‘If the NHS is not fixed by the next election, then I am quite happy to suffer the consequences.” Tony Blair threw down that challenge in 2002 in the wake of the Rose Addis case. That old lady was sucked into the party political vortex when her MP, Iain Duncan Smith, then leader of the opposition, claimed that the National Health Service had treated her worse than a dog. Certainly she had spent a long time on a trolley, apparently unattended, at the Whittington hospital in north London.
The Addis case resulted in a messy draw. The hospital staff joined the government in rejecting the accusations. The Labour machine smeared the patient’s reputation, suggesting that she had rejected care offered to her by black staff. The spat dragged public esteem for all politicians to new depths.
When Neil Kinnock was Labour leader a party election broadcast highlighted the case of Jennifer Bennett, who was awaiting an operation for glue ear. The so-called war of Jennifer’s ear also ended with no clear winner, again because the facts were complicated. Only one thing was clear to voters: that politicians had demeaned themselves by exploiting the case of a sick child in a glare of national publicity.
With those experiences etched on Britain’s political psyche, last week mouths fell open in the Commons when Michael Howard launched an assault on the prime minister over Margaret Dixon’s postponed operations. The Tory leader was taking an enormous gamble. What unforeseen elements might emerge from the minute scrutiny by Labour and the media that was bound to follow? In any case, could it be sensible for the Conservatives to draw attention to health, an issue on which they always lag behind Labour?
Labour’s political ascendancy has been closely correlated with the saliency of health as an issue of concern to voters. During most of the Tory years in power, opinion poll results showed that health was some way down the list of people’s chief anxieties. But by 1997 Labour had forced it to the top. Since then the Tories have had two options: either to change their policies so as to convince voters to trust them with the NHS, or to push health off its top spot by making other issues seem more pressing.
Tory efforts to win public confidence on health have been faltering at best. The party has largely avoided discussing the issue. Its policy work has centred on supplementing the money provided by taxpayers to healthcare by attracting personal funds. The Conservatives promise to offer patients who have waited for operations in the NHS a 50% subsidy for immediate treatment in the private sector. The policy, known as “the right to choose”, has substantial merits but it can easily be misrepresented as “the right to charge”, as John Reid, the health secretary, did last week.
The Conservatives have put most effort into re-ordering the public’s list of priorities, with marked success. Immigration, security from terrorism, and crime and disorder have climbed in the polls while health, education and transport have slipped back.
Those developments help to explain why our politicians compete with each other to strike illiberal postures. Incidentally, it is the background to the game of chicken being played with our civil liberties as the House of Lords debates the government’s legislation on house arrest for terror suspects. The Tories are nervous that if they defeat the government they will appear soft on national security.
Given the Tories’ achievement in relegating the health issue, many thought it unwise for Howard to push it back into the spotlight.
I disagree. Margaret Dixon is much more effective than an opposition spokesman could be because politicians are discredited. The Tories have spotted that Blair’s worst moments come when a real person gets up close. He was savaged over Iraq by a television studio audience. During the last election Sharron Storer berated him outside a Birmingham hospital. Recently Maria Hutchings marched out of Five’s programme The Wright Stuff, shouting “That’s rubbish, Tony”, unhappy with his response to the plight of her autistic son. Marion Baxter, a Brighton nurse, asked the prime minister if he would wipe someone’s backside for £5 an hour.
These brushes with the reality of particular cases dent the government’s generalised claims to have improved healthcare and other public services. Statistics mean nothing to the public. Voters rely on generalised impressions. Interestingly, negative reports from third parties, such as Margaret Dixon, can be highly influential even with a person whose own medical treatment has been satisfactory. Voters wonder whether they can trust their own experiences. Certainly they do not trust Blair.
Howard knows that health professionals’ opinions of Labour have been transformed since 1997. The enthusiasm they felt when Blair bragged of having just 24 hours to save the NHS has been squeezed out beneath the weight of hospital bureaucrats and paperwork. The Conservatives have been careful in the Dixon case to avoid Duncan Smith’s mistake of criticising care staff. The finger now points at the administrators who have no friends inside or outside hospitals.
Seeing Dixon on television it seemed highly unlikely that Labour would succeed in smearing her. Seasoned politicians watched her interview with admiration and envy as she guilelessly handled the questions. She paid tribute to the government for what it had achieved in health, but thought that public money could be better spent. She and her husband had twice voted for Blair and would decide their next vote on the eve of poll. But she felt that she had to blame the government for what had happened to the health service.
Reid was nearly lured into visiting her, but spotted the trap and slunk away to engage in some party political ranting. If a Martian had been asked to say which of the two was the accomplished professional communicator it would not have hesitated in identifying the softly spoken Dixon.
Labour claimed that the Tories had done it a favour by opening up the health issue. It certainly does not look that way. Howard has tarnished the government’s record in an area where it takes pride. Labour would have raised the health issue at some time during the campaign, so it is as well for the Conservatives to open it up early and on their terms.
Elections, like other battles, are largely about morale. Howard’s deserted him some weeks ago but it has returned now. He has had huge exposure in the media in recent weeks. His policy initiatives have been deftly launched. For example, his offer to cut council tax for pensioners was accompanied by letters from him to millions of voters and massive coverage in local newspapers. Last week regional television stations turned their attention to postponed operations. The Tories are calling the shots.
Labour morale is not good. Charles Clarke’s performance in the Commons last week on the terror legislation was lamentable. His incompetence conjured a massive Labour rebellion from thin air. The government’s narrow escape from defeat owed everything to those Liberal Democrats who stayed away from the vote.
Howard cannot compete with Blair on charisma. The electorate shows no sign of warming to him. So he has decided to do what he is good at. He is a bruiser with a ruthless streak. His ferocity intimidates his opponents. Few expect him to win the election, which frees him to take enormous risks.
He is assisted because half the Labour party is delighted to see its campaign going badly. The left can blame the shambles on Alan Milburn, appointed by Blair to manage the election. If only Gordon Brown were running the campaign (as he did in 1997 and 2001), all would be well. Its consolation: a reduced Labour majority would hasten Blair’s retirement.
Margaret Dixon’s case may not do Blair massive damage. But it helps Howard to exploit Labour’s divisions. Maybe in 2002 Blair would have been more prophetic if he had said: “If Labour’s schism is not fixed by the next election, then I am quite happy to suffer the consequences.”
