Last Friday, in his widely reported Conservative Home blog, Tim Montgomerie said the Health and Social Care Bill currently going through Parliament is "potentially fatal to the Conservative Party's electoral prospects". Is he right?
The initial evidence from our latest poll for the Sunday Times is mixed. The two main parties are still level-pegging, as they have been for the past fortnight. The Conservatives have 38% support, one point up on their vote in the 2010 election, not sharply down as might be expected for a Government approaching mid-term with the economy flat on its back. Last week's disputes over the Bill, and Ed Miliband's clear victory (according to virtually all journalists covering it) in last week's prime minister's Questions, have had no observable effect so far on Conservative support.
On the other hand, the same poll finds that the Health Bill is unpopular. Only 18% support it (though there are many don't knows). Of those who express a view, voters say by more than two-to-one that greater competition, as proposed in the Bill, will harm the NHS. Ed Miliband narrowly leads David Cameron as the most trusted party leader on the NHS. Given that Cameron consistently trounces Miliband on other measures, such as who would make the best prime minister, and who is best on the economy, it is noteworthy that the figures on the NHS are very different.
So what's going on? The NHS always comes at or near the top of the league table of voters' concerns. If the Tories are alienating voters on this central issue, one might expect their support to slide. Why hasn't it done so?
My explanation requires a brief trip down memory lane. Back in the 1980s, polls consistently found that voters opposed the Thatcher government's programme of privatisation. They were twitchy about handing over basic services: water, gas, electricity, telephone, buses, trains, to private companies. They were unconvinced by arguments that privatisation and competition would drive up efficiency and be good for consumers.
Yet two things happened. First, the process of privatisation did the Tories no harm: they won the 1983 and 1987 elections with three-figure majorities. Second, after privatisation, efficiency did rise and services did improve. The only set of privatisations that remained unpopular were public transport, because passengers were unconvinced by claims of efficiency gains.
It's possible the saga of the NHS could resemble that of Thatcher's privatisation: people, if asked, say they are against change, but not to the extent of switching their vote. The verdict that will matter will come after reform, when people can judge by results. If the Health Bill is enacted, patients and their relatives will be able to cast their votes at the next election on the basis of experience. If the much-maligned Andrew Lansley is proved right, and the NHS provides a better service, then there is no reason why the Tories will suffer.
However, if the Bill’s critics are right, and the NHS deteriorates, then the electorate may exact fierce revenge. David Cameron has fought so hard to dispel old fears that the Tories don’t really care about the NHS: those fears may come rushing back. If Ed Miliband has managed to restore at least partially Labour’s reputation for competence, then we could see something that has happened only once before in the past 80 years: a Government being booted out after just one term in office.
So here’s my advice to the prime minister: if you are privately, honestly confident that the Bill will unquestionably be good for the NHS, stick to your guns. But if, away from the public gaze, you harbour doubts and fear that the massed ranks of doctors and nurses might just possibly be right, then pull the Bill. DON’T decide according to tactical calculations – either sticking to the Bill to avoid embarrassment or killing it to quell dissent in the coalition ranks.
As is more often the case than cynics believe, your long-term self-interest will be best served, prime minister, by doing what you genuinely think is right.