Do the public care about the NHS reforms?

A lengthy and complex bill to radically restructure a public institution is never going to capture the popular imagination. But the mess that is the passage of the Health and Social Care Bill suggests more than just a failure to inspire.

According to today’s Mail on Sunday, Cameron’s pollster Andrew Cooper has told the inner circle that the party is vulnerable on the NHS. He’s not alone in this, with Tim Montgomerie at ConservativeHome reporting that a Tory Cabinet minister has likened it to the poll tax. The e-petition to abandon the Bill has easily passed 100,000 signatures, and Ed Miliband has warned that the NHS will be ‘a defining issue’ at the next election if the changes go ahead.

But even if the NHS reforms are unpopular, that doesn’t mean that people particularly care about them. The crucial question is one of salience: whether or not the reforms can attract the attention of many outside the Westminster and medical villages.

There’s no doubt that the reforms are unpopular. According to YouGov, only about one in five (18%) supports them, with nearly half (48%) opposed. On the central question of the impact of increasing competition in the NHS, two thirds (66%) think health services will be unchanged or made worse.

Even among the government’s supporters, there is little enthusiasm for the Bill. Fewer than half of Tory voters (44%) think more competition would make services better, with an equal number saying they would be unchanged or worse. Lib Dems are even less supportive:

So there really is very little love for the reforms. But these are prompted concerns: they don’t tell us how much this actually matters to the public.

Over the last few weeks, the issue has shown some increase in salience, according to YouGov’s issues tracker. At the start of January, health was only the sixth-most named issue as the most important facing the country. Now it’s third, behind only immigration and the economy.

But we should keep some perspective here. Health may have increased in salience, but the economy is still seen as an important issue by 2.5 times more people.

Looked at another way, the results show that only one in three people thinks that health is one of the top three issues facing the country. It hardly seems the defining issue of the age:

To be fair to those who say the Bill is a potential disaster for the Tories, there doesn’t need to be a mass uprising for the reforms to spell trouble. The damage to the party could be less tangible.

The argument is that Cameron helped the Tories to be trusted on the NHS, which – since the NHS is the closest thing we have to a religion – detoxified their whole brand and so made them electable. If the Tories were to lose this trust, they would once again be the nasty party.

It’s certainly true that the Tories have lost trust on the NHS relative to Labour. Soon after the last election, the two parties were about equal in terms of being the most trusted for the health service; now Labour have a 10pt lead.

But the trouble with this is that, while it suggests that the Tories have lost trust on the NHS, it doesn’t take into account that they’ve lost trust on everything else as well. Since the election, the Tory polling lead of 7pts has become a Labour lead of 1pt. Accordingly, their lead on each named issue has also fallen away.

YouGov regularly track which party is seen as strongest for various policy areas, including the NHS. Around the last election, the Tories’ average score on these areas was 37%. It is now 30%, and their level of trust on the NHS has moved almost exactly in line with the average: remaining several points behind other policy areas.

We can use the same trick to see how Cameron’s leadership has changed the party’s image on the health service. According to the view that he detoxified the Tories on the NHS, we should expect to see that it was a particular weakness when he took over, and that he improved the score more on the NHS than on other areas.

But the data suggest that, in the public’s eyes, there was very little specific improvement in trust of the Tories on the NHS under Cameron before the 2010 election.

What there was, instead, was a general increase in how the party was viewed on all issues. The gap between the NHS and other policy areas decreased, but only slightly, and not enough to support the view that there was a revolution in trust of the Tories on the NHS:

This is course only measures public attitudes, and not how elites viewed the Tories. It’s entirely possible that there was a Tory detoxification on the NHS among some politics watchers, which didn’t filter through to the rest of the population – or filtered through in terms of a general improvement in brand perception.

So I take two conclusions about what the health reforms mean for the Tories in terms of public opinion.

Firstly, the Bill has very little public support but still quite low salience. Even if it does become higher-profile, the question of the future of the NHS remains still of much lower importance than the big issues of the economy and immigration. From Labour’s perspective there’s a double challenge of getting people aware of the changes, and also convincing them to care.

Secondly, the improvement of perception of the Tories on the NHS over the last few years looks to have been overstated. It’s possible that pre-election NHS pledges lifted the Tory brand, and that damaging their reputation on the NHS now would undermine their brand. This is more likely to be true among those who pay a lot of attention to politics or the health service, but there is little evidence that the general public noticed and were swayed by the earlier promises, or that the current reforms are close to retoxifying the brand.


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