Labour has spent billions more on public services over the last decade. It has increased real pay in the public sector considerably and raised standards. But overall public confidence in Labour to deliver on public services remains weak, and if anything, worse than five years ago when the real investment began.
Looking at health and education there are some clear lessons. Education has been the greatest success. Public concern has halved since 1997 and satisfaction is up. By contrast, the initial recognition of success in the NHS, at least in terms of public opinion, has fallen apart. By the time Tony Blair left office, public pessimism about the future of the NHS was higher than at any point in his tenure, and, for the first time in polling history, the Conservatives came close to having a lead over Labour.
Is the quantity of ‘reform’ a clue? In education one could argue that Labour built on Conservative reforms and put in more money, whereas in the NHS, Tory reforms were scrapped, money put in, and reform had to be reinvented. News of ward closures, redundancies and cut backs following the measures needed to avert an NHS deficit, as well as an apparent war with the professions, are to blame.
Whether or not the overall public mood is based on reality, Labour has a problem. This is despite the fact that the national picture is nearly always much worse than the local one, that patient satisfaction with actual healthcare tells a more positive story, and the public are not negative about Labour’s health policies per se.
The irony is that despite the furore in the Labour party and the health professions about many NHS reforms – in particular foundation hospitals and the involvement of the private sector in the NHS – numerous studies show that people are happy to be treated in the private sector provided the NHS pays, and that most believe that increasing choice would have a positive impact on the quality of healthcare. However, while the public has not seen ‘choice’ as a bad thing per se, it is a long way down most of their list of desired improvements, and not viewed in the same, almost totemic, way that the government does.
Indeed, one of the problems for Labour on public services is its lack of clarity about whether ‘choice’ was a moral good in its own right, something deeply valued by the public, or a means to an end – introducing competition where the state was the monopoly supplier of a service. At the time of Blair’s departure, it was still the case that the majority of patients being referred into the acute sector by GPs were not being offered a choice of specific hospitals, but this was not the reason for dissatisfaction with the NHS.
It is public sector staff themselves who impact most on public confidence in public services. One of the more contradictory aspects of the Blair years is that millions of public sector workers experienced considerable increases in pay – teachers’ salaries increased by 64 per cent alone, while GPs are among some of the best paid in the world – yet became increasingly negative about their employer. By early 2007, public sector staff were as likely to say they planned to vote Conservative as they were to vote Labour, reversing Labour’s huge lead among this group in 1997. While Brown’s arrival has made inroads here, the rumblings around pay settlements and strike action still have plenty of potential to damage the ‘bounce’.
The NHS under Blair shows, along with all the textbook research on employee motivation, that increasing pay does not build motivation. Much more effective is showing that you value, respect, and listen to people, and have a clear simple narrative – but on many of these aspects, Labour sometimes seems to be either on a deliberate or accidental collision course. The result is that up to 70 per cent of GPs – the most trusted public servants – have been negative about the direction of NHS reform to their patients and community.
If Labour is to win on public services, getting public service workers and unions onside will help, as well as being clear that the public are looking for simple end benefits, not the process of reform itself, however enticing it is to technocrats. A vice-like grip on a cynical media would help too!
Ben Page is managing director of Ipsos MORI Social Research. He will be speaking in the Progress annual conference seminar, The public services: Will Labour get the credit?