Something struck me this week as I read through media coverage of the first few days of Rishi Sunakās election campaign trail. The Mirror explained that he had travelled to a distribution centre in Derbyshire on Thursday, and while he was there an employee explained that both he and his wife had encountered long NHS waiting times. His wife had already been waiting for 3 years, and still hadnāt received the treatment she needed.
The Mirror piece says:
āMr Sunak responded: āThe area where I wish I'd made more progress is with waiting lists. A priority of mine is to cut waiting lists and we haven't made as much progress as I would have liked, I have to be honest about that.ā He then went on to blame strikes by NHS workers for the failure.ā
Itās certainly not the first time that Sunak has blamed the NHS waiting lists on the staff themselves. He began doing so in earnest last Summer and hasnāt stopped since. Try googling āRishi Sunak blames NHS staff for waiting listsā Ā it comes up with dozens and dozens of articles and videos, so many that if you know the facts of the situation, you can almost feel your blood pressure rising as you scroll. But his accusations arenāt based in fact; It is simply a fallacy to blame the waiting lists on striking workers. The Health Foundation came out with some analysis last October, and updated it recently. Itās excellent, and is well-worth reading if you have ten minutes to spare, but hereās a quote from the piece about the strikes and the waiting lists:
ā...our analysis estimated that between March and October 2023, industrial action by hospital doctors was responsible for approximately 210,000 missed completed pathways (the outflow of people off the waiting list). This accounted for just over half of the growth in the waiting list over this period but is a tiny fraction (less than 3%) of the overall size of the waiting list. For the most recent junior doctor strikes in December 2023 and January and February 2024, we estimate another approximately 58,000 missed completed pathways.ā
However, regardless of the facts, I expect weāll hear Rishi Sunak telling us that striking workers are to blame again and again as election season rolls on (not least because the NHS is currently thought to be the number one issue of importance for the public, as they decide how to cast their votes). A new poll from Ipsos shows that it has overtaken the economy in terms of issues of importance, up 6 percentage points since last month.
If we consider the situation in political terms, itās unsurprising that Rishi Sunak is attempting to sow seeds of division between NHS staff and the public. In recent years, this strategy has been enormously powerful; politicians have successfully split groups of the population, and turned them against one another with clever messaging as they push through policies, or drum up public support for the politicians themselves (who are framed as the saviours of whatever imagined crisis they have created through their rhetoric).
It worked for the Vote Leave campaign group ahead of Brexit, who whipped up anger towards nameless, faceless bureaucrats in Brussels. It worked for Boris Johnson too, who shaped his election campaign by channelling the anger of a huge portion of the electorate who felt fed-up, put-upon, angry, and in limbo. His promise to āget Brexit doneā propelled him into Number 10 Downing Street. It didnāt matter that his plan wasnāt fully formed, or that it wasnāt the most important thing that an elected Prime Minister should have been focusing on at the tail-end of 2019. āGetting Brexit doneā, after all, hasnāt led to a re-genesis of our economy, or our NHS). The division, the āus and themā rhetoric, fulfilled its aim for Johnson and his allies though.
Anger is a powerful emotion after all; in the immediacy it supersedes any other, creating an energy which is very useful to a politician. That anger, that energy, and the votes it generated, brought Johnson to power.
Sunak tried a similar tactic when he took over the premiership, with the āStop the Boatsā campaign he began in early 2023. By then, of course, the Conservative governments had been failing the public profoundly for 13 years, had ransacked the public coffers by funnelling huge amounts of money into private hands, and had little material to offer, in terms of positive, hopeful policies for the public. Rishi Sunak fell back on hatred; this time towards vulnerable immigrants who arrived on our shores in treacherous conditions. To an extent, it worked. Anti-immigration rhetoric gained a degree of traction from many of those same people who had felt embittered in 2016, and were still, unsurprisingly, embittered as their well-being and needs had still not been prioritised by those in charge. Some of these people were happy to direct their anger away from Sunak, when instructed, and towards people who were often even worse off than themselves.
But any campaign relies on its momentum and on the achievement of its goals. Sunakās government has been beset by chaos and scandal, and it never felt like there was a meaningful plan behind his anti-immigrant rhetoric. He didnāt have the benefit, as Johnson had, of a clear stop, like a General Election. Whatās more, the goal posts had shifted. Thereās only so much energy anyone can direct at vulnerable immigrants when they themselves are cold because they cannot afford to heat their house, or hungry because they cannot afford to put food on the table. These situations are not extreme examples of the poverty faced by the public; poverty levels are extraordinarily high. Even for those not living in poverty, many are dealing with challenges they hadnāt anticipated in 2024. Perhaps theyāve realised theyāll never own a house. Perhaps they have realised theyāll never pay off the student loan that they were encouraged to take out 20 years ago when they were reassured that it would be easy. Perhaps theyāre worried about their future, or their childrenās, or their grandchildrenās. Most people are worried about something at the moment.
Rishi Sunak, cushioned by his extraordinary wealth, probably didnāt anticipate peoplesā preoccupation with their basic well-being. How could he have done? He is totally out-of-touch with most people, flying around in private jets. His lack of awareness has caused him to misread the political mood. The āus vs themā anger against immigrants which he has whipped up in earnest isnāt enough to carry his campaign along and keep him safely in power as he enacts draconian, authoritative, discriminatory policies against vulnerable people.
A decent number of people may well be concerned about immigration, but itās not enough to distract people from the other more tangible problems, like the NHS. And hereās whatās interesting - with the NHS, Rishi Sunak has missed a trick; missed the point; absolutely failed to grasp the way people are feeling. He has revealed himself to be politically rigid, to lack campaigning malleability, to lack what it really takes to successfully manipulate the public into hatred against one group or another. Johnson had this dubious ability, and Sunak does not.
The fact is that the NHS is a big enough issue to be an election winner, given the right strategy. Sufficient numbers of people feel fed up and are looking for someone to blame. Regardless of the facts, a successful manipulator like Johnson could probably have convinced a good number of the public that the government wasn't to blame. Heād have concocted some other, alternative enemy. But Rishi Sunak chose to blame the striking staff, and thatās where he went wrong.
It is impossible to separate and silo the NHS staff from the rest of the public, to demonise them and blame them for the problems that millions of people face. Why? Because NHS staff are the public; a good chunk of the electorate works for the NHS.
As The Kings Fund said a couple of weeks ago:
āThe NHS in England currently employs around 1.5 million people (on a headcount basis, counting each individual member of staff) and 1.3 million people on a full-time equivalent (FTE) basis. These figures include staff in ambulance, community, mental health and hospital services, as well as those in commissioning roles and central bodies such as NHS England, making it the largest employer in England.ā
Those 1.5 million people have an acute understanding of what has happened to the NHS because of the decisions made by politicians, and they have also been treated appallingly by the government for many years, through pay squeezes and from being scapegoated for problems they havenāt caused. But it doesnāt stop there; their family members and friends are also aware of whatās going on, because they live with them, and they worry about them, because theyāre having such an awful time. I have lost count of the number of people who have contacted me simply to say they support NHS staff and are desperately worried. The group of people within the electorate who feel this way is enormous, and itās borne out in figures and polls.
Despite the enormous disruption caused by NHS strikes, the support for striking nurses actually increased from the public after the first 6 months of strikes. As the Royal College of Nursing stated in June 2023:
āA new poll by YouGov for the Royal College of Nursing (RCN) shows the level of public support for a strike by nurses is higher than it was on the eve of the first strike in December last year. Polling conducted between 9 and 11 June shows public support for nurses is higher than before nursing strikes began in December last year. The latest poll shows 62 per cent of the public support striking nurses ā the highest for any profession taking strike action ā with the majority of supporters saying they strongly support nurses. More than 8 in 10 (82 per cent) of those polled also said they support a pay rise for nurses.ā
By February this year, support for striking workers softened slightly, but the majority of people still supported strike action from NHS staff.
It is galling to see politicians attempt to blame NHS staff for problems that they have not caused, and to whip up criticism towards the very people holding the service together; yet this situation feels very hopeful too. The public supports the NHS, and they broadly support the staff, and I donāt think any politician is going to make their way into Downing Street on the back of a wave of hatred that theyāve whipped up against striking healthcare workers. There is little sympathy for politicians who have undermined the NHS.
Rishi Sunak and his spin doctors might be able to convince themselves that they can frame the NHS as an āus vs themā situation, but itās not going to work. The public supports the NHS, and support the staff. They know that the doctors and nurses and every member of every team has held the service together through all the cuts, are holding it together now, and will be doing everything they can to keep the public safe long after these politicians have gone.
What is the psychology of a man that thinks he can get the public to blame striking NHS staff for the current situation? Apart from the fact that itās not true it would be an indictment on the rest of us if we are to be attributed with thinking that NHS staff are mere chattels put on this earth to serve us for inadequate pay and conditions.
Iām having a bit of an argument over on Threads with someone who thinks the NHS being free at the point of use is unsustainable. I guess heās entitled to his opinion but I suggested that maybe he has fallen for the right wing narrative. I dare say he will tell me not to worry my pretty little head about it.