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.