Archive for the 'NHS' Category

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The Tory Keogh report offensive appears to have had no impact on the “best party on NHS” ratings

Tuesday, July 30th, 2013

One of the big apparent “wins” for the Tories before they broke up for the summer recess was their response on the Keogh report on hospital failings which had happened on Labour’s watch. This it was hoped would help the party eat into the traditional LAB lead that they have on the NHS.

The CON attack was high octane and certainly LAB, with its less than convincing shadow health minister Andy Burnham, were put on the defensive.

The view, certainly from the right wing pundits, was that this was a win and a demonstration of what the Lynton Crosby approach could do.

Today we see the first YouGov best party on the NHS tracker since then and, as can be seen all parties move up 2 so the LAB 12% lead remains.

It doesn’t appear as though the blue message has got through.

As I’ve been arguing the NHS is one of those areas where the Tories are almost bound to come off second best. Far better to stick to areas of strength like the economy and immigration.

Mike Smithson



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The NHS is to the Tories what immigration is to Labour – a policy area they can’t win. Better to move on

Wednesday, July 24th, 2013

The best strategy is to steer the debate on to areas of strength

A week, as Harold Wilson used to say, is a long in politics and just seven days ago the Tories felt they were on to a winner with the concerted attacks on a Labour’s custodianship of the NHS when they were in power.

Whether it was the right thing for the Tories to do is one thing but there’s little doubt that seeing the main opposition party on the defensive on a policy area that they’ve always made their own sent CON MPs off in good heart as they left for their summer recess.

    But was this politically the right thing to do and should this aggressive approach be repeated when hostilities resume in September?

    In essence is the Lynton Crosby strategy right?

The polling at the weekend on the aftermath of the Keogh report found barely one in five blaming Labour for what had gone on which must have been a disappointment to the blues but not really surprising given how well as Labour continues to be regarded.

To my mind the NHS is to the Tories like immigration is to Labour – a policy area where whatever they do or say they can’t win. Better to move the debate onto areas of strength which I believe is what they’ll now do.

Mike Smithson



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Corporeal on David Cameron and the NHS

Thursday, February 14th, 2013

The Three letters of David Cameron

When David Cameron won the Conservative party leadership contest he said he could state his priorities in three letters: NHS. More than any other issue, from the Big Society to hugging huskies in hoodies, he’s tried to connect himself to the state of healthcare in this country.

While prescribing declaring cuts had to take place in almost every other department he declared he would protect the NHS by ring-fencing its budget. It is a personal crusade (he has talked about how his experiences with his son made the issue so important to him), it is central to his campaign to de-toxify the Conservative party, with the Stafford hospital report published it is very much on the agenda.

From a polling standpoint on YouGov’s issues tracker it ranks as the 2nd most important issue facing ‘you and your family’ (behind the economy) and 3rd facing the country (behind economy and immigration).

But has Cameron’s focus on the issue been successful?

Or at least has it been popular (in politics the two are so entwined with each other). Below are graphs tracking the Conservative score, and Conservative lead (either positive or negative) over Labour, I’ve drawn them from YouGov’s recent tracker (which since early 2010 has regularly been tracking issue ratings, and infrequently in between 2005 and 2010) and Ipsos Mori’s unparalleled historical data which covers a much longer time span but always infrequently.

Firstly the YouGov data:

What we can see here is just how badly the Conservatives have rated on the NHS, since 2005 and including 75 polls taken since the start of 2010, they have one instance of being level with Labour, and three of leading them (with leads of 1, 1, and 3). The other 71 polls have them behind (even while they were leading in voting intention polls).

Cameron’s time as Leader of the Opposition up to the early years of his premiership show some sustained improvement in the Conservative ratings (and that helping to drive a similar level of improvement in the gap to Labour) with the caveat that given how the polls since 2010 jump around the infrequency of the polling 05-10 casts a bit of doubt on reading too much into it.

From the start of 2010 we have much more frequent data that places them mildly behind Labour up until the election and improving after the election through to that autumn, but then turns downwards and heads below even the 2005 ratings.

(The separate lines indicate a change of methodology, before 1988 the question was about the National Health Service, from the start of 1988 the question referred to “Health Care”).

What the longer historical perspective offers is a suggestion that Cameron is still performing relatively well even after his decline, remaining higher than all the ratings apart from Major’s stretch before the 1992 election and his peak the highest Conservative rating of the past 25 years (and comes outside of election time, while the other Conservative high points cluster around elections).

The leads (fairly unsurprisingly) tell a broadly similar story, that Cameron’s worst result (or conversely Miliband’s biggest lead) is better than any other since the 1980s.

That is certainly the most positive way of interpreting this data (it also depends on how much you think the change in wording has changed the results) but for all Cameron’s efforts on what in many ways has been his flagship project, I think he’ll view these figures (and hello to Dave if he’s reading, or Samantha for that matter) with some disappointment.

Corporeal



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Maybe, just maybe, voters are starting to believe that the NHS is safe in Tory hands

Thursday, December 20th, 2012

Concern about the service drops to lowest level since election

Last night the Ipsos-MORI Issues Index for December was published and one of the highlights was the decline in the numbers of those saying that the NHS was an important issue facing the country.

The Index operates in a totally different manner from any other regular poll and has done for the past 37 years. For rather than ask how respondents feel about specific issues it seeks to test the salience.

All the interviews are carried out face to face and those questioned are asked to name as many important issues as they like which they think are facing the UK at the moment. It is important to note that this is totally unprompted.

    This month the proportion including the NHS dropped to 15% – the lowest level since the general election and, as can be seen from the chart, in line with the long-term trend.

If these figures are in any way accurate then, I’d suggest, it’s good news for the Tories. An issue on which they are almost always seen as doing worse than Labour has lost a lot of its salience.

Mike Smithson

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Will Romney be cheering the Olympics NHS reference?

Friday, July 27th, 2012


Nursing Times

According to the Nursing Times there’s a segment in tonight’s opening ceremony that celebrates the “greatness of the NHS”.

I wonder if Mitt Romney will take a bathroom break at that point.

Mike Smithson @MSmithsonPB



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Will the Lords euthanize Lansley’s bill?

Wednesday, October 12th, 2011

Is the government about to lose a major reform?

This has not been a good week for the government. The ongoing difficulties of Secretary of State for Defence, Liam Fox, are far from over as the investigation into both his own and his friend Adam Werrity’s conduct continues. This alone will make for a difficult Prime Minister’s Questions. It could be about to get worse.

    The Conservatives went into the last election with plans to empower local providers of many services to enable the providers and clients to shape those services according to local and individual needs, free of the controlling hand of Whitehall. For the NHS, the Health and Social Care bill was the result of that objective.

It has not had a happy passage through parliament. First there was a revolt among Lib Dem activists at their party’s Spring Conference, filtering up to MP’s at Westminster, which prompted a ‘listening exercise’ and substantial rewriting and watering down of the proposals. Then the government tabled a huge number of further amendments as the bill reached the Lords, prompting accusations of inadequate drafting and giving opponents a fine stick with which to beat it.

Those opponents (and perhaps some who agree with it in principle but believe that no bill is better than a badly written bill), will today seek to send it to a special select committee, where progress would be likely to be delayed so long that it would fail. If it does, Lansley and the Tories are unlikely to try for major reform again this parliament – it simply would not be worth the effort for what could be passed.

    It is rare for any government to lose a piece of legislation, never mind such a major one, but then it is unusual for Britain to have a hung parliament and if one consequence of that is that proposed legislation will in future need to be better written and subject to more scrutiny, that’s no bad thing. For Lansley, the only consolation if the bill does fall is that there’s plenty else in the news to drown out the (for him) bad news. On the other hand, if Fox does leave the cabinet one way or another, it would leave him vulnerable in the reshuffle that would ensue.

Mentioning Fox, Ladbrokes’ market asking whether he’ll still be in post at the turn of the year is 4/6 that he will and 11/10 not. It’s really a bet on the nature of what else there is to be revealed, and for how long it will go on, which is too much of a blind guess for my liking.  However, if he does go, it’s more likely to be within the next week than after it.

David Herdson



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Will NHS chaos be an election issue for Cameron?

Friday, September 9th, 2011

Henry G Manson on the health changes

In a speech to the Royal College of Nurses GPs in 2008 David Cameron won applause for his election pledge against “pointless top-down reorganisation that aim for change but just bring chaos.”

Yet ‘chaos’ is surely a considerable risk now. The biggest restructuring of the NHS since it was created, contradictions running throughout the revised Health and Social Care Bill alongside £20 billion of efficiency saving targets. Oh and let’s not forget the real threat of industrial action in the NHS over pensions if the Nursing Times is to be believed.

A number of Conservative-supporting friends are clinicians. In the course of the last week I’ve made a point of speaking with them about what they understand will be the impact of the Governments’ revised health plans. They never shied away from telling me where Labour was getting it wrong. But their attitude was different this time. Among the four, three of them used the word “chaos” or “chaotic” unprompted. The other simply described it was “mad” and that we will be looking forward to his forthcoming retirement as a result.

I’ve never worked in the public sector, but what I do know is that with any dramatic organisational overhaul in the private sector there are inevitably are huge teething troubles even when staff are fully on board. That is still not the case within the NHS.

My sense now is that it will not be ‘privatisation’ in the health service that will alarm voters in 2015, but instead a general sense of ‘chaos’. Given his pre-election pledges, Cameron’s health bill risks making the implementation of his health plans a real election issue.

HenryG Manson @henrygmanson



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Obesity: should fatties be taxed rather than fat?

Saturday, August 27th, 2011

Could a risk-based National Insurance system ever work?

Government health drives are always dangerous things politically, as they tend to deliver unpopular information to people who know the truth of it but dislike having to admit their failings to themselves and so blame the messenger. That the message is frequently accompanied by tax increases doesn’t really help either.

The reports about obesity published in The Lancet yesterday and widely covered in the media fit very much into that mould, advocating more micromanagement of people’s lives and taxes on high-fat food.

It is true that there’s a problem and as the BBC’s report boldly commented ‘this is likely to get worse if current trends continue’. That being the case, what other options – well beyond those put forward in The Lancet – might there be to encourage healthier lifestyles?

One of the givens of British politics is that the NHS is untouchable. It might be possible to reform administrative structures far away from the patient experience but the idea of the hospital or GP available to visit free at the point of delivery is so ingrained and accepted that it would be suicidal for any mainstream party to advocate a change to that settlement.

That may well be the case but even if it is, it doesn’t imply that the funding need come from general taxation based on a single national tax rate. People are well used to their household and motor insurance being linked to the risk they’re perceived to present and the record they have. With the right systems in place, it would be entirely possible to apply the same principles to the national insurance system – those most likely to use it pay more.

The advantage of such a system being tax-based is that unlike private health insurance, the amounts paid would vary with income. Additionally, the universal principle could enable the rate for any one individual to be capped and for no-fault conditions to be excluded from the calculations.

Even with such fairness features incorporated, it would still be a courageous minister who proposed such a policy. There would be losers and there’d no doubt be an outcry that people were being penalised for their lifestyle choices. In practice, the poorer social groups may also end up with higher rates (though lower bills) if, as the evidence suggests, there’s a higher preponderance of unhealthy habits such as smoking, than in the richer income groups. While that’s a choice-based outcome, it would still be a political problem (it would be a problem now in relation to tobacco duty were the relationship not more apparent).

Introducing a direct connection between lifestyle and health tax, or between risk and premium, would be hugely controversial. It would, however, be improving transparency and leaving people to determine for themselves how they get to a healthier life, while incentivising that outcome.

Will it happen? I doubt it – the political costs are too high and it’s far easier to carry on as things are. In which case, as the saying goes, if we continue to do as we’ve always done, we’ll continue to get as we’ve always got. Fatter.

David Herdson