Why might 2029 be a critical year for the NHS?

Never let it be said that this blog doesn’t monitor the outermost regions of the political world to keep you informed.

Regular readers will know that I read the right-wing Telegraph commentators daily so that you don’t have to. I have posted a couple of times about how Allister Heath (Deputy Editor of the Sunday Telegraph) is planning to campaign for a referendum on the future of the NHS. His strategy is to have a referendum commitment written into the Conservative Manifesto in 2029 and have a vote to abolish the NHS in the early 2030s.

By which time he is convinced the NHS will have failed to deliver on long waits for over a decade.

The direction of this argument is congruent with much of the overall politics about the NHS we hear from Telegraph commentators. It is a firm part of the 40 year long post-Thatcherite tradition of the right in the Conservative Party. A smaller state and lower public expenditure are the goals, and the NHS is in the way of them both.

Margaret Thatcher herself though was crucially a politician and not a commentator. She did not therefore, during her long time as Prime Minister, move against the NHS model. She liked winning elections (and was good at it), recognising the political saliency of the NHS in the hearts of voters. In fact – over her time in power – she averaged an annual 4% increase in money for the NHS.

But Telegraph commentators don’t have to win elections. What is important to them is taking positions they believe in.

Not many of them are to be found in Red Wall seats trying to persuade working class people to support their right-wing politics. If they were, they would probably realise that voters there are rather in favour of an effective larger state and a stable and improved NHS.

And that is where the first important political lesson about right-wing politics and the NHS comes in. The Telegraph right of the Conservative Party want to abolish the NHS but, as a policy, this is not popular.

In another part of the right-wing jungle there exists an entirely different politics from Telegraph commentators – populism. The Telegraph commentators yearn for it but, like some on the left, expect the public to come to them.

For the left and the centre, all over the world, the thing that is most distressing about populism is…er…. it’s popular. Most of us really really don’t like what they are saying at all but, for a section of the population, right-wing populism is popular. In the next few days right-wing populist parties across Europe will do well. I, like many of you, lose sleep over the possibility of Trump being elected in America, He will however only be elected if he is popular.

Populists do well because their policies are popular. They try them out at rallies and in crowds and adopt those that get the cheers.

So, what does that mean for the NHS?

Another point about populists and popularity.

Boris Johnston was good at it. His first real national political appearance was during the Brexit campaign. It was he that introduced the idea of providing more funding for the NHS to the Brexit campaign with the infamous £350 million bus message.

(Yes, yes, I know it wasn’t true but bear with me).

Why did a populist introduce more money for the NHS into a debate about Europe? Yes, you’ve got it. It’s because the NHS is popular.

Politics (and I think much of life) for Boris was about popularity (which is what made him so psychologically well suited to being a populist).

So, the Brexit bus was evidence of right-wing populism in favour of the NHS.

The 2019 Conservative campaign and manifesto – run by Boris – was a master class in how right-wing populism can hoover up votes. Both in argument and in the reality of that government, it offered Red Wall voters a connection to a better state that did things for them. Not the smaller state of the Telegraph commentators.

The fact that we now have the highest taxes since the 1940s is deeply puzzling for right wing Tories, because they are against high taxes. But Boris recognised that his type of right-wing populism (the sort that is popular) appealed to poorer voters that needed a strong state to improve their lives.

I am loathe to write this next paragraph, so I want to start by saying that this is an historical comparison and is in no way suggesting that the current right-wing of which I speak are fascists. But if you look at all closely at the practice of fascist governments in the 1930s, they built both their electoral popularity, and their effectiveness with the public not just on the awful policies of conquest and the horrors of racism, but also by creating thousands of infrastructure jobs and spending vast amounts of public money.

They were not small state Thatcherites.

This difference in right-wing politics is potentially very important for both the wider politics of the country and the future of the NHS.

Let’s bring this analysis to the politics of the last few weeks. Boris has left right-wing politics and what remains on the right of the Conservative Party is an angry mess. The one thing that unites them (against their own Government) is lower taxes and a smaller state. Right-wing Conservative politicians are silent on the NHS but noisy on smaller taxes. Right-wing commentators are bringing those issues together by producing convoluted plans about referenda on the future of the NHS.

And then there is Reform.

Reform is a populist party not struggling under the burden of right-wing small state economics. Insofar as it is talking to the electorate it is talking to two very different groups – an older group of disaffected Conservative voters and a bigger group of what can be historically labelled as ex working-class voters (Thatcher’s 1980s economics destroyed the jobs they and their parents had depended upon and until Brexit no one had listened to them.) There is a real relationship between the leadership of Reform and many of these people.

And what does that relationship mean for the NHS?

In the period before the election the then Reform leader, Richard Tice, outlined his policy on the NHS. For him it neatly brought together an anti-green policy and a pro-NHS one.

“At a press Conference in Westminster on Monday Reform’s leader Richard Tice suggested that scrapping the UK’s pledge to reach net zero greenhouse gas emissions by 2030 could free up cash for the NHS” (Guardian 08/04)

For any other political party (the Greens for example pledged similar amounts of money for the NHS and received a lot of publicity for doing so) this would have been big news. But most commentators see something odd about a right-wing politician pledging to put much more public money into an organisation which is seen as being left-wing.

It just doesn’t compute. Don’t right-wing people want to abolish the NHS? So, they don’t know what to do with the story and it just sort of dies.

But for readers of this blog there is an understanding that the real right-wing populists want to be popular and therefore recognise the deep need that the more deprived people in this country have for the NHS.

There is therefore a split on the right about the future of the NHS. Far right commentators want to abolish it while Reform want to give it more money.

Enter Nigel Farage.

In the last week Nigel has not only become leader of Reform but has made it clear that his main political goal is, over the next Parliament, to realign the right of the country and lead it into the election in 2029. This is a big goal. And to reach it his electorate moves from the more deprived Red Wall seats to those Telegraph commentators who will have big say in the next Tory leadership campaign.

In the BBC seven-sided political debate on Thursday 6 June Nigel changed Reform’s policy (always a team player). He said he thought we should change the NHS funding model and move to an insurance scheme.

This was very odd. Odd mainly because he is now in favour of something a bit complex and which, if he sticks to the policy, he is going to have to explain to his supporters. This will be much harder political work that his usual stance of being against something. And more to the point – won’t it be difficult to say that Reform now wants to abolish the NHS?

I think there are a number of strands to why this has happened. Nigel Farage has a decade-long history of being a popular populist. He spends time and effort connecting with his electorate. In 2019 Boris Johnston did it better. And Nigel has not only faded from the national political scene but is (as he said himself a fortnight ago) much more interested in US politics and flying across the Atlantic. His politics is less rooted in the people with whom he needs to be popular. He will have lost touch with the inconvenient affection that many Reform supports have for the NHS.

He also (see above) wants to lead a realigned Conservative into the 2029 election and will therefore, like me, be reading the Telegraph commentators. He will have picked up their hatred of the NHS.

I don’t want to big this up too much, but it is possible that looking at the politics of the NHS in 2029 this is all very important. Nigel has set himself the task of having to explain to potential supporters how an insurance system will be better that the NHS (Good luck with that).

He has also moved Reform away from an element of populist politics in order to align himself with the people who could well run his campaign to lead the Conservative Party.

And to do that he has picked up the politics of the very few and rejected the politics of the many.

Not too good for a populist.

But all of this is much less significant for the future of the NHS than what is normally contained in this blog. If by 2029 we are not back to the shorter waits of 2010, leading a campaign against the NHS will be a lot easier.

Over the next few years, it is the experiences that real people have of the real NHS that will see it through to its future. Getting that right is much more important and if we do Nigel Farage and the right won’t matter.

If we don’t…. this post may be important.