The accepted rule is that it’s the economy – and perceptions about it – that determine election outcomes.  But with just 16 weeks to go before voters place their crosses, we should just pause and check this assumption.

Something changed over the last few weeks: the NHS has leaped up the public’s agenda and now vies for top concern slot, alongside the economy. And immigration remains in the mix as well.

The surge in concern about the NHS is easy to understand. Hospitals in most regions have moved into special measures as a result of extreme pressures on Accident and Emergency services. A&E waiting time targets are being missed. Health professionals are talking openly about a service in crisis.

The timing couldn’t be more awkward for the Conservatives. Just as the economy begins delivering an unexpected bonus for the party, through dramatically lower inflation and the attendant boost to any ‘feel good’ factor, the most widely revered public institution, the NHS, appears to be tottering. The Conservatives want a relentless focus on the economy.  The public’s attention appears to be marching off in another direction.

The two issues now vie for top slot in voter concerns.  The economy plays to the Conservative’s advantage; the NHS to Labour’s. We now have different parties with different agendas. Is this a struggle leading only to a dead heat on concerns about health or wealth?

At first sight, the polling data looks worrying for the Conservatives. Amongst all voters, they are not seen as leading on concern about the NHS. Voters score Labour at 6.7/10 for being concerned, with the Conservatives at 5.3/10.

When Andy Burnham’s (Labour’s Shadow Health Secretary) line – “the NHS is heading for the rocks, something has to change” was put to all voters, 69% agreed.  Amongst Conservative voters, 62% agreed with Mr Burnham. By contrast Health Secretary Jeremy Hunt’s line, “the NHS now has more doctors and more nurses” just isn’t believed. It was backed by just 22% of all voters, and only by 34% of Conservative voters.

Spending on the NHS has risen through the Parliament, but still 35% of voters believe it has fallen, as against 41% acknowledging the increase. More significantly perhaps, whatever the view on spending, the verdict on performance is stark. Amongst all voters, only 15% believe the service has improved. 34% think it is unchanged and 51% think it is now worse.  Amongst committed Conservative voters, those believing the service has got worse edge those thinking it is getting better by 33 to 28%.

In terms of electoral implications, the question is whether can Labour keep voters focussed on the NHS, or can the Conservatives pull the election back to the economy? Both are positioning cautiously on immigration – the other top issue – where both rate poorly with voters and only UKIP gains an advantage by any airing of the topic.

David Cameron has been attempting some triangulation, by endeavouring to link the NHS question to the economy: ‘the only way to secure a better NHS is to ensure a sound economy’, and variations to that theme. As yet, polling indicates that voters aren’t buying the link. Current polls show that when asked what matters most for ‘me and my family’, voters are ranking ‘Improve the NHS’ at 54%. By contrast, ‘cutting the deficit’ (which the Prime Minster set out as his top priority) is identified as top priority by just 22%.

Stripped to its basics, voters seem to be saying ‘we are worried about the state of the NHS, we think it’s declining, and we reckon the country is wealthy enough to be able to afford to spend what it takes to have a decent quality service.’

Will the NHS remain a dominant issue through to polling day?  Yes, if its ‘winter crisis’ persists. Headlines about long waits, cancelled operations, and disillusioned doctors will persist.  No, if winter conditions relent quickly, urgent additional funds are pumped in and A&E target figures recover. So, expect the Coalition to do more to address the NHS ‘crisis’, b ut don’t expect voter scepticism to abate.  The issue isn’t going to come good for the Conservatives.

Can the economy be brought back to centre field and made to eclipse NHS concerns? More likely, yes, if the answer the previous question leans towards no. Inflation will stay very low through to polling day. Without any lift in wage settlements, voters may begin to feel a bit better off, and the ‘feel good’ measure may tick upwards. But the movement isn’t going to be big; real earnings are still 8% lower than before the financial crash and that shortfall isn’t going to be significantly eroded over the next three months courtesy of tumbling oil prices.

Conservative strategy from here on has to be about containing the NHS issue. There isn’t a winning card for them on this one and it will rely heavily on the fact that the NHS is abstract for most voters. It’s central for those currently using its services but it’s one step back from that for the majority, who are aware of the issue but not living with it day to day.

By contrast, the economy is real for everyone, every day.

The competition for control of the narrative is set.  The Conservatives will do all they can to contain the NHS issue, and to play up the economy in terms of who can manage it better.  Labour will remain focussed on the NHS and will attempt to turn the economic question onto the cost of living.

The swayable audience is relatively small – the still undecided voters in the marginal constituencies. What makes it even smaller is the departure of at least one-quarter of the electorate to other parties. Here the evidence is they are not up for coming back. One of the most interesting findings from the latest polling is that UKIP supporters rate their party at 7.1/10 for concern about the NHS.  And the party has yet to publish an NHS policy.

It’s a safe assumption that most voters wish to be both healthy and wealthy. The fact that they can’t see a party clearly offering them a convincing pitch on both is just going to add to their frustration.


Photo credit: Ronny Richert