This week: Part two of our interview with Ben Page, chief executive of pollsters Ipsos MORI
Why he matters: As well as rising through the ranks of Ipsos MORI for the last two decades, Ben Page has been advising prime ministers and health secretaries about public attitudes toward the NHS since 1997.
In the first part of this interview (which you should read first if you haven’t already), Mr Page explained the sometimes contradictory and partial ways in which the public form their views about the NHS.
Faced with this reality, how can politicians exert influence?
A&E appears to be the one area of NHS operations which has a direct impact on the public’s view of the service. Little wonder then, that it has been the subject of so much government intervention and funding over the last two decades.
Mr Page stresses that what impacts the public’s view is experience, not outcomes. A&E is the NHS’s “shop window” he says, where the public can see with their own eyes how the NHS is faring. “You can’t really see [elective] waiting lists,” he adds.
New Labour’s success in bringing down A&E waiting times added an unprecedented 20 percentage points to the public’s satisfaction with the NHS. Little surprise then that Mr Page says that if the four-hour A&E standard is to be removed “it needs to be done delicately” and that, on balance, he would “probably keep” the target.
Keeping staff happy is the second most effective lever politicians can pull. The influence of NHS staff on public attitudes is a product of their number and the fact nurses and doctors (in that order) are the most respected people.
“If they go home and say, ‘it was a f*****g nightmare in my hospital today’, that has a huge impact,” remarks Mr Page.
Reducing the amount of “bad mouthing” of the service by staff is of course to some degree affected by the resources available, including whether pay is rising or falling in real terms and relative to others. But other tactics are available to government ministers.
Mr Page contrasts the approach of John Reid, Labour health secretary between 2003 and 2005, and his successor Patricia Hewitt.
Mr Reid, he remembers, would tell almost any group of NHS staff he met that they were “the greatest force for good in the world”. Ms Hewitt would, instead, offer some faint praise before moving on to talk about the service’s financial problems (which for fairness sake it should be noted developed on Mr Reid’s watch). No prizes for remembering which health secretary got booed off stage at the Royal College of Nursing annual congress.
This, of course, was a time when New Labour “poured money into wages and pensions”, but then managed reform in a way which ended up with staff “slagging them off”, remembers Mr Page.
This proves the futility of “winding the staff up by beating them over the head”, as was illustrated during the junior doctors’ strike where the “deep well of sympathy for medical staff” resulted in public support for strike action – even if emergency cover were to be withdrawn.
Mr Page adds a caveat, saying that even for doctors that well has a bottom. He says it is uncertain what would have happened to public opinion had the strikes continued and caused harm. He also points out that “people generally support the idea of paying doctors more”, but that when they are shown what some doctors earn the response is often “oh my God!” and support becomes more muted.
The Ipsos chief suggests that as well as “saying nice things” about staff and showing that you “feel their pain”, politicians “go and see them, [because] they love visits”. He also suggests giving out awards has a noticeably “positive effect on morale”.
Don’t close anything
Politicians are often accused of being obsessed by media coverage – but when it appears as the third most significant way to affect public opinion it is perhaps not surprising.
Careful media management is key, as Mr Page illustrates with another story from the New Labour days.
Tony Blair’s government was keen to show how it was progressing against its manifesto commitments to cut waiting times and, therefore, decided to produce monthly reports. They also commissioned Ipsos MORI to analyse the media coverage these sparked.
The report Ipsos delivered declared, in Mr Page’s pithy summary, that most stories were headlined something along the lines of “waiting times still s**t”.
Ipsos MORI advised the government to “slow down their announcements about waiting times”, as they just reminded everyone how bad things were and would never produce positive stories.
“Best not to say anything,” suggests Mr Page, and to focus announcements on good news, as well as making the most of events like anniversaries and the Olympic opening ceremony where increased awareness of the NHS boosts public satisfaction, regardless of the service’s performance.
The Bedpan comments that for the past 18 months or so, NHS England has been pumping out regular summaries of NHS performance, and wonders if chief executive Simon Stevens – who, of course, was the recipient of Mr Page’s advice when he was Blair’s policy adviser – was using an old trick to keep the heat under the government in the run up to the spending review.
I couldn’t possibly comment,” says the Ipsos MORI chief.
As explained in the first part of this interview, bandying about billion-pound pledges on NHS funding just sails over the public’s head or is simply discounted (Ipsos MORI’s polling showed that only 14 per cent of people thought the NHS’s recent £20bn cash boost would improve care). But, says Mr Page, it is very important the “public sees that money is being spent on the NHS”.
Therefore, what counts is the number of announcements, not the necessarily the cash involved. It also helps if the public can see what is being bought and who is responsible.
“So therefore, if you’re the secretary of state for health,” Mr Page adds, tongue only partly in his cheek, “it’s very important that you attend the opening of every new MRI scanner”.
He cautions it is important these “positive” announcements do not strain credibility to breaking point, or make it look like you are ignoring problems that are obvious to all. But then, with a grin he adds: “After a few drinks I’d be saying ‘buy some fields and put [billboards] up on them saying ‘massive new general hospital coming soon.’”
The reverse is also true in that the worst thing that a politician can do in the public’s’ eyes is “closing lots of beds” or “white boxes” bearing the NHS logo. If you absolutely must do so, Mr Page says you must “put in the new things first”, so that “it becomes much easier to go to the walk-in clinic than it does to go to the big white box”.
The public are also very keen on hearing about “new treatments”, and anything that suggests the NHS is on the “cutting edge”.
Mean Tories and incompetent Labour
But, as the Ipsos MORI analysis shows, warm words about staff and a healthy news grid of new innovations is still trumped by people’s political views when it comes to forming a view on a government’s stewardship of the NHS.
Here the classic head and heart divide between right and left comes to the fore.
“People have always liked the Labour party more than the Conservative party,” says Mr Page. “The Conservative Party is [viewed as] mean, but efficient. It’s good when you need things sorting out. Labour [are thought of] as well meaning, but often incompetent.”
Competency matters, with Mr Page pointing out that the same proportion of people believed Neil Kinnock (in 1992) and Tony Blair (in 1997) would raise taxes if they became PM.
The difference was, says Mr Page, “that by 1997 people believed that money needed to be spent on the NHS and they also believed that Tony Blair and Gordon Brown would be competent in spending it” unlike, in their view, Mr Kinnock.
Recognising that the NHS “has a problem” unless it receives significantly more funding sometime in the next decade, Mr Page says support for tax rises to boost health spending – particularly a hypothecated NHS tax – is now significant.
But again, the public’s’ real willingness to put their hands in their pockets is very influenced by a government’s “perceived competence”.
So, to ask the obvious and pertinent question: Is Jeremy Corbyn perceived to be competent enough to trust with a big tax rise to fund the NHS? Mr Page says the public response at present is “mmm… not sure”, before adding with a laugh, “mind you, I’m not sure which party is at the moment”.
It’s good, but it won’t get better
Ipsos is a global business, so is able to compare British attitudes about health and healthcare to opinions throughout the UK and world.
Mr Page says that, globally, the British are both the most positive about the quality of the healthcare they receive and the “least optimistic” about whether it will get any better.
Within our still just about United Kingdom there is no “conclusive evidence” that the Scots are more or less satisfied with their NHS, while the Welsh “have been more miserable about public services since the year dot”.
When it comes to the role the government should play in attempting to resolve the nation’s bad habits, such as poor diet or lack of exercise, our nation appears as split on the subject as it does on Brexit.
Ipsos’ polling shows that 33 per cent agree with the statement “it is the government’s responsibility to influence people’s behaviours to encourage healthy lifestyles”, while 35 per cent believe “the government should not get involved with interfering in people’s lifestyles”.
Within European states there are some expected and unexpected disparities. Forty-one per cent of Germans support state intervention, while only 26 per cent oppose it. In France, just 20 per cent want government advice, while 47 per cent wish to be left alone to enjoy their soft cheese and red wine in peace.
More interesting is the seeming willingness of Swedish governments to go against the wishes of their electorate. In a country which, as Mr Page points out, “they do things like take your children away and put them in kindergartens out of your control from an early age”, support for state action sits at 27 per cent, while 38 per cent oppose it.
Bedpan readers will not be surprised that the US is least keen on the state getting involved in public health matters. The population of Indonesia are the most positive about it.
When it comes to the views of patients born outside the UK, the reviews of the NHS are not always as glowing as one might expect.
The tweet or Facebook message from a grateful ex-pat American marveling at the free at the point of NHS care is a familiar trope. However, Mr Page points that in London especially there are some people, “often from Southeast Asia”, who are frustrated by the inability to pay to get treated faster, as that is what “they are used to”.
Bedpan is taking a two week holiday. It will be back on 12 May with an interview with knife crime campaigner and Labour shadow housing minister Sarah Jones
If there is any political figure you would like me to interview, please email firstname.lastname@example.org or if you are reading this on the website leave them in the comments box.
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