The only big political story of the summer, apart from the decision by the SNP to release a terrorist bomber into the welcoming, Saltire-waving arms of the Libyans, has been the row over the NHS. On the face of it, Dan Hannan’s extended US media ego-trip was good news for Labour. The Tory MEP proved a useful idiot for the US Republicans, fuelling their fear of socialism with tall tales of soviet-style queues for cancer treatment in the United Kingdom. It allowed Labour to go onto the attack, fielding Andy Burnham to speak up for the NHS, and forced Cameron onto the defensive, including the breath-taking claim that the Conservatives are ‘the party of the NHS’, which displays the same level of cheek as his claim that they are the party of the environment, the party of co-operatives, and the party of the poor. What’s next? The Tories are the party of the trade unions and nuclear disarmament? Watch this space, I hear you cry.
After what many commentators have described as Labour’s best week for months, why have the voters not responded positively?
The August Ipsos-MORI tracker of issues uppermost in the voters’ thoughts placed the NHS as the sixth issue that people considered important, after the economy, crime, unemployment, immigration, and in the month when mounting casualties in Afghanistan were in everyone’s minds, defence.
In the monthly ICM poll for the Guardian, Labour was down one point to 25%, with the Tories on 41%. Asked about the NHS, 48% thought it would get better under a Conservative government, compared to 41% who think it would get worse. When asked which party would be better on the NHS Labour was ahead, by three points, compared to eight in February and 13 back in 2005. In the Independent on Sunday ComRes had the Conservatives on 41% and Labour on 25%. ComRes asked if people agreed or disagreed with the statement ‘the NHS would be safer under Labour than the Conservatives’. 39% of people agreed, but 47% disagreed.
The opinion polling since the NHS row suggests that it has afforded Labour absolutely no advantage whatsoever, so what’s going on?
It is well established that the British are proud of the NHS as a national institution, and when it is being attacked by gun-toting, gay-bashing, red-neck melon farmers (or US Republicans as they are also known) it is natural that we will defend it. How dare the Americans, with their patently unfair and inefficient healthcare system, criticise what Aneurin Bevan called ‘the most civilised thing in the world’, our NHS? It is exactly the same when Americans complain about anything British: the weather, the trains, the food, our hotels, our media, or the Royal Family. Brits, for whom grumbling is a national pastime, will mount heroic defences of anything, no matter how pisspoor, if it is being criticised by an American.
But it would be a stupid error to equate Britons’ willingness to defend the NHS against foreign attack with overall satisfaction with it. That million-strong ‘I love the NHS’ Twitter is the equivalent of the massed ranks of Labour supporters addressed by Michael Foot in 1983. Even in the darkest times for Labour, you could get several hundred people in a hall to cheer. It was the several million people outside we should have been worried about.
Users of the NHS are often impatient with it, sometimes frustrated by it, and occasionally harmed by the treatment they receive from it. From the 1960s onwards, social reformers, especially the Fabians, developed a critique of the NHS, which whilst lauding and supporting the founding principle of free care at the point of need, pointed out its failings. One was that whilst Bevan thought demand for NHS services would go down once everyone had got their free NHS specs, dentures and jabs, in reality demand far outstripped supply from 1948 onwards. Today, the NHS cannot possibly supply the latest drugs and treatment to everyone who needs them. Another was that the NHS failed to provide equitable treatment to everyone, and worse, it was the poorest people who got the poorest services. In the 1970s Dr Tudor Hart coined the phrase ‘inverse care law’ to describe how the worst NHS services were given to the people with the most health needs – the poorest people in the poorest communities. Ask yourself, if the NHS treats everyone the same, why there are so many GPs’ surgeries in leafy suburbs and so few on council estates? Why has Surrey got so many hospitals?
From this analysis flowed much of Labour’s health policy from 1997 onwards, which was designed to drive up NHS standards, especially for the poorest people, and get hospitals and clinics built where people needed them most. More choice and information for patients was designed to empower them to insist on better treatment. The introduction of private sector suppliers for NHS operations eradicated at a stroke waiting lists for ops such as cataracts.
The NHS is so huge, and so lumbering, that the only way to ensure it delivers the healthcare people need and expect is radical, never-ending reform. If you stop modernisation, the NHS doesn’t just settle down. It gets worse. That’s because people’s expectations are constantly rising, and the technology and drugs are constantly improving. I consider it a mistake for Labour to have taken the foot off the gas when it came to NHS modernisation after 2007. The strategy may have succeeded in getting the NHS out of the newspapers, but it did not succeed in maintaining the momentum of modernisation.
Which takes us back to this summer’s row. There is an enormous political elephant trap ahead of us, and Cameron knows it. If the public sense that Labour is defending the NHS, without demanding improvements and driving them forward, Cameron can portray us as the party of the status quo. And the flipside is that he can paint himself as the radical reformer, even without any concrete policies. This is the same trick Thatcher pulled off in 1978/9, when Labour ministers looked like the establishment, and the Tories looked like radicals.
The public love the NHS. But they also know it isn’t perfect. They know they can’t get hospital treatment as fast as they would like, that some GPs are closed when they want them, that some of the latest drugs for breast cancer are rationed, that they run the risk of hospital-acquired infections, and that if something goes wrong, the process for redress is complicated, confusing, and stacked in favour of the professionals.
Labour is the party of the NHS. We created it, in the teeth of opposition of the Tories and the British Medical Association (BMA). We’ve invested in it, to deliver on Tony Blair’s pledge to bring health spending up to the EU average. We’ve reformed it, to bring down waiting lists and build more hospitals. Our greatest mistake now would be to defend it without demanding even greater improvements.
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