(c) Steve Bell 2008

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Comparing a banking crisis and an A&E crisis is comparing chalk and cheese. Likewise, potential English voters will have personal reasons for why they might think one crisis is more significant than the other.

It is said that James Carville, campaign strategist for Bill Clinton’s successful 1992 presidential run, posted a sign at campaign headquarters that succinctly set out the key messages: “Change versus more of the same; the economy, stupid; and don’t forget health care.” English voters in all probability do not do a direct comparison of economic performance and performance in the NHS, but it is easy for a right-wing dominated press to forget the impact of the NHS. Whilst the raison d’être of the current Coalition has always been to ‘sort out the mess’ from 2010, the facts are that a series of catastrophic mistakes by George Osborne has left the economy in a dire state when it had been recovering when David Cameron was bequeathed the keys to Downing Street even having not won the General Election. Not voting Labour, furthermore, has been seen as a punishment for “fiscal incontinence”, or “reckless spending” of the Labour Party whilst in Government 1997-2010. The issue there is that the Conservatives promised to match, at least, the spending commitments of the Labour administration last time around, and there is no conceivable argument for blaming public sector nurses or teachers on a global economic crisis.

What happened was that a £0.8 trillion cash injection was pumped into the “banking crisis”, for which Labour has never been given any widespread credit (and only blame for increasing the deficit.) As such, it did not receive much credit either for the highest level of public satisfaction recorded by the King’s Fund. And yet, even daily, Conservative supporters remind potential voters about ‘the lack of regulation’ in the financial sector, even though it was the Conservatives who felt the City of London was over-regulated compared to its competitors abroad. The Conservatives have tried through innuendo to pin the Mid Staffs blame tail on the Labour donkey, and latterly tried to the pin the A&E tail on the Labour donkey. What happened in Mid Staffs, certainly in terms of substandard clinical care (whether or not you agree on the precise mortality statistics), has never resulted in an electoral backlash against the Labour Party. In fact, the “NHS brand” of Labour has been very resilient, as demonstrated in the recent poll findings from Lord Ashcroft:

And yet there is barely a ‘cigarette paper’ between Labour and the Conservatives on an ability “to steer the country through tough times”. It could be, simply, that there is a ‘time lag’ – for example, Tony Blair supporters have often argued that Labour won a General Election, in spite of the dubious (allegedly) reasons for the UK to go to war against Iraq. Likewise, people may not instantaneously (or ever at all) blame the Labour Party for failings at NHS Trusts, or the current Coalition for the A&E crisis. Yet, the reasons for these failings matter immensely, and all parties are aware of the massive importance of finding reasons for these failings with a view to ensuring that these disasters do not happen again. There is concern about whether ‘the Mid Staffs experience’ was replicated elsewhere, hence the genuine organic support for ‘Cure the NHS’ led by the inspiring Julie Bailey. The Labour Party argue that the ‘banking crisis’ could have become a real crisis felt by members of the public, with people being seconds away from being unable to take money out of cash machines.

It is possible that the best days of the ‘National Health Action Party’ are yet to come, but it is likely that the Labour Party has more of a chance to getting into government than the National Health Action Party. That of course does not stop either Party from standing up for what is right. People generally have more affection for their hospitals than banks, and this could be one of a number of reasons why there was never felt to be a need for the ‘National Banking Action Party’. Without banking, as per without hospitals, England would collapse, except the fundamental problem for the Conservatives is that hospitals as yet do not “create wealth”. It is easy to measure the success of a director in generating profit for his shareholder, as he is legally obliged to do under the Companies Act, with regard to his environment, but it is very hard to quantify degrees of bad care. ‘Success’ in the financial sense, creating a profit, in the voters’ eyes may not be paralled by ‘success’ in quality-of-care, and certainly there have been reports of people having been reported to have been given very generous pay-offs despite poor clinical care in institutions with which they were connected.

The media’s obsession with Labour’s blame for the global financial crisis is indeed staggering, and its inability to cover accurately issues such as the Health and Social Care Act (2012) has been a scandal in its own right. Parts of the media have been trying to ‘rubbish’ the NHS brand, but have latterly discovered that private healthcare providers using the NHS brand, which has a lot of goodwill, can be very profitable. An argument which the media could have argued, which they did not, either due to stupidity or incompetence, is that the NHS overall was under-regulated, in the same way the financial industry allegedly was. There has been a notion that private companies are restrained from making profit by ‘legal red tape’, but it is worth noting that much of this legal regulation is there to ensure safe standards for workers. One only has to look at reports of corporates making profit out of collapsing factories in Bangladesh to understand the importance of corporate social responsibility, and it has been an on-running theme in healthcare that employee relations when bad in hospitals or in social enterprises can be very much to the detriment of the organisation.

It would be therefore be very convenient had the Health and Social Care Act (2012) addressed any of the issues which led Mid Staffs to be unsafe clinically. It did not. That is why even in their wildest dreams parts of the news media cannot argue that the £3 bn reorganisation which nobody voted for will do anything to prevent another Mid Staffs. If anything, even with a more fragmented market, regulation of healthcare providers will be harder. Much focus has been put into ‘breaking up the monopoly’ of the NHS, rather than defending the need for a comprehensive, universal service free-at-the-point-of-use  (as far as is feasibly possible, of course). Labour does have a ‘head start’ in that it has a loyal following regarding the NHS, despite ‘controversies’ in policy, such as PFI or the introduction of NHS Foundation Trusts. Labour seems desperate to restore its ‘economic credibility’, even though it still has never won the argument, and is likely to do so in the near future. Labour politicians are lining up to establish their ‘pragmatism’ in managing the UK’s finances properly, but even the response to last week’s announcements of means-testing benefits has either been welcomed by those who would never vote Labour or derided by Labour ‘core voters’ for bringing Labour ever closer to the Conservatives.

England in my view will never learn to love Labour over its running of the economy, although it is probably fair to say that if Labour is considered economically incompetent it is unlikely to win a General Election. However, it does have an opportunity to lead on its running of the NHS. This takes real leadership from all involved in the NHS, and needs a very clear vision of what sort of society we wish to live in. This might include, for example, making Doctors, nurses, healthcare professionals, and other NHS staff feel valued, rather legally ensuring primacy of the shareholder. The A&E crisis is unlikely to get as many column inches as the banking crisis, and as such the A&E crisis hasn’t brought the country to its knees, but the thing is: in a non-financial sense, it has every potential to.