James Frayne is Director of communications agency Public First and author of Meet the People, a guide to moving public opinion. The focus of this column is Theresa May’s conservatism for “ordinary working people”.
This Budget should be the Great NHS Budget. Yes, the Conservatives should think about policies for young people, particularly on housing, but the electoral reality is that the Party can’t reboot its post-election reputation on the back of policies for the young. Such policies would likely barely dent their poll ratings. Not enough of the electorate share the same priorities as the youngest voters. It’s becoming clear that, if the Conservatives want meaningful change in public attitudes towards this Government, they must focus on the NHS.
For many years, the Conservatives’ attitude towards the NHS was to neutralise it as an issue. In David Cameron’s early years, that meant endlessly praising its qualities and committing to its future, while (mostly) downplaying the prospect of reform. More recently, the Party dabbled with a retail approach to health – with the idea of a seven-day NHS – but was badly scarred by its battle with the BMA. As a result, health has disappeared as a campaigning issue.
It’s easy to understand the Party’s thinking. Why talk about an issue where Labour has enjoyed longstanding and significant competitive advantage? And why talk about an issue where the public would fear some of the remedies that might be required to improve the NHS?
But it’s becoming clear that it’s impossible to play the issue down. Anyone that has conducted any vaguely political focus groups (not even on healthcare) in recent times will have heard healthcare spontaneously jumping out as an issue of concern. And the Conservatives’ perceived lack of interest in the issue – and its supposed desire to privatise health services – is dragging the Party’s ratings down.
But this can hardly be a surprise. For some time, the polls have put healthcare right at the top of voters’ priorities – rivalling Brexit and immigration for top spot. And two campaigns have secured unexpected success by focusing on the need to defend the NHS. Firstly, most obviously, the Labour Party secured vast local traction at the last General Election by raising concerns about funding levels. Secondly, Vote Leave won in part by linking funding and capacity pressures on the NHS with membership of the EU. Amid the controversy of the vote, an important lesson has been missed: a retail healthcare policy helped pull Britain out of the EU.
Vote Leave’s suggested policy – of spending money associated with EU membership on the NHS – has a bad smell associated with it because of the remain-led backlash against it. It’s therefore unlikely any Government would go near it. This is a mistake. Vote Leave won for a reason. It’s a policy that was tested to destruction through opinion research and it was tested to destruction in electoral combat. This policy – or something similar – should be at the heart of a Budget. (To my knowledge, only Boris Johnson has suggested that this policy is still viable). We shouldn’t hold our breath for it, though.
It’s the Budget, and therefore any health policy announcement will fundamentally have to be financial. That said, money alone isn’t ever enough to capture the imagination of the public – who want to know what the money would be spent on. My caution for politicians is not to mistake an NHS policy with a pay policy. Giving more nurses a pay rise may be sensible for other reasons (though, as I’ve written before, there’s little polling evidence for this) but it won’t fundamentally solve the issues around capacity and treatment. That’s where they should focus.
In the last few weeks, all the attention has been focused on the Chancellor – as if the success of the Budget is entirely down to him. While he, working with Theresa May, will set the crucial envelope of spending, other Cabinet Ministers will need to come up with the ideas. Ahead of this Budget, that ought to make Jeremy Hunt the most important man in Government.