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"The NHS is the closest thing the English have to a religion"

- Nigel Lawson. Why does the NHS take center-stage in British politics?

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Image Credit: Alan Wilson

Over the past decade, the political class have identified one concern which has consistently engaged voters of all demographics and political persuasions: the NHS. In 2016, this sense of attachment was utilised advantageously by the Vote Leave campaign, claiming that ‘£350  million a week’ for the NHS was readily available if the UK left the EU. The groundwork was built in 2015, with both Labour and the Conservative party promising further NHS reforms and it being central to their manifestos. In the 2019 general election, It is arguable that Corbyn had too employed similar tactics by shifting the narrative with the slogan ‘Save the NHS’, claiming that another Conservative government would lead to the NHS being ‘sold’ to US corporations in a post-Brexit trade deal. So what is it about the NHS that animates voters so effectively?

Perhaps the most obvious reason is the emotive nature of healthcare. Unlike the abstract notions of the economy or climate change, healthcare provision is something which feels immediate and affects everybody. It conjures images of the elderly, childbirth, and concerns our very own survival. This is compounded by our ageing population, who are now heavier users of healthcare than ever before.

Yet other issues, such as law and order, or child poverty, can be similarly emotive. Unlike these, however, the NHS is something which is highly valued across the political spectrum. 69% of people in the UK support the general principle of the NHS: free at the point of use healthcare funded through taxation. For the left, it is valued as a symbol of social equality, being the most enduring legacy of the first majority Labour government. For the right, it is perhaps similarly a symbol of social cohesion, but also it has become a key part of British national identity, as it is associated with the nostalgic image of a victorious post-WW2 Britain emerging from the rubble and building a new society. This is why it appeals equally as strong to rural tories as it does to metropolitan liberals.

The final reason for its continual resurgence as a topic of debate is that it functions as a microcosm of the most central debates between the left and right. First of all, it acts as a signifier of the health of public services in the UK; when the government provides a funding boost for the NHS, it hopes to sell the narrative that it values public services more broadly, or at the very least it is not neglecting them. For Labour, the struggling position of the NHS has provided a clear illustration of the harmful effects of austerity, and one which has broad appeal.

Secondly, it ties neatly into the decades-old debate over privatisation and marketisation in public services. In 1990, the NHS was divided into purchasers and providers, and an internal market was created, with the goal of increasing efficiency. In 2012, this marketisation was extended, yet the 2019 NHS Long Term Plan pointed towards an abandonment of the goal of increasing competition. 2017-2018 around 10.9% of NHS spending was on non-NHS organisations. Advocates for increased private and market involvement in the NHS argue more competition between providers leads to increased efficiency. Critics point to the loss of coordination due to the fragmentation of organisations, and the increased administration costs required for market transactions. In 2019, Labour’s campaign team took a leaf out of Dominic Cummings’ book and used healthcare as a platform from which to express their concerns over Brexit, that NHS privatisation was an existential threat. They did so by claiming the NHS was at a crossroads, as it risked being ‘sold’ to American corporations in a post-Brexit trade deal. It is argued by some commentators that this issue was almost as fictitious as Vote Leave’s ‘£350 million for the NHS’. Whilst it is entirely possible a US trade deal could open up access to pharmaceutical markets and increase drug prices, the increase would be nowhere near the £500 million figure estimated by Labour. Moreover, US companies can already bid for private contracts for the NHS, so a trade deal would be unlikely to have a significant change in terms of the way the NHS is funded. Despite this, the ‘Save the NHS’ line became the most successful of Labour’s campaigning motifs in 2019, even if it was subsumed by the Conservatives’ rhetoric in wanting to ‘Get Brexit Done’. Due to the long-held ideological positions on markets held by the left and right, this debate is likely to continue.

Given this, it is probable that the NHS will continue to be a central issue in the coming years. The pandemic has kept healthcare at the top of the agenda, and we should expect to see Labour challenge the government on its use of a test and trace system that has been provided privately, given its current failure to meet demand for tests. What remains to be seen is whether parties continue to appropriate the image of the NHS for their own gain, or whether they decide to treat the organisation with the respect it deserves.

(Image Credit: Alan Denney)

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