As voters head to the polls, many people will be hoping that their vote, regardless of who they vote for, will do something to help secure the future of their local NHS services. This time, more than any previous campaign, it seems to have been the ‘it’s the NHS, stupid’ election.
The NHS has topped the list of voters’ concerns in Mori’s polls fairly consistently since January, registering its highest levels since 1997 in April, and parties have been scrambling to reassure voters that they are uniquely placed to save the NHS, with promises of more staff, better access to GPs, faster tests and, of course, money. Much more money.
For most voters – and the politicians vying for their votes – the NHS is a local issue: the future of their local hospital, the availability of treatment close to home, the quality of their local GP services. It doesn’t matter if there are world class national standards in place or pioneers, vanguards or other stellar performers in the next county if the service a person experiences locally is poor.
Yet the television coverage seems to have been devoid of the sort of local public vs candidate confrontations about local NHS service failures that we’ve seen in previous campaigns: for example Tony Blair being ambushed by questions on GP access, or confronted by the angry despair of a woman whose husband was gravely ill with cancer. And mainstream politicians know better than to use individual cases in their campaigns, like Jennifer’s ear in 1992, to make a political point.
Perhaps there have been confrontations over closed hospitals or local NHS issues not picked up by the national media, but commentators have noted that the campaign walkabouts by the three big parties have seemed more stage managed than ever. Full of happy, smiley party loyalists, with no sign of the sort of lippy determination of the doughty, be-scarfed woman in a mac striding to confront Callaghan in Joseph Strick’s 1966 film The Hecklers, featured recently on Newsnight.
In one sense, the NHS is very odd sort of election issue. What voters are being asked to choose between are not genuine choices about NHS policies. 20,000 new nurses? Yes please. Or, £250 million a year for mental health services? Good idea. Or same day GP appointments for over 75s? Excellent. (Unless you’re 74, of course).
Instead voters are being asked to choose between parties primarily on the grounds of what they plan to do to increase the amount of money the NHS gets from national government each year: which party has convinced you that they can find the money for the NHS? But even this isn’t a properly informed choice.
As the IFS have pointed out, there is a great deal of detail lacking from each of the parties about which non-NHS services might face further cuts in order to raise the money for the NHS. Our woeful lack of joined up data makes it impossible to quantify the impact on people’s health who’ve lost their social care funding or welfare benefits, and increasing spend on social care for older people, or benefits for people unable to find work is definitely not on any of the manifestos.
Assuming a party, or combination of parties, gets into power and forms a government, and assuming that additional funding is raised on the scale promised, there is a risk that voters will, after this campaign, think that everything will be alright for the NHS. That there won’t be any more difficult local decisions to make about closing or reconfiguring services, or choosing between expensive drugs, or encountering long waiting times for treatments, or that social care will be made available everyone when they need it.
But given the scale of deficits across hospital trusts in England, the NHS is in for a rocky year, before any cuts in social care are factored in. Clinical Commissioning Groups, already under strain from deteriorating finances, will face tough decisions about which treatments they can continue to prioritise in their areas. NHS England is likely to face similar dilemmas over where to set the limits for specialist but expensive treatments.
These huge challenges facing the NHS risk coming out of the blue to a public who think the politicians they have voted for will be able to secure the future of a service under extreme strain. Even if additional money is found for the NHS, it takes time to train new staff, and the new models of care need breathing space to allow staff to try and embed new ways of working.
Additional funding won’t miraculously reduce waiting times or delayed transfers of care overnight, and the risk is that continuing headlines of NHS gloom and crisis will dismay voters and provoke a new government (particularly if it has anxieties about its legitimacy) into attempts to control an NHS in apparent chaos, through more targets and terror. This would be the last thing the NHS needs.
Thorlby R (2015) ‘The NHS and the General Election: a false sense of security?’. Nuffield Trust comment, 7 May 2015. https://www.nuffieldtrust.org.uk/news-item/the-nhs-and-the-general-election-a-false-sense-of-security