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Health Reform: Time Is of the Essence

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A new poll has found that six in 10 Britons think Prime Minister David Cameron has failed to deliver on the NHS.

President Peter Kellner asks – can the Tories recover from this perception before the 2015 Election?

The politics of health reform are becoming ever more tangled. And the more tangled they become, the worse it will be for the Government. Last week I argued that, if David Cameron genuinely believes that the Health and Social Care Bill really will drive standards up and costs down, he should ignore the doubters and keep going. However, fresh YouGov research underlines the risks that he is running.

Our survey, for Progressive Polling, a new not-for-profit consultancy, and the trade union Unite, finds that:

  • Labour enjoys a 15-point lead over the Conservatives on having ‘the best approach to the NHS’
  • Six out of 10 voters think the Prime Minister has failed to deliver on the assurances that he gave on the NHS at the last election
  • By six-to-one, voters trust the verdict on health reform of health professionals rather than Cameron and Andrew Lansley
  • Even Conservatives tend to trust health professionals more than their own party’s leader and Health Secretary
  • Big majorities of supporters of all three main parties think the government is wrong to try and keep secret the ‘risk register’ drawn up by its own civil servants outlining possible risks to the government’s plans

It may be that in years to come, voters – and patients – will look back and wonder what all the fuss was about. After all, many of the groups, such as the British Medical Association, who oppose the current bill opposed the creation of the NHS in the first place. One should always guard against self-interest masquerading as public-interest in the views of those subject to change.

The problem for the government could be one of timing as well as substance. The next general election is three years away. Assuming Cameron persists with the Bill, it will probably receive Royal Assent with just under three years to go. Then it has to be implemented. After that it will need to bed down. Only then will patients start to notice whether the NHS is getting better or worse. And reliable post-bedding-down data on NHS performance is unlikely to appear for at least another year.

In short, a settled verdict on the new act may not be possible until after the next election. All we shall have to go on are anecdotes, individual experiences, the comments of the health professionals, and – possibly most damaging of all for ministers – stories about the fees and profits earned by the private companies who will win contracts to treat NHS patients.

One does not have to be cynical about the media to imagine that the bad news will come first – before the next election – and the good news only afterwards. Each hospital scandal, each botched operation, each unnecessary death, is likely to be attributed by someone, somewhere to reform.

And here’s the really frightening prospect for the fans of Lansley’s strategy: it could well be that the bad-news stories have nothing to do with his reforms. If waiting lists continue growing, this may be because of the tough financial climate. But, faced with doctors and nurses complaining that the new Act is getting in their way, I’d hate to be the minister (whether Lansley or a successor) trying to persuade voters that the waiting lists would be even longer without reform.

That’s the true significance of our latest research: they suggest that if at the next election, Conservative politicians are still arguing with health professionals about whether the Act is helping or harming the NHS, most voters are likely to believe the professionals.

Would that doom the Tories to electoral defeat?

Not necessarily. If the economic news is better and Labour’s reputation still weak, then Cameron may still win. But for a man who has striven mightily to persuade voters that the Conservatives are both competent and caring, and whose personal contact with the NHS has been so significant, it would be a bitter blow to be thwarted by the possibly unfair perception that he has messed up the NHS.

Perhaps on reflection, he should have remembered the lawyers’ maxim: time is of the essence. Had he used the government’s considerable powers under existing laws and implemented more limited changes in his first six months as Prime Minister, then the bad news stories might have died down well before the next election, and the gains from reform become visible before voters have to decide who runs Britain after 2015.

See the survey details and full results here

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