As far as “earthquakes” go, this was not a bad one for Ed Miliband.

Did the earth move for him?

Probably not, as, in the European elections, Labour finished behind UKIP but ahead of the Conservatives, while its vote share was up by nearly 10% on 2009. In the local elections, Labour boasted of wins in areas such as Cambridge, Croydon and Crawley where it hopes to gain parliamentary seats next year. Labour took comfort from a strong performance in London, a key general election battleground with 73 seats, where Ukip’s appeal proved less potent. But arguably Labour’s gains fell well short of the 400 council seats experts said it needed to show it is on course for general election victory. A Ukip surge in Essex saw Labour lose control in Thurrock.

Is it Ed Miliband’s fault that Ed Miliband or even Labour seem out of touch with the rest of the country? Or could Miliband be doing more? Critics have argued that ‘the cost of living crisis’ is synthetic, but such critics have tended to be metropolitan journalists who spend much of the time abroad anyway.

Are the people in London basically wrong? Labour seized control in battleground London boroughs including the council said to be “David Cameron’s favourite”. Hammersmith and Fulham has been hailed as an exemplar by Mr Cameron, but Ed Miliband’s party claimed a coup by snatching the borough. After sweeping the local elections, Labour dominated Lewisham’s European election vote too, taking 32,507 of the borough’s votes, ahead of the second-placed Green Party, who won 10,228 votes. UKIP finished third (8,720), ahead of the Conservatives (8,161). The Lib Dems trailed-in fifth (4,252). These of course have been huge battlegrounds for the NHS.

And Nick Clegg looked upset and tired. The Liberal Democrats’ strategy going into this campaign had been to try to attract pro-European voters with an appeal for an open-minded, generous-hearted Britain, but going head-to-head with UKIP leader Nigel Farage in a TV debate back-fired. By far the most significant policy announcement made by the Lib Dems at their conference last year was that the party will pledge to protect the NHS and schools from cuts after 2015. Nick Clegg suggested that both budgets should be ring-fenced until 2020. And, under the 2012 Legal Aid, Sentencing and Punishment of Offenders Act, implemented earlier this year, access to legal aid in civil cases has already become far harder for children and young people under the age of 25.

UKIP spokesperson Suzanne Evans is reported as saying that UKIP did not make a breakthrough in London, in part due to the capital’s “well-educated” population. But what are these arguments that Labour is taking to the capital on the NHS? Chuka Umunna, MP for Streatham, is for example citing the £3bn top down reorganisation which nobody voted for, the “efficiency savings” returned to the Treasury without being put back into frontline care, and the problems in the A&E service known as the “barometer” of the NHS.

The inevitable refrain will be to question whether Labour did enough on this occasion to head towards Downing Street. On the good news, it does not think it’s already done it. The media have given Ed Miliband a pasting for not remembering the name of a local leader, nor for eating a nutty with due etiquette. But these are not make or break issues for people concerned with the NHS, like the amount spent on the private finance initiative, safe staffing, the concerns of whistleblowers, whether the NHS can afford or have the energy yet to implement whole person or integrated care.

UKIP is apparently going to hone in on a few geographical areas and to consolidate efforts on developing policy. One of the policy areas it must develop is in the NHS, where it has given off a garbed mood music through Paul Nuttall MEP on making the NHS more ‘efficient’. There has even been talk of GP charges in the UKIP repertoire. This would all matter if UKIP were a serious contender. Whilst it still appears likely with first past the post they are unable to make gains in electoral seat numbers it seems likely that they have the ability to be a pain the arse for a number of seats in London. With the Liberal Democrats having been annihilated again, and rumours of their death once again exaggerated, it is uncertain how pervasive immigration is going to be in the 2015 general election. While immigration appears to have gained an elevated importance, because of the effect it has in other policy areas (such as immigrants ‘using our NHS’ or ‘stealing our NHS’), it is perhaps possible that Labour is still not showing an ‘electoral leg’ by signing up to the austerity agenda (e.g. NHS ‘efficiency savings’), not considering how to increase taxation to fund the NHS and social care adequately, or even taking fully the argument to the public that health pervades much of Labour’s message, for example in housing or education. It would pervade more of their message if they were true socialists of course, but many dispute whether the Labour Party has ever demonstrated much socialism to write home of since Hugh Gaitskell and Nye Bevan.

As the late Tony Benn would have remarked there’s a definite sense of history repeating itself. Maybe in the rural leafy suburbs, where citizens are not yet surrounded by cosmopolitan comrades, people are so struck with the fear of globalisation that they cannot bear to bring themselves to vote Labour. And there is some sense to that, as Labour is a card carrying member of free movement of capital as well as free movement of persons. But Labour does wish to promote an unique selling point of giving empoyees’ rights compared to multinational companies (though it has to be said that UKIP has struck a chord with many on the left wing by slagging off multinational companies).

The question of whether London is representative or not of a democratic deficit or not is relevant in that we do not know yet whether Labour is following or leading. Whenever the question of leadership in any political party rears its ugly head, the question is: and replace with whom? There may be some who believe that Ed Miliband should be replaced by Andy Burnham, Yvette Cooper or Chuka Umunna, but there are possibly as many who believe that he should not be replaced by one of these three. Ironically, the person who stands to influence the NHS policy the most for Labour, whether it’s on ‘efficiency savings’, the overall spend or the NHS, Ed Balls MP, is generally not flavour of the month.

Whatever, the 2015 election will thankfully not be won by Nick Robinson getting excited about Nigel Farage. It will be, not to be hyperbolic, be a make or break election for England, especially regarding the NHS is concerned. Now is the time that true socialists should make their opinions clear about what they want to see from a future Labour government. On the list of ‘things to do’ are regulation of healthcare professions and repeal of the Health and Social Care Act (2012), and. while these issues are far more sophisticated than anything UKIP have to offer, one of the reasons why people might be exasperated with Ed Miliband and Labour is a distinct lack of national policy. And people do care about the NHS to vote on NHS issues: see, for example, arguably, those who did vote Green or the National Health Action Party whom some people say offer quite an attractive offering on the NHS.

And what we’re all trying to avoid from Labour is too little too late. This is above all what many of us got a flavour of from the local and European elections, despite some good gains.