The government has got itself into another fine NHS mess by trying to cover up both public satisfaction and dissatisfaction with the service
There were several interesting elements to the results in last week's British Social Attitudes Survey about what the public think of the NHS.
The first and most important aspect of the story is that we are very lucky to have the data at all. The government decided to cease financial support for the survey and threatened its future. That the Kings Fund stepped in to the funding breach was vital to the continued existence of the data set. Those of us interested in what the public think about the NHS have the Kings Fund to thank for the continued publication of data that has now been collected for over a decade.
On a sour note, given these results, the withdrawal of government funding is not at all surprising given that this government did not want this data collected. Their prescience in trying to kill off data collection tells us something interesting. Even before their policies on the NHS made the government unpopular, they recognised that this was likely to happen. Aware of this coming unpopularity they felt it would be better for the public not to know about it.
(There is of course something completely self defeating in this. What you are trying to hide from the public is evidence of what the public itself thinks, and since by definition they are thinking it, you can’t very successfully hide it from them. If they think your policies on the NHS are no good, they will go on thinking that irrespective of whether you tell them!)
The second interesting political aspect of this data reflects the problems the government has had with public opinion about the NHS since they came to power. Within a couple of months it published a white paper which argued for a set of very comprehensive changes in the NHS. At the time these changes were deemed ‘revolutionary’.
But the government already had a problem with public attitudes to the NHS. During this first year of government it was clear that more of the public were satisfied with the NHS than ever before. Over the summer and autumn of 2010 there were several sets of data published which showed how much the public liked the NHS and how well it was doing for them.
This presented the government with a big political problem. The public liked the NHS so much that they could not understand why the government wanted to make ‘revolutionary’ change to it. The public thought that since we think it’s good, why do they want to change it so much?
This meant that on the occasions when news was published showing that the public thought the NHS was doing well, the government had to publish statements that disagreed with this view.
This is always a tricky thing for democratic politicians to pull off. It is no easy thing to have a conversation with the public that goes along the lines 'You, the public, think the NHS is pretty good as it is, but we, the government, disagree with you. Therefore we are going to change it all – even though you think it’s OK'.
Disagreeing with the public is not an easy undertaking for democratic politicians. If you’re going to do it successfully, you need a really good communicator with a very good explanatory narrative. The government had Andrew Lansley.
Andrew Lansley is not a good communicator. He did not have a good narrative to explain what he was doing.
So there ensued a prolonged disagreement with the public, where essentially he said that the NHS is not as good as you think it is and we are going to change it. This created a row not only with the public but with the NHS. This row was a page one news story for a long 15 months.
Over this period – contrary to what Andrew Lansley believed – the public were not following the detailed changes in the organisational structures of commissioning from PCTs to GP-owned organisations, to state organisations of CCGs. Only a few hundred of us very sad people watched the current secretary of state struggle with these and blow with the policy wind as his bill started, stopped, and started again – and as various interest groups succeeded in making major changes to his bill.
What most of the public experienced was ‘a big row about the future of the NHS’. And there was. Including occasional flashes from the secretary of state and the prime pinister saying that the NHS had real problems (citing, for example, poorer death rates for cancer and heart disease than in other European countries).
Last week we saw how successful this government policy on managing public opinion has been. In only two years the record public satisfaction rating of 70% has dropped by 12%. This may not sound much but it is significant because it is a reversal of a trend of growing satisfaction that had been going on for years.
The point I am making here is that the government has solved the problem of making radical changes to the NHS - in the face of public opinion that believed it was doing well as it was - by reducing levels of satisfaction. More of the public now agree with the government and are not satisfied with the NHS.
But let’s be frank. The publication of these results in June 2012 did not elicit an invitation from the prime minister to the secretary of state to attend a congratulatory kitchen supper. There will be no little note from the PM saying 'Congratulations! In the last two years you have succeeded in lowering public satisfaction with the NHS'.
Instead there were immediate denials from ministers at the Department of Health about the figures – saying that they have evidence that there is 92% satisfaction with the NHS.
So let’s sum up. Last week we had a successful outcome for the government policy of lowering public satisfaction with the NHS.And also last week we had the government pointing out that the results of this successful policy weren’t true.
They have spent two successful years creating a new political problem for themselves that they will now have to spend the next two years undoing. To say this is a dog’s dinner would be unkind to pet food.
Paul Corrigan was formerly senior health policy adviser to Tony Blair when he was prime minister. This post first appeared on Health Matters
