The Conservative manifesto’s centrepiece of “get Brexit done” links to its NHS commitments: with Brexit out of the way, the government can focus on other priorities – and the NHS is the first. The effects of austerity on NHS performance, alongside an increasingly older population, have led to longer waiting times and poorer service. As in all elections, the NHS matters. In this one, the links between Brexit and the NHS matter too.
The NHS is key to the Tories winning votes from pro-Brexit “left-behind” communities in the north of England. Their views are seldom reflected in social research; they don’t join focus groups or answer polls. Our project, with more than 200 street conversations in three northern English towns, gives some insight into how they might respond to the manifesto.
The prime minister, Boris Johnson, has already drawn widespread scepticism over an NHS funding promise made during the Brexit referendum. The manifesto promises “more than £650 million extra a week” – a clear allusion to the discredited weekly figure of £350 million on the Brexit bus.
Almost no one we spoke with believes the promise on the bus. They refer to it as “bullshit”, a “pack of lies” or a “complete hoax”. Mostly they don’t think anyone believes it, though a few admit that they did at the time. Some say that it would be lovely if they could believe it. They would like Brexit to mean more money for the NHS, even while they understand that it won’t.
People want more frontline staff, especially nurses. They often express regret that it seems so hard for young English people to become nurses. The manifesto’s promise of a £5,000-£8,000 nursing bursary may help, but student nurses will still incur debt in order to cover their fees.
Of the manifesto’s pledge of 50,000 more nurses, it transpires that 18,500 are actually retentions – that is, not losing the staff we currently have.
When we talked with NHS staff, they sometimes spoke of morale issues brought about by the effects of working in a failing service and of increasing control by managers seeking greater “efficiency”. More staff won’t solve this. What NHS staff want is a meaningful discussion about where changes (and money) are needed.
A question of trust
Many people we talked with in northern English towns are sad, demoralised and distressed. They worry about the future of the NHS. And some are very angry.
People feel strongly that they do not trust Johnson with the NHS. One person suggested Johnson should be “nailed to the bus” as punishment for the deception that Brexit would mean better NHS funding. Others would like to see him prosecuted and sent to prison.
But there is an equal lack of trust in all politicians. They are seen as all the same “liars and crooks”, “sods and lying bastards” who “lead you down the garden path” then let you down. Neither party manifesto can overcome this underlying rupture of faith in the UK’s political system and feelings of disempowerment.
Can we afford the NHS?
The Conservative manifesto restates a commitment to the NHS being free at the point of use. The people we talked with are critical of having to pay for anything associated with NHS care, including hospital car parking.
Labour has promised to end parking charges. The Conservative manifesto doesn’t go this far, offering free parking only to some groups, such as disabled people, parents of sick children staying overnight and staff working night shifts. This probably won’t be enough to persuade the people we talked with.
Perhaps the biggest surprise in our conversations is that many people feel that, as a country, “we can’t afford” their ideal of what the NHS should be, or was in the past. People said we need to take personal responsibility for our health, which chimes with the Conservative manifesto promise of a new strategy to empower people to live healthier lives.
And people also said that, because we can’t afford it, we will have to privatise the NHS. This is something many suspect Johnson is eager to do – despite his protestations to the contrary.
Labour will have to work hard to convince people in the north of England who think this way to embrace their economic model, which seeks to return to Nye Bevan’s ideal of a more nationalised NHS.
Tamara Hervey receives funding from the ERSC's Governance after Brexit programme ES/S00730X/1. She has previously received funding from the ESRC, European Commission, AHRC, and the Leverhulme Trust. She is a specialist adviser for the House of Commons Health and Social Care Committee. She was a member of the Advisory Board of 'Healthier In', which campaigned to remain in the EU.