The news that A&E departments have seen their worst quarter for a decade crystallised the phrase that had slowly been coming into focus over the past month: “NHS crisis”.
1. Perceptions of NHS decline are not new
While the crisis may be new, impressions that the NHS is in decline are not. Just before Christmas, 46% said NHS care was worse than it was a decade ago – but 42% also said the same in March, before the current crisis. For most of this Parliament, at least one in three Britons has thought that local NHS services are getting worse, compared to around one in ten who has thought them getting better. Nevertheless, over the last four years people are most likely of all to have thought there has been no change to local NHS services, suggesting that although attitudes may remain neutral, there is plenty of scope for a crisis to move opinion further into the red.
2. The public blame the Government (at least more than anybody else…)
ComRes/ITV News polling before Christmas showed that the Coalition Government is considered most to blame for the missed A&E waiting targets. However, this sentiment is not overwhelming - just 28% of Britons blame the current Coalition Government most (compared to 23% who blame individual hospital managers and 13% who blame the last Labour Government).
The Conservatives will also be encouraged to see that those blaming the Government are mostly those who already oppose the party. Their key demographics of support which they are looking to protect from Labour advances, such as people aged 65+ and those living in the South East or the marginal seat-saturated Midlands, are more likely to blame individual hospital managers than the Government.
That said, if the crisis continues to rumble on nationally with hospitals across the country in dire straits, responsibility will decreasingly be seen at the hands of individual hospitals and evermore in the hands of the Government in the middle of it all.
3. Perceptions of the current situation in A&E are bad
Just because they are not overwhelmingly blamed does not mean the Government can be relaxed about the crisis. In fact, public opinion contains much for them to worry about. The overwhelming majority of the public (81%) agree that it is unacceptable to wait longer than four hours in A&E, suggesting excuses about England having some of the globe’s strictest targets are unlikely to cut the mustard. Worse still is that two thirds (65%) think the NHS is not being given the support it needs from Government and 71% that A&E departments are underfunded.
4. People like blaming each other
One of the curious aspects of the public is that few individuals see themselves as part of it. One good example of this is that the vast majority of British people (83%) think “too many people go to A&E unnecessarily”. In other words, nearly everyone is pointing their finger at someone else. This is perhaps the reason why David Cameron claimed at PMQs yesterday that A&E pressures were due to too many people using it. While this may have resonated with many people listening, Ed Miliband’s fierce reply that the Prime Minister was “blaming patients rather than apologising to them” – difficult to disagree with and harder to rebut – may make Mr Cameron think twice about saying the same again for fear of being seen as offering no solutions.
5. Cameron is currently more trusted more than Miliband on the NHS
It is well-known that Labour leads the Conservatives as the party most trusted on the NHS. But the same cannot be said for their respective leaders. Tracking polling by ComRes for Incisive Health has shown David Cameron consistently just ahead of Ed Miliband for the past nine months on the issue.
Attempting to redress this is the reason that Labour is very deliberately seeking to pin the crisis on Cameron rather than the Conservatives as a whole – for example, in the posters saying “The NHS cannot survive another five years of Cameron” or Miliband claiming that if you “want to get rid of the crisis in the NHS, you need to get rid of this PM". They will no doubt be hoping that these attacks also dent Cameron’s lead over Miliband in “best Prime Minister” metric as well as on the specific issue of the NHS.
6. This is primarily a crisis of confidence in the Government not the British model of healthcare
One of the key challenges that Labour has faced over the past four years is how to attack the Government over healthcare without attacking their cherished NHS itself. If they criticise the NHS too much they risk harming public support for it and giving oxygen to the case for privatisation. This point has not yet been reached though. Although half the public (49%) don’t think the NHS is a well-managed organisation, just one in eight (13%) thinks it is damaged beyond repair and two thirds (65%) actively disagree. It is a political issue rather than one of the NHS model being dead.
7. Labour have a tough tight-rope to walk themselves
While it all may be giving the Government a headache, it is not trouble free for Labour either, who cannot be seen to be relishing the crisis. It is certainly difficult to deliver an “I told you so” message without appearing smug, and despite the party’s attempts to appear like they are offering positive solutions, as with their proposal for an A&E summit, David Cameron’s accusations of using the issue as a “political football” remain hazardous for Labour. Few members of the public will have picked up on the “weaponise” line that a Labour insider told Nick Robinson was their intention for the NHS, but the phrase will not be lost on journalists and it presents the future opportunity for the epithet to be thrown back at the party.
8. The NHS is both a local and personal issue and therefore the crisis has the potential to get much worse for the Government
The key point about the crisis however, is that it is a local and personal issue, as well as a national one. This puts it in contrast with immigration for example, which is the most important issue when people are asked what should be the top priority for the Government, but comes below housing and the cost of living when asked about their local area. So while 64% of the public thought Michael Fallon was right to say that Britain was “swamped” with immigrants, just 38% thought their own area was “swamped”.
This is not the case with the NHS. Although people may be more satisfied with their local hospital than with the organisation as a whole, they are as likely to think that it is getting worse: 49% think the NHS generally is getting worse, compared to 46% who say the same of ease of access to local NHS services in their area such as GPs and A&E. Furthermore, more than a quarter (27%) of Britons say that they have experienced unacceptably poor standards of care in the NHS in the past two years, either personally or through family members – a very high proportion of dissatisfied customers. Finally, missing the waiting times target by 2.4% equates to more than 133,000 more patients having to wait longer than four hours to be seen at A&E.
Winter always brings with it a squeeze on NHS resources, but not every winter precedes a General Election. With the weather expected to get yet colder, we can expect the row to continue for the time being. The real test of its potency however, will be what effect it has when things start to warm up as May 7th approaches.