“We want to spend the day talking about the National Health Service.”
So spoke Lord Ashcroft as he opened his latest research event in central London yesterday. We have covered two of these events on ConservativeHome before – one on immigration and one on Europe – so you may know the drill. 80 members of the voting public had been gathered, eight to a table, in a hotel conference room. They then discussed the issue at hand. As Lord Ashcroft explained, this is different from normal opinion polling which reveals how many people think one thing or another. “Discussions like this help reveal why they think as they do.”
The idea is to build the most comprehensive survey of attitudes towards the NHS since… well, ever. A mega-poll of 20,000 people has also been conducted to go alongside yesterday’s more qualitative research. The whole shebang will be published in the New Year.
After Lord Ashcroft had finished his introduction, the stage and microphone were given to our emcee for the day, Rick Nye of Populus. His first task was to explain the little gadgets that were waiting for everyone on their tables, and then to put them to the test. “Has the NHS got better or worse in the last five years?” he asked. “Press ‘1’ for ‘much better’. Press ‘2’ for ‘slightly better’,” and so on. As it happened, button numbers 3 and 4 got the most attention from audience-members’ fingers. 39 per cent voted “neither better nor worse”. 34 per cent voted “slightly worse”.
But to return to the point of this exercise again: why? For the first of several times throughout the day, the different tables were asked to talk amongst themselves, to lay out why they think as they do. And, for the first of several times throughout the day, I busied myself with eavesdropping their conversations. The people had already been grouped according to their overall views of the health service, so perhaps that explained some of the consistency I witnessed: one table was unequivocal about the best feature of the health service – “it’s free”. Although there was some inconsistency too: the same table wrangled over its worst features, from “waiting times” to “free boob jobs”.
So much, for the time being, for what the audience thought. What should they think? A couple of expert witnesses were summoned to the stand. The first was Ruth Thorlby from the Nuffield Trust. The second was my old boss Andrew Haldendy, director of the think-tank Reform. They were invigilated by the Economist’s Anne McElvoy.
The pair’s statements were nicely bifurcated. Thorlby’s basic argument was that the NHS needs more money: it has gone through a period of uncommon stress and strain, and faces more in the years ahead, so “extra investment is required to give people time to work out what needs to change”. Haldenby’s was that the NHS needs to make do with less: not only is this the harsh truth that all public services face, but it could be what forces this traditionally unreformable organisation into changing for the better.
As Rick Nye put it, Haldenby “bore the brunt of the audience’s scepticism” during the questions that followed, particularly when it came to his profession of faith in profit-making companies. But this wasn’t just a parade of support for the NHS in its current form. The temperature of the room noticeably rose when someone asked about “people just walking in” from abroad and using the health service without making any prior contributions to it – aka, health tourism. “Why is this allowed to happen?” Neither panellist’s response seemed to much satisfy the audience. “They just dodged that question,” grumbled one man next to me.
The baffled silence that met McElvoy’s own question for the audience – “who can explain Andrew Lansley’s health reforms in one sentence?” – also told its own story.
The extent of people’s frustration with health tourism was clarified after lunch. The audience-members were asked to return to their buttons for another round of quick votes. One of these was on the question of “what is the worst thing about the NHS?” Bureaucracy came out on top, with 38 per cent of the vote. But health tourism was in second, with a hefty 25 per cent share. This may be a small problem in terms of its overall fiscal cost, but it seemed to matter greatly to yesterday’s audience.
This postprandial session produced another of the day’s most striking findings. Asked about how the NHS should be funded, the people responded:
Had Haldenby persuaded some of them, after all? Or had his supporters just been quieter than his detractors during the earlier Q&A?
Which left the audience with two final tasks. One was to chat about the NHS in connection with the political parties: which, from what I heard, meant a comparison of the Tories’ “competence” with Labour’s “conviction”. The other was to choose, from a selection of eighteen printed cards, what the health service’s priorities should be. Should “out of hours services” trump “free prescriptions for the elderly”? Is “treatment for the terminally ill” more important than “free parking at hospitals”? Most of the tables managed to get their selection down to about three cards; their irreducible core. The most popular options, chosen by almost every table, were “free at the point of use” and “emergency treatment”.
Despite that closing blast of unanimity, the overall impression from the day was, in a way, the absence of an overall impression. This audience’s views about the National Health Service were more complicated than I had expected when the event began. Perhaps that’s just the nature of a mixed group of people gathered in a room like this, but it’s surely also the nature of a mixed electorate. Politicians may want to take note when Lord Ashcroft’s full research is published on his website in January.