At the end of last week I discussed the voting intention figures from the recently-reported (though conducted in November) Lord Ashcroft ‘mega-poll’. Interesting though those findings doubtless were to regular readers of the blog, the main purpose of the poll was not simply to test the waters regarding voting intention. Rather, the bulk of the poll was devoted to exploring public attitudes to, and experiences of, the NHS. Large samples of voters in Scotland, Wales and across the regions of England were asked about the health service through a range of different questions.
I’m not going to attempt to summarise all the findings. The tables of results published by Lord Ashcroft come to very nearly 850 pages, so it would take a lot of summarising! Nor am I going to make any personal contribution to on-going arguments about the management of health across the UK – that would be straying a long way beyond my professional competence. Here I simply want to point out what I think are three main general points to be drawn from the morass of detail in Lord Ashcroft’s poll. But while doing so, I very much also want to encourage all of you to take some time to look through the detailed poll results for yourselves.
First point. The manner in which the poll was conducted and reported (which decent-sized samples in Wales and Scotland, plus a very large one across England) allows us to make fairly robust comparisons between attitudes in the different nations and regions of Britain. And when we do compare attitudes, the picture that emerges is not flattering to the NHS in Wales. The NHS is a bigger concern to people in Wales than elsewhere in Britain, while direct evaluations of the service offer poorer ratings here in Wales than the rest of the country:
- When asked to nominate the ‘most important issue facing Britain’, the NHS comes fourth in Wales. But it is chosen by a higher percentage of survey respondents in Wales (14%) than in any other region/nation in Britain. When respondents are asked for the most important three issues, the NHS is again chosen by more people in Wales than anywhere else;
- When asked about the ‘most important issue facing you and your family’, Wales again has more people nominating the NHS than anywhere else in Britain;
- When people are asked whether they would ‘recommend’ any NHS care they had received to friends or family, respondents in Wales gave the worst ratings of any nation or region in Britain;
- Respondents were asked to rate, on a 0-10 scale (with 10 being the best rating) the quality of their personal experiences of the NHS. Scottish respondents gave an average rating of 7.53, English ones 7.38, and Welsh respondents only 7.23;
- When asked to make a more general rating of the NHS on a similar 0-10 scale, Scottish respondents gave an average rating of 7.01, English ones 6.40, and Welsh respondents only 6.06. Some 16% of Welsh respondents rated the NHS at between 0 and 3, compared to 8% of English ones and only 5% of Scots;
- When asked whether the NHS had improved or declined over both the past 5 years and the past 25 years, Welsh respondents were less likely than both English and Scottish ones to detect improvements and more likely to perceive declines;
- Similarly, when asked to look forward to the next five years, Welsh respondents were (albeit only slightly) the least likely to expect improvements, and the most likely to expect the NHS to get worse.
Quite what implications one draws from this for debates about how the NHS should be managed in Wales is for others to consider. But for all of us in Wales, these ratings must be rather disheartening. The findings also suggest why the Welsh NHS is likely to remain an issue in a UK general election where control of the NHS here is not obviously at stake.
My second point relates to another set of questions in the Ashcroft poll, where it asked respondents how important they thought the NHS was to the different parties. Again, this question used a 0-10 scale. Here are the mean average ratings given for each of the main parties by the Welsh sub-sample:
Liberal Democrats: 5.4
Plaid Cymru: 5.9
These results are clearly rather more heartening for the Labour party. One can readily see that, whatever difficulties might face the NHS in Wales, Labour retains a significant advantage over the other parties, and particularly the Conservatives, in being seen as caring more about the service. The NHS is, though, not absolutely and inevitably owned by the Labour party as a political issue: in Scotland, the SNP has a mean average rating of 7.0 on the NHS (with Labour there rated at 6.5).
A final point. One very disappointing aspect of the poll was the almost total lack of recognition of devolution, and the fact that the NHS is managed separately in Scotland and Wales from England. This comes through quite explicitly in a small number of questions: most obviously in one of the final questions, Q24 (see pages 701 and following in Lord Ashcroft’s published details), which talks about “the government” having “introduced a number of NHS reforms”. There is no acknowledgement that the relevant government for managing the NHS differs across Britain, nor that the reforms that have been introduced in England might not be relevant to survey respondents in Scotland and Wales. Similarly, earlier on when there is a question regarding which people survey respondents would ‘trust to tell the truth on the NHS’, Jeremy Hunt and Andy Burnham – the Secretary of State for Health and his Shadow at Westminster – are listed; no attempt is made to identity equivalent relevant figures in Holyrood or Cardiff Bay, nor to suggest that Hunt and Burnham might only be directly relevant to debates over the English NHS. I’ve greatly admired many of the contributions Lord Ashcroft has made to political polling in the UK in recent times, but I think this complete ignoring of devolution – in probably the highest-profile devolved policy area for both Scotland and Wales – was both unpardonably sloppy, and a great missed opportunity. It is amazing to me that even sophisticated political operators like Lord Ashcroft seem sometimes to ‘forget’ that devolution exists.
Postscript (21/01/15): Tables for this month’s ICM/Guardian poll have been released. This poll has a standard sample size (just over 1000), and a Welsh sub-sample of only just over 50, so it is distinctly more hazardous doing cross-regional comparisons. However, the poll includes a small number of questions that touch on the NHS, most particularly this one:
‘Which of the following do you think best characterises the current condition of the NHS?’
with the following response options:
- It is working well, with few problems that are not being dealt with
- It is feeling the financial squeeze, but generally functioning satisfactorily
- It is struggling, and not delivering services it should in some places
- It is not coping with the demands being made of it, and is in danger of ceasing to exist in the form that Britain has known it
- Don’t Know
The pattern of responses in the Welsh sub-sample was:
Working Well: 10%
Generally Satisfactory: 12%
Not Coping: 50%
While comparisons between such relatively small sub-samples should be made with considerable caution, it may be worthy of note that the proportion choosing the ‘Not Coping’ option in Wales was substantially higher than anywhere else in Britain. In line with the Ashcroft results it was lowest in Scotland (26%, barely half the level in Wales), and also lower throughout England. Indeed, in no other ‘region’ did even 40% choose the ‘Not Coping’ option.