If it wasn’t already clear, Ed Miliband’s final conference speech before next May’s general election indicated that he intends to wage his campaign on the basis of the United Kingdom’s National Health Service — and not a full-scale attack on the ‘austerity’ anti-deficit policies of David Cameron’s coalition government.

It’s hard to believe that Miliband has now been the leader of the United Kingdom’s Labour Party one year longer than former  prime minister Gordon Brown was, especially after the bravura performance that Brown delivered for the ‘Better Together’ campaign, which may have swayed enough Scottish voters to reject independence in the surprisingly close referendum.

When he won the leadership in September 2010, upsetting his opponent and brother, former foreign minister David Miliband, it was a shock. While Labour’s MPs and the party faithful narrowly preferred David, unions and other affiliated Labour groups gave Ed just enough of an edge to narrowly defeat the more seasoned Miliband, who promptly left frontline politics and moved to New York.

In the past four years, Ed Miliband has benefitted from the polling lead that Labour has consistently held against the Conservatives, who have been mired in unpopular decisions to slash the national budget after years of more permissive spending under Brown and his predecessor Tony Blair, for whom Brown served as chancellor of the exchequer.

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In the first year of Tory-led government, the British economy grew by 1.7% — sluggish in absolute terms, but vigorous by what would follow. In 2012, British GDP fell to 0.3% before rebounding last year to 1.7% and a forecasted growth rate of 3.2% in 2014.

As the economy has improved, it means that it might not be enough for Miliband to attack Cameron and the current chancellor, George Osborne, for inflicting greater damage on the economy by cutting spending in a time of low economic growth. While it may be true that Osborne’s budget cuts didn’t necessarily promote growth, it’s unavoidable fact that the United Kingdom is now growing faster than the rest of the European Union, which emerged from the 2008-09 global financial crisis and the 2010-12 eurozone debt crisis to face a growing deflation threat today. Italy, which has struggled to enact reforms under its energetic new prime minister Matteo Renzi, recently entered a triple-dip recession.

Polls, meanwhile, show an increasingly tight race. Labour’s once dominant lead is shrinking, in the most recent September 18-19 YouGov/Sunday Times poll to just 4%. If the election were held today, Labour would edge out the Tories by a margin of 36% to 32%, with the eurosceptic United Kingdom Independence Party (UKIP) winning 16% and the junior coalition partners, the Liberal Democrats, just 7%. That could result in any number of outcomes, including a Labour minority government, a Conservative minority government, or the continuation of the Tory-Liberal Democratic coalition.

That goes a long way in explaining why Miliband is increasingly shifting from an anti-austerity message to a campaign that places greater funding for an increasingly burdened National Health Service (NHS) at the heart of his bid to defeat Cameron in eight months’ time.

Accordingly, in his speech to the Labour faithful in Manchester yesterday, Miliband pledged to deliver an additional £2.5 billion in funding to the NHS, designed to add 20,000 more nurses, 8,000 extra general practicioners, 5,000 careworkers and 3,000 midwives.

To avoid taunts from Cameron and Osborne that Labour would simply borrow more money to pay for additional NHS funding, Miliband announced his plan to raise a ‘time to care’ fund to pay for it all, which will include raising £1 billion from tax avoidance, including closing loopholes used by hedge funds, the introduction of a new tax on houses worth more than £2 million, and more taxes on British tobacco companies.

Pivoting off the success of the ‘Better Together’ campaign in last week’s Scottish referendum, Miliband used the word ‘together’ over 50 times in his speech, spinning easy slogans about how the Tories will leave British voters ‘on their own,’ and that only Labour can introduce truly nation-building policies.

As easy as it might be to attack hedge funds, cigarette-makers and wealthy homeowners at a Labour conference, Miliband’s latest maneuver demonstrates two strategic decisions.

First, he believes that championing health care is a better path to 10 Downing Street than savaging the fiscal decisions of the past four years. Secondly, Miliband also believes that Labour, in particular, is still vulnerable to attacks that it was fiscally irresponsible during the Blair-Brown years. That may or may not be true, but Miliband’s fears reflect the reality that voters, especially in Middle England, don’t entirely trust Labour as frugal enough. (Never mind that Brown led the international response, beginning with his decision to nationalize Northern Rock, to prevent the 2008-09 crisis from turning into the 21st century equivalent of the Great Depression.

But as Miliband shifts strategy from austerity to health care, he’ll face the same problems in 2015 than Brown faced in 2010 among a traditional working-class base that’s more worried about secure employment and growing immigration from the rest of the European Union than about deficits or NHS funding. Though UKIP will probably be greater threat to Conservatives in marginal constituencies in 2015, UKIP could easily win a large chunk of traditional Labour voters as well. In the aftermath of the Scottish independence referendum, Miliband also risks being outmaneuvered by Cameron and UKIP leader Nigel Farage on the issue of English devolution and the question of ‘English votes for English laws.’

Though Miliband, in a 67-minute speech delivered without notes, discussed immigration and devolution, and he further called for extending voting rights to 16- and 17-year-old voters, he didn’t convey in any compelling way that he understands the fierce cultural underpinnings of the immigration and English devolution issues. Nor did he especially demonstrate that he understands the motivations that led 45% of the Scottish electorate to support a permanent split from the United Kingdom last Thursday.

Never mind his reticence on EU matters, including his opposition to holding a 2017 referendum on British membership in the European Union. Or his hesitation in discussing a British military role, alongside US and Arab allies, in attacking the Islamic State group that now controls much of eastern Syria and northern and western Iraq.

Miliband’s most difficult problem, however, might not have a policy solution at all. That’s because there’s still a nagging worry that Miliband doesn’t convincingly play the role of prime minister. It’s a charge that both allies and enemies have leveled since 2010 against Miliband, who at age 44 is just three years younger than Cameron and the same age as Blair when Labour won its landslide victory in 1997. Maybe it’s because he looks so much younger, or geekier, than Cameron, or maybe it’s because he always suffered from an experience and gravitas gap in comparison with his brother David.

But four years into the leadership, he’s still struggling with the fundamental threshold of measuring up as prime ministerial material, as Jonathan Freedland wrote yesterday in The Guardian: