Why Labour's 'NHS First' election strategy didn't work in 2015
The 2015 general election marked the first time in Labour's history where the party bet the house on the National Health Service.
Even in 1945, three years before Aneurin Bevan launched the service, other issues like housing came first in the party’s manifesto. When fighting Margaret Thatcher’s 1980s reforms or backing Tony Blair’s 1997 claim that there remained ‘24 hours to save the NHS’ the party has never centred healthcare in its electioneering to the extent Ed Miliband favoured.
Amongst the bitter mud slinging of Labour’s leadership election it is prescient to assess the party’s recent engagement with the NHS and ask why the gamble did not pay off. While conjecture and counter-conjecture has defined the debate so far, examining ‘NHS first’ provides a far more grounded view of the issues Labour must deal with to regain power.
If critics portray Miliband’s leadership as lacking emotion then this charge falls flat with the NHS. The last five years witnessed a barrage of affective statements and gestures towards the health service, all aiming to convince the public that Labour represented its true custodian.
Celebrity supporters like Delia Smith and Steve Coogan amplified this message, encouraging voters to help save ‘one of our greatest achievements’. Affirming Russell Brand’s view that ‘there isn’t anyone in Britain that don’t love the NHS’, Miliband demonstrated a higher than usual deployment of the British politician’s favourite pronoun/institution combination: ‘our NHS’.
Labour intimately reminded the 44 million Britons born through the service the meaning of the welfare maxim ‘from cradle to the grave’ with an online tool that provided an individualised ‘NHS baby number’.
The 2014 Labour Party Conference marked the apotheosis of this emotional outpouring. Ninety-one year old activist Harry Leslie Smith brought delegates to tears recounting the ignominy of Depression-era healthcare. Shadow Health Secretary and current leadership candidate Andy Burnham, never missing an opportunity to appear dewy-eyed over the service, hugged him close on stage, later casting the election as a ‘battle for the soul of the NHS’.
After January 2015, Labour placed the health service in the centre of their campaign strategy, hoping to exploit the government’s mishandling of the worst ever NHS A&E waiting times. Throughout the election, as these crises unfolded, leading pollsters revealed the NHS at the top of voters’ concerns.
Historically, Britons have always demonstrated some degree of a love affair with the service. As Nigel Lawson remarked, it is ‘the closest thing the English have to a religion’ and has topped surveys of what makes the public ‘most proud to be British’.
While immediate risks existed in ramping up the emotion around the NHS (David Cameron labelled Miliband’s alleged aim to ‘weaponise’ the service ‘disgusting’) the odds seemed favourable for those Labour strategists thinking the route to Downing Street went via the front door of an NHS hospital.
But why did voters not vote with their hearts for a party that they seemingly trusted more with the NHS?
The answer partially lies in the more general failure of polling in the months leading to May 2015. The evidence that informed the strategy proved dubious.
ComRes told in April how Labour’s lead over the Tories on dealing with the NHS had doubled, but you would be forgiven now for asking where that paid dividends. Voters, after giving earlier signals to the contrary, did not think the health service more important than the budget deficit, shutting the SNP out of government, or, in certain seats, restricting immigration. Cameron’s claim that ‘you can only have a strong NHS if you have a strong economy’ resonated at the polls.
So is Labour’s ‘NHS first’ failure a simple case of listening to pollsters too much or another episode in ‘it’s the economy stupid’? Should the party not talk up the NHS so much in future?
No, on all counts. Facing a £30 billion shortfall by the end of this Parliament, Britain’s health system is entering yet another period of uncertainty. Jeremy Hunt stokes outrage among weary doctors over his plans for a ‘seven day service’ and Lord Prior intends to set up a full-scale inquiry into the funding of the service. The NHS needs a credible progressive champion that demonstrates hard thinking about securing the institution’s future.
Sadly, this did not prove the case during the last five years. The lack of interesting policy detail in ‘NHS first’ is another reason for its poor performance.
Labour offered much on the emotional front but little innovation in terms of recommendations. Hiring more nurses and combining health and social care budgets are a good start but other more radical solutions should be embraced. Devolving power down in the NHS offers much potential, as the pioneering Greater Manchester authority hopes to demonstrate, helping save money and empower patients.
Labour must strive to reform Clinical Commissioning Groups, now they are entrenched as part of the landscape, rather than just clamouring for the repeal of the Health and Social Care Act.
Even if Labour wants to limit private competition, they require clarity over the role of the market. Burnham tied himself in knots wrangling over the appropriate public/private divide, supporting private sources of funding in government but changing his mind in opposition.
PFI aside, Labour can be proud of its record on the NHS between 1997-2010. The party can look to it as a source of optimism.
According to the independent U.S. based Commonwealth Fund, Britain possessed the best healthcare system in the world in terms of returns on public investment when Labour left office. Patient satisfaction in 2010 stood at its highest ever levels. Building on these achievements by articulating a purposeful vision for the years ahead is one of the easier ways the party can regain the public’s confidence.
The NHS stands as a powerful symbol of Labour’s failures in the last election but also speaks to the current leadership race. Serious opposition cannot simply play up older messages of ‘fair shares for all’ in a policy area and hope the rest will sort itself out, as the result of ‘NHS first’ testifies.
If this strategy proved electorally unconvincing based on the prime candidate for these ideals then it is unlikely to work elsewhere.
Passion and feeling are desired qualities in the next Labour leader, but the party will only regain office if it fuses these attributes with smart policy shaped in co-operation with external voices.
Andrew Seaton is a NHS historian based at New York University.