Did the NHS win or lose the election?

Conservatives Election

The Labour Party has claimed political ownership of the NHS since 1946.  We like to forget that Beveridge was  a Liberal and that the wartime coalition government produced a plan for a National Health Service in 1944.  And that the real founder of the Welfare State was Lloyd-George.

Since 1983  politicians have been competing to demonstrate that “The National Health Service is safe in our hands.” The Labour Party has been saving the NHS for years.  Tony Blair said we had 14 days to save it in April 1997.  Nurses gave the Labour Government six months to save the NHS in April 2000.  In 2010 there was a “conspiracy of good news” to pretend that the NHS was safe from the coming economic storm. But it is never entirely clear exactly what the NHS was being saved from, nor how we could tell it was saved.  So everyone can claim credit for saving the NHS, even David Cameron, as he did in the middle of the row over Lansley’s Health and Social Care Bill. So perhaps it was inevitable that Ed Miliband’s cry that we had “100 days until the election, 100 days to save the NHS as we know it”, went unheard.

Professor Allyson Pollock would say, and does say, that the government has abolished the NHS. Keep Our NHS Public doesn’t seem to quite go that far, but their message is certainly that the end of the NHS is likely and imminent.

The point of this article is not to evaluate the validity of any of these claims, but to consider their political effect. The Lansley plan to turn our NHS into a regulated market probably was intended to end the NHS as we know it, but although his legislation is in place it has not actually had that effect – at least not yet.  It appears that the Conservatives have realised that this is a toxic issue for them and are largely ignoring their own legislation.  Indeed they appear now to be undermining many of the principles of the NHS internal market by forcing organisations to co-operate rather than to compete with each other.  The NHS has always been more amenable to control by direction than by legislation, and the new boss, Simon Stevens, is proving to be very active, very innovative, and to pay no attention at all to Lansley’s legislation.

There seems to be common agreement that the NHS was a very powerful motivator of Labour activists and supporters in England and Wales during the election campaign.  Scotland is a different country, about which I don’t feel competent to comment.  During the election campaign the NHS featured on Labour leaflets and petitions to save it gathered lots of signatures.  But for those who didn’t regard themselves as natural Labour supporters all we could do was threaten it would get worse. It was working fine for most people at the time, even though it had spent 5 years under a government which we claimed would abolish it.  Of course Labour is in a difficult position because we want at the same time to claim that the NHS is a great Labour success and at the same time that it is being ruined by the Tories.

Local campaigners report that the NHS was a potent issue in places where there was a local hospital closure issue, and in some places where there were local problems. But most voters don’t appear to relate to the concept of the NHS as a whole in any operational way.  They believe the NHS is a wonderful thing, they are against privatisation, but it doesn’t affect their voting. The whole privatisation argument went down like a lead balloon in the places where we needed votes. It worked fine in Labour areas with people who see Tories as the enemy who eat babies. Labour promises about promised improvements to services didn’t convince anyone inside the NHS, because they know there are no staff to deliver them and people outside the NHS didn’t believe there would be any money to pay for them.  People who use the NHS the most are older, and they are more likely to vote Conservative. We didn’t convince many of them that the whole thing was on its last legs.  Undecided voters mostly thought the Tories wouldn’t destroy the NHS and that it would always be free at the point of entry and no insurance based system would be introduced.

It is entirely possible that in 2020 the NHS will still look much the same as it does now.  There will probably be an increase in the proportion of services delivered by the private sector in non-clinical areas and in community and primary care but the clinical services will still be overwhelmingly provided by NHS hospitals and by the sort of GP Practices that are familiar today.  It seems unlikely that charges and co-payments will be introduced.  There will certainly be more talk about rationing and efficiency, and we may see decisions that some services – IVF is the most common target – are not provided by the NHS.  Of course it may be that the prophets of doom will be proved right and by 2020 everyone who can afford it will have private health insurance.  But if the NHS is still recognisable in 2020 it will be a big problem for the Labour Party.