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Survival of the slickest?

Polling figures show Cameron is out in front, but only because the public dislikes him less than Brown

A silhouette of a politician giving a speech in front of the UK flagThe latest polling figures for the General Election show voting intentions at 40 per cent for the Conservatives, 32 per cent for Labour and 16 per cent for the Lib Dems. What is clear is that the general public is not that keen on elections and voting. 'None of the above' is what most people would vote if it was an option, and of those who claim they are 'absolutely certain to vote', around half will have changed their mind on which party they will vote for in the run up to the election.

This is hung Parliament territory, the swing is not sufficient to give the Conservatives an overall majority if there is a uniform swing across the whole country. Turnout is critical to the outcome of the election. When Blair won his landslide in 1997, 72 per cent of the electorate voted, today, only 52 per cent say they are 'absolutely certain to vote', although it is unlikely to be this low on the day. Crucially, those least likely to vote are Labour supporters.

At 52 per cent current voting intention figures suggest that Cameron will go to the Palace as Prime Minister. If instead the turnout was 78 per cent, Labour, with the support of the Lib Dems who have said they will support the party that gets the most seats in this election, could have a coalition government. The reality will lie somewhere between the two.

For the Conservatives, how do you campaign for a low turnout on election day? At this stage the most likely outcome is a hung Parliament, which will mean short-term paralysis until another election is called.

Issues are about 40 per cent of electoral determinants, while party and leadership image make up for the rest. The most overwhelming issue for the public at the moment is the economy (at 39 per cent) followed by healthcare. While the Chancellor may have announced that we are finally out of recession, the public are yet to believe this – slowly but steadily confidence is returning. The degree to which this will have increased by election day will have an impact on the outcome.

 

Most Important election issues
Looking ahead to the next General Election which, if any, of these issues do you think will be very important to you in deciding which party to vote for?

Most important election issues

 

Popularity contest
When it comes to image, our polling findings show that around 35 per cent is the image of the leader, and 25 per cent the image of the party. Cameron is out in front, as the electorate dislikes him less than it dislikes Brown. Grammatically a difficult way of explaining it, but ultimately Cameron has to beat Brown; whether that's because we dislike him less or like him more is neither here nor there.

Whatever the final outcome, any Chancellor is going to be faced with an out of control budget deficit and national debt at the highest level since records began. Reigning in spending is going to be a key issue, but the general public doesn't want across the board cuts, it wants priorities to be set and services protected.

Clearly, one of the areas in which the public won't tolerate cuts is the NHS, with 82 per cent saying it should be protected. Indeed, more people want to protect the NHS from spending cuts than education, this is possibly why David Cameron said that his three priorities were N. H. S.

Health is clearly an important policy area for the Conservatives, they want to persuade voters that they will protect or even improve services while Cameron has presented himself personally as a friend of the NHS. On a Conservative Party poster released in January 2010, Cameron said: "We can't go on like this. I'll cut the deficit not the NHS."

The end of an era
What would an NHS under the Conservatives look like? Clearly, the economic environment will lead to increased pressures on the NHS budget. The Conservatives would like to cut 'red tape', rather than frontline services, estimating this could save £4bn a year, by reducing the cost of health service central bureaucracy by a third.

In addition, they pledge to end top-down targets in the NHS, which would be replaced by an emphasis on outcomes. This might be through measures such as PROMS (patient recorded outcomes) and clinical outcomes. Cameron believes that the Conservatives can get rid of targets at the same time as raising standards. By increasing patient choice and providing more information to patients to inform that choice, he believes this will force providers who don't provide good quality services to 'raise their game'. Interestingly the Labour Party has also suggested that there will be less need for targets in the future.

 

What can be cut?
Which TWO or THREE, if any, of the following main areas of public spending do you think should be protected from any cuts? And which TWO or THREE, if any, of the following main areas of public spending do you think should be cut to restore public finances?

What can be cut?

 

A patient-led service
Patients would have increasing choice over where they receive treatment, which is likely to include provision for more use of the private sector. They may also have more control over their health records, managing them personally online, and scrapping the massive spend on Labour's centralised IT system.

There will be a need for more information about the quality of services available to patients so they can make informed decisions, which may include the views of patients themselves, again published online. This potentially changes the dynamic between patients and physicians, with care provision being more customer or consumer based.

New ways of commissioning
There is likely to be an increased focus on clinicians commissioning services. GPs would be able to negotiate the best deal for their patients by considering private sector and third sector providers. There is also likely to be more payment by results, based on both the views of patients and on outcomes. This approach means putting providers in competition with each other: open and fair in Cameron's view.

This means that providers will have to find new ways of measuring medical outcomes and patient experience to help develop the intelligent commissioning of services.

Giving control back to clinicians
The Conservatives want the NHS run by clinicians, not politicians. They want to remove the burden of bureaucracy and reporting to civil servants from NHS staff. Their NHS board will be independent of government and of political interference and will be able to allocate money to the regions where there is greatest need. This is to stop perceptions that resources are allocated according to political, rather than medical need.

Cameron has promised to stop further reorganisation of the NHS and implement a moratorium on the closure of District General Hospitals, their A&E and maternity units. He argues that Labour bases these reorganisations on the needs of staff, not on the needs of patients. In addition, there is opposition to the polyclinic plans that came out of the Darzi review, instead, favouring family doctor services and local GPs.

And finally…
The Conservative Party has promised that drug pricing will be reformed to ensure that patients will have access to all clinically effective treatments, especially cancer drugs. This is not simply emotive, it is a potential vote winner. (As PM goes to press, eight cancer patient support groups have come together to express their extreme disappointmentabout NICE's decision not to make Vidaza available through the NHS.)

Cameron is clearly trying to change the Conservative approach towards the NHS, being pro-NHS is traditionally very un-Conservative, yet even under Thatcher, spending on the NHS increased. However, 2010 is a different world, with a huge budget deficit. There will have to be cost-savings, but no government can allow a doctor or nurse to lose their job as a result. The service will become more patient-led, with experience and outcomes data high on the agenda. And every effort will be made to avoid cries of: "We can't get access to the best drugs."

What is important in the election is not the gap between Labour and Conservative, but the share for each party. If the Conservatives don't achieve 40 per cent of the vote share, they won't have an overall majority. Whether Cameron makes it to Number 10 is difficult to call, but if he does, the NHS will have a tighter budget to manage, and a patient-led service that will rely on patient experience and outcomes.

The Author
Sarah Phillips is head of health at Ipsos MORI

To comment on this article, email pm@pmlive.com

25th March 2010

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