just a few months’ time, but it also warned that public spending cuts would continue to hit consumers. In particular, it said spending on the NHS was due to fall by 9% per person over an eight-year period. However, it did forecast that consumers would see their real wages – which allow for inflation – increase for the first time in five years. Likewise, ahead of the Eastleigh by-election, Iain Duncan Smith reported Britain faces a “crisis” of increased immigration from Romania and Bulgaria, as all three major parties consider their response to the UKIP Eastleigh surge. Called to the Commons to explain how the government plans to deal with new immigrants from within the European Union once existing restrictions are lifted next year, the work and pensions secretary said he was working to “tighten up” what benefits were payable to new arrivals.

“There is somewhat of a crisis over this,” he said. “Some people want to come here solely to claim benefits.”

Twitter is incredibly democratising for political parties, liberating them in getting their message across. David Axelrod, Labour’s newly appointed senior strategist and Barack Obama’s closest long-term political adviser, will apparently make mobilisation of Labour’s grassroots central to the election campaign.  Axelrod himself has stressed that he could not help Labour succeed at the next election without the mobilisation of local communities, adding – in his first effort to energise Labour members – that the world would be watching the outcome of the 2015 vote. The Guardian has revealed that Axelrod was joining the Labour campaign team as a senior strategist. And Miliband has been talking about creating a ‘social movement’ for ages, perhaps inspired by his brother’s interest in ‘Movement for change’. But also the great thing about Twitter is that one can easily out the postcode lottery of pledges made by the main political parties – what a LibDem says in Cumbria might turn out to be very different to what a LibDem says in Oxford, say on the NHS.

“Lucky Generals” are the ad agency that produced the broadcast for Labour. Apparently the controversial Party Election Broadcast, known as “The Un-credible Shrinking Man” has not just been produced as a brief  comedy experiment. They have been paid good money to obey instructions from their client – the Labour Party, to deliver strategically against what they have been told are the Labour Party’s goals. That’s “the 35 per cent strategy”. As the political arithmetic under the constituency boundaries means Labour only needs to poll the 35 per cent it currently polls to win a majority (as opposed to 42 per cent for the Tories), Labour appears to have decided to hold on to what it’s got. That PEB is designed to do two things to the Lib Dems. It tells disaffected voters from 2010 who have defected to Labour why they should stick with them. And it signals to the Liberal Democrats now, they can forget to aspire any repetition of Matthew d’Ancona’s “In it together” with Miliband’s Labour.

In a way, the persistent pathology in the National Health Service has lasted for decades. Factors include a chipping away in real terms in overall budget, poor budget allocation, PFI loan repayments, the need for efficiency savings, nurses not getting pay increases, delays in A&E, delays in seeing a GP, and so on. But there is concern that such a ‘lean’ large entity will simply be unable to bear any small shock to the system. Astra Zeneca and Pfizer are much in the news headlines these days. They are both powerful multinational pharmaceutical companies which have much in common with film companies. They will both produce their fair share of bananas and donkeys, but they only need one huge blockbuster to survive. Similarly, the Labour Party, if it found its blockbuster policy, might find itself with a consistent poll lead of a few percentage points in the run up to the General Election to be held on May 7th, 2015. The reason the ’35 perent’ strategy might be sensible for Labour is that the risks of a blockbuster going wrong for Labour are huge. This is Labour’s election to lose, given the massive unpopularity of the current Con-Dem coalition for a number of diverse reasons.

A ‘blockbuster’ might indeed come in the form of the Labour Party producing a political signal to bring all the PFI hospitals immediately into state control – but many of these contracts are due to run out in 2017-9 anyway; or might be to ‘renationalise the NHS’ , building on the left populist strength of the desire to renationalise the railways. The latter, a sort of ‘reverse clause 4’ moment for Ed Miliband, could be boom or bust for Miliband, but no-one would really know until the move is executed. Miliband would almost certainly for the chop if Labour lost the general election in 2015. But how he lost it, if indeed he does, can only be a matter of speculation now. It is widely predicted that UKIP will ‘win’ the European elections, with the Labour Party coming second. But what happens in third place is of considerable significance – might the Green Party manage to capture a lot of disaffected voters themselves, throwing the Liberal Democrats into 4th place?

If that materialises, what happens to the Liberal Democrat and Green vote between 2014 and 2015 is of massive significance. The problem that Ed Miliband has is that the cost of living crisis may not be a sustainable crisis. But an opportunity for Ed Miliband is that the performance of the NHS continues to decline, such that there is a genuine acute-on-chronic crisis in the NHS. Campaigners on the NHS have done a terrific job so far, but the best is yet to come (or ‘the worst’ depending on your perspective).