He may have thrown money at the NHS, but Gordon Brown looks set for a rough ride from staff, judging by the results of HSJ's survey, writes editor Richard Vize
Health staff have savaged Gordon Brown in their responses to HSJ's survey on the prospects for the NHS under the incoming government.
According to the 1,964 respondents, morale is low, belief in a better future is thin on the ground, and trust in political judgement is so depleted that two-thirds think politicians should hand over the health service and more than£90bn of taxpayers' money to an independent board.
HSJ respondents give a damning verdict on the state of morale. A decade of record investment, sharp pay increases and an unprecedented renewal of infrastructure has earned New Labour a zero per cent score for excellent morale, while two-thirds say it is poor or very poor.
The same proportion believe Mr Brown's arrival at Number 10 will make no difference to morale, despite Mr Brown identifying the health service as the top priority for his premiership. Even more damning, 19 per cent think he will worsen morale - 5 per cent more than those who believe he will improve it.
His reputation as a control freak comes through clearly when readers are asked whether they believe he will continue the drive to reduce top-down control in the NHS. The health community is deeply suspicious that Mr Brown will reverse the central thrust of existing policy - the results were split almost exactly into thirds between yes, no and don't know, with the 'no' camp marginally ahead.
The idea that the government should hand NHS control to an independent board, as advocated by the British Medical Association, is supported by two-thirds of respondents - although a further 21 per cent actively oppose the idea. At one time, Mr Brown was said to be warming to it, and to back up this suggestion some parts of the media made largely irrelevant comparisons with Mr Brown's decision to give the Bank of England independent control of interest rates. It now appears, insofar as it is possible to discern anything of substance about Mr Brown's policies on health, that he has rejected it.
But the biggest score of the entire survey took issue not with Mr Brown but with GPs, whose growing perception among the public as being more focused on personal wealth than patient care seems to have rubbed off on NHS staff.
A massive 71 per cent believe Gordon Brown should compel GPs to provide out-of-hours services to help achieve his declared aim of improving access to healthcare. This stark result reveals considerable animosity towards GPs, and breaking down the responses even reveals clinicians are slightly more in favour of the idea than managers.
One of the key unknowns of Mr Brown's health policies is his attitude towards the private sector. Tony Blair's governments have actively encouraged its involvement as a means of providing choice and stimulating competition. Will the new prime minister follow suit? A total of 64 per cent of respondents expect private sector involvement to increase or increase a lot, compared with just 15 per cent who expect it to drop.
When asked to reveal the emotions they feel as they prepare for Gordon Brown to take power, our respondents are not a happy bunch. Around 42 per cent are either pessimistic or depressed, while half as many are either optimistic or inspired.
The degree of pessimism in the NHS about the future hits home again and again in HSJ's survey. A total of 38 per cent believe the NHS will be in a worse state by the next general election, compared with 25 per cent who believe it will improve and 36 per cent who say it will stay the same. Put another way, 74 per cent of health service staff surveyed have no expectation that Gordon Brown will improve the NHS, despite it being his top priority.
At first glance, the next question - who would be the better prime minister for the NHS? - finally offers some encouragement to Mr Brown, who is 15 percentage points clear of David Cameron. But on 39 per cent - one percentage point ahead of Mr Brown - comes 'don't know'. In light of the astonishing focus Mr Brown has given the health service as chancellor, that is a catastrophic result.
The fact that so many health service staff are unable to choose between the two politicians demonstrates the success the Conservative leader is having in eroding old assumptions in the public sector that Labour will always defend the NHS while the Tories are not as committed to its underlying principles.
Driving the point home, only 32 per cent of respondents believe the NHS is safe in Gordon Brown's hands, compared with 33 per cent who don't know and 35 per cent who say 'no'.
Your advice to Mr Brown
When asked what Mr Brown could do to improve the NHS, 'cut down the ridiculous rate of repeated restructuring', 'reduce the incessant introduction of initiatives and targets to enable stability', 'give reforms time to work', and 'stop meddling with the structure', summed up the frustrations of many. One explained: 'I have been in post less than 10 years and in the same provider job but for four organisations, and the commissioners have changed four times, too.'
Several called for consolidation of the existing wave of reforms before implementing further changes.
Calls for an end to 'political interference' were common, with comments such as 'reduce the direct political influence of the government on the NHS', and 'let professionals get on with their jobs'.
A few focused on the position of GPs, with suggestions such as 'remove from GPs the protection of independent contractor status and make them salaried employees'.
When asked: 'What do you most fear that Gordon Brown will do to the NHS?', one wag replied: 'Try to improve it.'
The overwhelming sources of NHS terror were more reorganisation and privatisation, closely followed by more targets.
Some of the comments betray real anger and resentment, such as fearing Mr Brown will 'continue to destroy morale', or 'continue the savage cuts culture'.
But there is a trickle of comments supporting the current reforms. One reader's biggest fear is that Mr Brown will 'cave into pressure from those who do not want to change'. A second worries that he will 'roll back current efforts to modernise', while another fears Labour will 'lose the election to the Tories; we may think it's bad now, but I remember what it was like in the 1980s and 1990s'.
Yet, despite those few glimmers of approval, the overwhelming picture painted by HSJ's survey is of a government and an incoming prime minister who have lost the confidence and trust of NHS staff both managers and clinicians.
The depth of this collapse is all the more remarkable given that many Tories admit Labour has improved the health service. As former Conservative health secretary Stephen Dorrell said in Parliament on 23 May: 'I do not dispute that there have been big improvements in some aspects of the service it delivers. Conservative politicians who say the NHS has got worse since 1997 are simply wrong. That defies the evidence.'
While attempting to isolate simple reasons for the alienation of staff is risky, issues that stand out from HSJ's survey are anger, frustration and weariness over reforms being repeatedly implemented before previous policy has taken effect, and what is evidently a widespread refusal to accept the legitimacy of the private sector providing NHS services.
If Mr Brown cannot restore the trust of health service staff - the group of public sector workers that has seen the greatest benefit from Labour's spending over the last decade - it is difficult to see how he will win the trust of the voters.