The NHS reforms could be the coalition's poll tax - but may well not be

After a year in parliament, and more than 1,000 amendments in the House of Commons and the House of Lords, the government got a majority of 88 and finally passed its health reform bill. There has been a huge amount of wailing and gnashing of teeth amongst the political classes and professionals, with more vigorous opponents suggesting this means the end of the NHS as we know it. But when we ask the public what they know about government reforms to the NHS, whether under the previous government or with Andrew Lansley at the helm, most say they know little or nothing. Ipsos typically has found around a quarter of the public who say they know what the government is doing in health care reform – whoever is in charge. In some ways campaigning by both the Labour party, and the most trusted professions in the Uk – GPs and nurses – could be deemed a failure, if it was intended to get the public out on the streets. So far, anxiety about the NHS remains well below the average of the Labour years, or indeed the average of the last two decades, even as the Bill completes a turbulent parliamentary passage. Only 22% see the NHS as the biggest issue facing Britain, well below the average of 38% of the last 20 years. Why? In part because much of the debate has been technocratic and managerial and about the machinery of reform. And in part because the public remain much more satisfied with NHS services than they were in the 1990s – as our tracking surveys show. billions of extra spending has made a difference. Debates about commissioning arrangements leave most people cold. So in some ways, it may be that like previous waves of reform, the government’s changes to the NHS will be somehow got through, despite the challenges, and join a host of other reforms over which many were deeply hostile, but which came to be accepted, or even seen as broadly sensible. Will Andrew Lansley be vindicated? I remember the furore inside the Labour party when they passed the 2003 Act setting up Foundation Trusts. John Reid and the Chief Whip, Hilary Armstrong had a really tough time despite a vast government majority . Their own back benchers argued it was privatisation through the back door and would create a two tier system. Public concern about the NHS declined in the following years. Similarly as a young researcher, I advised the Thatcher government on their privatisation of the water industry. The idea of selling off national assets like reservoirs was in some ways as popular as the recently abandoned forestry sell off. But the minister Nicholas Ridley, ignored public concerns and protests – I can vividly remember him saying that “they’ll forget about it next year” – and as far as water privatisation was concerned he was right. Few are worried today or suggest reversing utility sell offs. Or health reform may be like the Poll Tax. Here concern rose from nowhere and hit 49% during Mrs Thatcher’s last summer as PM - before she went and it was abandoned. We’ll know by 2015. The key issue will be actual waiting times and actual patient experience. This, along with accompanying media coverage which amplifies and confirms public anxieties, is how the public judge the NHS. Its chief executive says it is now facing “the most dangerous moment” since its creation , as it attempts a reorganisation so large you can see it from space, AND year on year savings which no comparable health care system has ever managed before. The challenge will come if the Daily Mail and Telegraph et al decide to major on growing disparities in treatment around Britain, or generally rising waiting times, which will be blamed on the government. Stories about “unfairness” are what government will need to avoid: 73% of the public believe that treatments should only be available via the NHS if they are equally available everywhere. On waiting times, our analysis showed a tipping point applies: when waiting times fell, the public didn’t really notice, until they fell dramatically. If waiting lists start rising, public concern will not follow immediately – but if they go past a certain point – and break David Cameron’s promise to keep them down, then Labour’s current lead on the NHS might actually matter in the 2015 election.

Everything depends on what now happens out there in real life, rather than in the House of Commons.

Ben Page wrote this article for the Health Service Journal.