A couple of months back I wrote a short piece for the People’s History of the NHS blog comparing the way healthcare featured in both the UK’s EU referendum campaign and the Australian federal election. Following the news that the campaign slogan/promise (delete depending upon political stance) has been quietly but officially dropped – of course, Nigel Farage dramatically distanced himself from this line only hours after the result was announced, but then it wasn’t his part of the Leave campaign that used it, it was those campaigners who are now the ministers in charge of delivering Brexit – it’s worth a quick recap of a few points.
In the run-up to Britain’s referendum on its European Union membership, the Electoral Commission declared Vote Leave’s £350million per week slogan to be ‘misleading’. Certainly some voters decided to vote ‘leave’ in the mistaken belief this was a promise extra funding for the NHS.
In one sense, this is an old story of those not ideologically aligned with a socialised health service seeking to associate themselves with the NHS to demonstrate national leadership across the usual political divides. This was something the Tories have done since the 1950s, understandably, given its continuing popularity (greater than that of the Monarchy or the BBC). And it was especially noticeable during the EU Referendum, not least because of who was speaking about the NHS. They may have brandished half-promises of extra funding on the side of their campaign bus, using the NHS as a national rallying cry, but they tend to be from the traditionalist wing of the party where antipathy towards the NHS is not hard to find. Former Conservative Prime Minister John Major memorably highlighted this during the campaign:
“I mean the concept that the people running the Brexit campaign would care for the National Health Service is a rather odd one. I seem to remember Michael Gove wanted to privatise it. Boris wanted to charge people for using it. And Iain Duncan Smith wanted a social insurance system. The NHS is about as safe with them as a pet hamster would be with a hungry python.”
During the campaign there was suspicion a post-Brexit right-wing government would be emboldened to dismantle the NHS, even as they used the health service as a fig leaf of national unity. And with Theresa May’s government tacking to the right on grammar schools, it would not be hard to believe that keeping Cameron’s health secretary in place signalled only delay. If that did happen, the public may well not be surprised. Fifteen years after May’s warning that many see them as “the nasty party”, the Deputy Chairman of the party recently warned that “working people” see them as “the party of BHS and not the NHS – by BHS I mean the corporate, awful revolting people like that Phillip Green and the dodgy guy he sold it to”.
And this is where the Australian parallel really comes in. Accusations of privatisation were levelled at the centre-right government after years of dabbling with outsourcing and cutting funding, indirectly increasing patient charges. This meant the electorate was ready to believe the worst and healthcare became a toxic issue that, to everyone’s surprise, almost robbed the Turnbull government of its majority.
The British electorate may well be ready to believe the worst of the Tories on the NHS, but that didn’t stop them winning an election in 2015 or a EU Referendum result a year later most loudly cheered by those on the right. The six years of David Cameron’s Coalition and Conservative governments were dogged by controversial structural reforms of the NHS and the ongoing contract dispute with the junior doctors, but they were given some space by accepting a central premise of the NHS: any notion of paying to visit the doctor has been kept firmly off the agenda. In this sense, although the NHS may have been reformed beyond recognition from that founded by Health Minister Aneurin Bevan in 1948, it is still committed to the “collective principle” he outlined in his 1952 book In Place of Fear:
“The collective principle asserts that the resources of medical skill and the apparatus of healing shall be placed at the disposal of the patient, without charge, when he or she needs them; that medical treatment and care should be a communal responsibility that they should be available to rich and poor alike in accordance with medical need and by no other criteria. It claims that financial anxiety in time of sickness is a serious hindrance to recovery, apart from its unnecessary cruelty. It insists that no society can legitimately call itself civilized if a sick person is denied medical aid because of lack of means.”
If the May government was to extend its rightward shift to the NHS, dabbling with introducing patient fees for visiting the doctor (something there is always talk of on the Tory backbenches, at least), then we should see this in the UK-wide context where, beyond England, the move has been in the other direction. It is tempting sometimes to consign NHS prescription charges as a political issue to history – being put to rest when Harold Wilson’s 1960s Labour government reversed its own abolition of them – but that overlooks the vast exemptions introduced after 1997 and their abolition by devolved administrations in Wales (under Labour in 2007), in Northern Ireland (under the power-sharing Executive in 2010) and in Scotland (under the Scottish National Party in 2011).
We know now that Theresa May’s Brexit government will not be sending the fictional £350 million a week to the NHS. Should this be followed by a move to the right on healthcare as we’ve seen already in other areas, it would fit into a whole series of larger narratives. A strident march to the right for her party and a polarisation more widely would also have to be seen in the context of her presiding over an increasingly disunited kingdom.