'The reforms could be the coalition's poll tax'

After a year in Parliament, and more than 1,000 amendments, the government got a majority of 88 and finally passed its health reform bill. 

There has been a huge amount of wailing and gnashing of teeth by the political classes and professionals, with more vigorous opponents suggesting this means the end of the NHS as we know it.

But when we ask the public what they know about government reforms to the NHS, whether under the previous government or with Andrew Lansley at the helm, most say they know little or nothing. Typically, Ipsos MORI has found around a quarter of the public say they know what the government is doing in healthcare reform – whoever is in charge. 

In some ways, campaigning by both the Labour party and the most trusted professions in the UK – GPs and nurses – could be deemed a failure, if it was intended to get the public out on the streets.

So far, anxiety about the NHS remains well below the average of the Labour years, or indeed the average of the last two decades, even as the bill completed a turbulent parliamentary passage. Only 22 per cent see the NHS as the biggest issue facing Britain, well below the average of 38 per cent of the last 20 years.  

Why? In part because much of the debate has been technocratic and managerial and about the machinery of reform. And in part because the public remain much more satisfied with NHS services than they were in the 1990s – as our tracking surveys show. Billions of pounds of extra spending has made a difference, while debates about commissioning arrangements leave most people cold.

So in some ways, it may be that like previous waves of reform, the government’s changes to the NHS will be somehow got through, despite the challenges, and join a host of other reforms over which many were deeply hostile, but which came to be accepted, or even seen as broadly sensible. Will Andrew Lansley be vindicated?

I remember the furore inside the Labour party when they passed the 2003 act setting up foundation trusts. Their own backbenchers argued it was privatisation through the back door and would create a two-tier system. But public concern about the NHS declined in the following years.

As a young researcher, one of my early jobs at MORI was working for the Thatcher government on its privatisation of the water industry. The idea of selling off national assets like reservoirs was, in some ways, as popular as the recently abandoned forestry sell-off. But the minister Nicholas Ridley ignored public concerns and protests – I can vividly remember him saying that “they’ll forget about it next year” – and as far as water privatisation was concerned he was right. Few are worried today or suggest reversing utility sell-offs. On the other hand, health reform could be like the poll tax. Here, concern rose from nowhere and hit 49 per cent during Mrs Thatcher’s last summer as PM – before she went and it was abandoned.

We’ll know by 2015. The key issue will be actual waiting times and actual patient experience.  This, along with accompanying media coverage, which amplifies and confirms public anxieties, is how the public judges the NHS.  Its chief executive says it is now facing “the most dangerous moment” since its creation, as it attempts a reorganisation so large you can see it from space, That’s not to mention year-on-year savings which no comparable healthcare system has ever managed before. The challenge will come if the Daily Mail, Telegraph et al decide to major on growing disparities in treatment around Britain, or generally rising waiting times, as these will be blamed on the government. Stories about “unfairness” are what the government will need to avoid: 73 per cent of the public believe treatments should only be available via the NHS if they are equally available everywhere. 

On waiting times, our analysis shows a tipping point applies: when waiting times fell, the public didn’t really notice, until they fell dramatically. If waiting lists start rising, public concern will not follow immediately – but if they go past a certain point – and break David Cameron’s promise to keep them down, Labour’s current lead on the NHS might actually matter in the 2015 election.

Everything depends on what now happens out there in real life, rather than in the House of Commons.

Follow Ben on Twitter: @benatipsosmori