Wednesday, 3 January 2018

The NHS Crisis and Stubborn Tory Voters

You know it, I know it, the government tacitly admits it. The NHS is in crisis. In fact, it's in permanent crisis thanks to funding not meeting demand. What we are witnessing are ebbs and flows in how acute the crisis is. Let's recap: all non-urgent operations (some 55,000!) and hospital appointments have been cancelled, and the targets which the (often private) providers who run A&Es have to meet are temporarily suspended. Meanwhile, ambulance stations have shut, 8,500 beds have been stripped out of the NHS, around one-in-six A&Es have got closed or downgraded, and ditto for 72 walk-in centres. In addition to the cuts ("but we're not cutting the NHS!", the Tories squeal), hospitals have increased their capacity to take private patients, hospitals are taking up the slack for the devastating cuts the Tories have made to adult social care budgets, poor health is rising and resistance to disease falling thanks to increasing poverty, mental ill-health is at epidemic levels thanks to a decade of dog-eat-dog social and employment policy, and on top of it all resources as a proportion of GDP is shrinking in relative terms. Matters, of course, aren't helped by the increased bureaucratic burdens foisted on the NHS thanks to Tory marketisation which, coincidentally, benefits companies who've donated some £20m to the party. Fancy that.

It's plain as day what the Tories are trying to do. Incompetence only goes so far as an explanation (something Jeremy Hunt has no shortage of). What we are seeing is the deliberate running down of the NHS. It is not privatised (yet), but under the Tories our health system has become a market place in which publicly owned medical and health care providers are competing with private entities for contracts. It's not unheard of private providers then winning the tender for a service, and subcontracting it back to a public body. And to think this parasitism is justified in terms of efficiency and value for money. By ensuring resource doesn't follow demand, and sitting idly by as huge amounts are squandered on marketisation and procurement, permanent crisis - it is hoped - will soften up the public enough for more reductions of "unnecessary" services, rationing, and the normalisation of charges. Which then stimulates the market for medical insurance ... you get the picture. Even the crisis solutions the Tories favour, i.e. bunging the NHS a billion here, a billion there to take the pressure off is calculated to give the impression of an all-consuming monster that is rapidly growing beyond the country's means.

And yet one question stubbornly remains. Despite the obvious crisis and Britons' professed love for their NHS, why is this not hurting the Tories more than it is? When you consider the voter coalition assembled behind the government and see it is disproportionately middle-aged to elderly and therefore more likely to use the NHS than any other age cohort, why do too many of them remain stubbornly welded to the authors of a crisis that is directly impacting their lives, if not life chances? It comes down to framing.

Consider this unrelated example from Stoke-on-Trent's recent political history. During the 00s halcyon days of the BNP as an electoral force, its support was drawn from council wards that were almost totally white. Why? Because people living in these areas were less likely to encounter Muslims or people who weren't white like themselves than those living in more mixed neighbourhoods. They were more likely to believe racist propaganda because their social life, their experiences did not contradict those claims. All the while, the media were ramping up antipathy to Muslims and refugees, and the then government pandered to these "real concerns" without challenging them. A case then of the world outside of direct experience presenting a view many found convincing and which the unlamented BNP capitalised on. Now consider the media habits of older people. The world outside of their direct experience tends to be mediated by traditional broadcasting and the mainstream press more so than younger cohorts, for whom social media is the place news is digested and discussed. It means the positions taken by the mainstream are likelier to be accepted as the story of what's happening. After all, as my mum was fond of telling me, it "wouldn't be allowed" if it was all lies.

What has this to do with the NHS crisis? Consider the key themes the press run with on NHS matters; doctors are paid too much, resources are wasted on people who can't be arsed to attend appointments, people are coming here overseas to get their operations done for free, and the old favourite, immigrants are swamping the NHS leaving fewer resources for everyone else. Already, by this third day of 2018 two of our fearless titles have led with these front of these pages. It's not that they're denying the NHS has serious problems, but they're trying to elbow out the way the real cause - a Conservative government and its intentional defunding and contracting out of the NHS - and supply secondary issues by way of an explanation. And because NHS structures and funding are complex and wonky, even as they deliver more tax money to the Tory party donatorate, being able to blame tangible scapegoats is more impactful than cataloging cash transactions. It follows that because NHS management and funding lies outside most people's direct experiences Tory voters who suffer in the system are more likely to find Tory scapegoating persuasive. Especially if they've shared a ward with people who aren't white and don't have a British accent.

Tory voters therefore aren't necessarily more selfish, or don't care about what's happening to the health service. It's that they find the arguments their media make more sensible than the alternative takes, which are actually the case. From this two things follow. First of all, persuading Tory voters (we're not talking the thinning ranks of activists and members here, but actual voters who don't live and breathe politics) doesn't mean egregiously insulting and belittling them, as satisfying as some would no doubt find it. We want to win them over, not least because they are (mostly unwittingly) contributing to the crisis. And second, we keep hammering home the message about Tory plans for the NHS, as well as amplifying the voices of everyone in the NHS, the nurses and doctors and managers, who are speaking out against the mess the government are deliberate cultivating. Only with persistence and patience can the old scapegoating narratives be worn down and with it an election of a government set on undoing their damage.


SimonB said...

I have to pull you up on one point: the internal market and subsequent marketisation were wizzo New Labour ideas, joyously welcomed and pushed to the extreme by the tories once elected. In fact there were even plans to completely privatise the NHS. As with so many of today's problems, they stem from New Labour.

Phil said...

Yes, but there is a difference: the Health and Social Care Act 2012 was a qualitative change in the depth of marketisation in which *any willing provider* has the option to bid for contracts that cover *all* NHS services. I certainly didn't support NuLab's approach, but theirs was more cautious and constrained by its relationship to Unison (yes, hard to believe) than the mess Lala Lansley devised and implemented.

Joseph said...

Just one point, Phil - excellent and thoughtful post btw. Simply this - many older people seem to take the NHS, state retirement pensions and benefits like the winter fuel allowance as given, even when they are under threat. They vote for the Tories for other reasons - deference, for one - and on other issues, like Brexit.

I agree with you that name-calling is counter-productive - the Left needs the support of people who currently support the Tories, or at least that such people fail to actively oppose a Left advance. People can - and should and will - change their minds.

Thomas said...

I think that what we are seeing with the NHS crisis, the mental health crisis and other social crises such as the housing crisis, social care crisis, homelessness crisis is that we are pushing up against the limits of social reproduction under neoliberalism. The elite can surely only solve these problems in a couple of ways - either new forms of ideology and repression, or a fundamental change in the class settlement (preserving a core of capitalist support). Probably a combination of both strategies. I don't think they can go many more years without some kind of reorientation of this sort. At the moment the Tories are stuck in a holding pattern, defending capitalism rhetorically CapX-style, but watch this space..

BCFG said...

Yeah the privatisation of the NHS and all public services was something fully embraced by New labour. They totally swallowed the neo liberal arguments, they probably did it because they thought it would result in better outcomes (it some cases it has), the Tories embrace neo liberalism because they actively believe in a society of winners and losers, rich and poor, master and slave etc. The Tories positively embrace those twin dangers of ignorance and want!

So the NHS is living with the logical conclusion of that great con man Tony Blair. What labour has always needed was someone with the balls to challenge the prevailing ideology and that man was never going to be Tory lite Tony Blair and those army of Yvette Cooper lobbing centrists. I think Corbyn can be the radical voice the NHS needs, but if for example he had the balls to bring Galloway back into the fold this would c=tell me he really did have the inner strength to genuinely transform British society. I still have great hopes but a little doubt remains.

The Tories contently warn us about Venezuela but with crime exploding, homelessness exploding, substance abusing increasing, ever increasing number of people relying on food banks, increase of people forced into the housing rented sector and ministers having to apologise that the health service cannot deliver health services you wonder if the Tories are aiming for Somolia rather than Venezuela!

I guess on the bright side a very cold winter might just about rid us of a few Tory voters and allow Corbyn to sweep into power with an overall majority. Now that would be a hell of an irony!

The answer to these issue is of course to look to the Scandinavian model and to completely break with the US model of capitalism. As socialists I am sure we would agree it wouldn’t be the end goal but it would make a start.

So from a tactical point of view a good dose of populist anti Americanism would be in order.

So on that score and in that spirit and absolutely pertinent to the topic in question, Down with trump, Down with Israel!