Striving for the NHS we want, not the NHS we have

At the age of 11 I was exactly one sticker away from completing Merlin’s 1997 Premier League sticker album – a very important accolade for any self respecting primary school boy back then! In the past two seasons I had been forced in shame to order the last stickers from Merlin – this time I was determined to finish the album myself, but try what may, I could not find a chap called Alf Inge Haaland who played for Nottingham Forest.

Then news went around the playground – Dee Chivers had the sticker! Two minutes later Alfie Haaland was mine, but I had lost something in the region of 20 stickers to get him, including several of the rarer ‘shiny’ club bages. Two weeks beforehand I probably would have traded him one for one. The reason for the sudden escalation in value is evident – it was obvious that I wanted the sticker badly enough that I would pay whatever it took to get my grubby pre-teenage mitts on it, and so Dee had absolutely no incentive to give me a fair price for it (The fact that 18 years on I still remember his name shows how much the injustice rankles!) I was so wedded to one outcome, it never occured to me that it would be less expensive to simply order the sticker by post, or not have revealed the need in the first place!

This anecdote, aside of revealing a rather sorry side to my character, neatly demonstrates a problem in our present politics – attaching such significance to an issue that you lose all sight of the cost, and potentially end up worse off as a result. Since the discovery of ‘issue-based politics’ by social scientists, there is one issue that without fail has a high valence with the elecorate – the National Heath Service. Any politician who dares impugne the honour of NHS or (heaven forbid) express the desire to abolish it, can profitably google ‘P45’ to discover what the electorate would be serving them up in May. Every politician upon becoming leader of their party falls head over heels to proclaim their love for the NHS, and their credentials as the best person to protect a national institution so cherished, that we boasted about it to the world during the Olympic Opening Ceremony in 2012. So emotionally charged is it, that the allegation Ed Miliband wanted to ‘weaponise’ the NHS made headline news.

The reason for this high regard is evident – we are all impacted by matters of health. Most of us are born in NHS hospitals; by extension, many of us will become parents for the first time in NHS hospitals.The NHS is the theatre for some incredibly emotional moments in life: relief when a diagnosis is positive, and shock when the prognosis bodes ill. Tears of joy when an operation succeeds, and tears of grief when you are told the worst. And over all of this – deep thankfulness, because most of the time the NHS does succeed in treating the sick, and all of us appreciate the difference it makes. With such emotional attachment, it is no wonder even those of us blessed with generally good health are righteously indignant that anyone should call the NHS into question.

And yet I am not sure that such devotion actually leads to good outcomes for our health service. When politicians get into a bidding war to top each other on health spending, nobody stops to ask themselves what incentives there are for wider healthcare providers to reduce their costs – they know that the NHS budget is never going to be reduced. Nor am I persuaded that politicians of any political creed decrying that their opponents will ‘wreck the health service’ produces the kind of thoughtful democratic accountability we ought to have for such a large publicly funded institution – the unfortunate example of the Staffordshire Health Trust is perhaps the most prominent recent example where this has gone badly wrong. The problem is, playing the NHS card is very sound politics –  you connect the remark your opponent has made about the NHS and connect it directly to the voters’ emotive experience of the NHS – “What evil types these political opponents are, asking awful questions about our cherished national treasure!”

I was once asked what my stance as a Tory was on the health service – the assumption being that I’d be pro-privatisation! My response was: “The maximum number of people obtaining the greatest amount of care at a sustainable cost.” Yes, it is a politician’s answer insomuch as it does not spell out precise policies – but I think it captures what all of us mean when we refer to the NHS. We don’t want to mortgage our children’s futures for today’s health costs, but we want to ensure the money we spend today goes as far as possible to improve the health of as many people as possible. For me that actually means one very practical policy – don’t let any politician conflate their point of view to make it synonymous with the NHS, and potentially hold us back from improvements that could benefit the nation. They would, as with my schoolboy example, be so doggedly devoted to an ideal that they have failed to grasp whether doing so actually benefits the nation or not. And where it is done purely for politican gain, that person should hang their head in shame for putting politics before service to the nation.

A general rule of aspiration is that we want to leave a world that is better than the one we lived in to the next generation. It because of this hope that my focus is on the NHS we want to have, not the NHS we’ve currently got.

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The Labour lead is soft

Around this time last year there was plenty for Conservatives to be gloomy about, with the opinion polls showing Labour hovering persistently in the high 30s and the Conservatives struggling to break out of the low 30s. The latest opinion poll by Lord Ashcroft shows the two parties more or less neck-and-neck on 30% and 31% – and most other polls show a similarly small Labour lead, but basically too-close-to-call. It reflects an assertion that I made last winter which is worth repeating now: The Labour lead is ‘soft.’

For the benefit of the vast majority who (very sensibly) don’t usually bother with opinion polls, a ‘soft’ number is an unreliable number that is highly likely to change. The classic example of this is in fact the polling numbers for the main opposition party during the middle period between elections – lots of voters indicate that they want to vote for the opposition because the main thing governments usually do is annoy the electorate – an astonishing example is from September 2008 when an Ipsos-Mori poll had the Conservative opposition on an amazing 52%! When you consider that the Tories ended up with 37% of the vote in May 2010, you can see that the number was not a reliable estimate but rather a reflection of voter dissatisfaction with the Labour government of that time (and, given that most other polls weren’t that high, also likely to be an outlier!)

So one year on the polls have narrowed, and the main news I am taking is this – the Labour lead was soft, and probably still is soft. Lots of voters were angry and disappointed, and probably still are – but they aren’t sure they are ready to trust Ed Miliband and Labour. The impact of this is potentially huge – using electoral calculus I did a base prediction of seats assuming that the Conservatives had 30% of the vote, Labour 31%, the Lib Dems 8% and UKIP 17%. In this model, the Conservatives would have 273 seats and Labour 324 – to all intents and purposes, a Labour government. I personally think that the polls will shift between 2 to 3 points simply because of the soft Labour lead – adjusting for a 2.5% swing from Labour to Conservative (ie. Conservatives on 32.5% and Labour on 28.5%) puts the Tories on 308 and Labour on 292. I took the model one stage further and supposed that a reasonable percentage of the UKIP vote swings back to the Tories – not impossible given that Lord Ashcroft’s findings showed that over half the UKIP vote placed the Tories second. Reducing UKIP to 10% and giving an extra 7% to the Tories put the Conservatives on 352 and Labour on 254 – a clear majority for the Conservatives.

Of course all of this is supposition – in all of this the Lib Dem vote remained stubbornly at 8% – but it may recover. Labour may in fact recover voters from the Green party – and this model did not account for the rise of the SNP in Scotland. But it does show that a soft poll lead can massively hide what is actually happening. It is also my theory that if the Tories begin picking up reluctant UKIP voters, and/or Labour begin picking up reluctant Green voters, that will accelerate a poll trend away from the smaller parties and towards the two largest parties. At the moment the polls are telling voters it is too close to call and no party is likely to win a majority – that incentivises voting for a smaller party to hold the balance of power. If either Labour or the Conservatives begin pulling away into a clear lead and there is the possibility they can form a majority government, then the smaller parties mean begin to lose support in the polls as the voters focus instead on whether they want David Cameron or Ed Miliband in Downing Street – and the lower those numbers go, the greater the likelihood more wavering voters will leave the smaller parties and vote for the big two.

It could go either way and it is still too close and too uncertain to call – but I am absolutely certain that the Labour lead remains soft, and the Conservative vote is certain to increase between now and the election.