BLAIR’S BRITAIN, 1997–2007
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long-standing belief that there was still a shortage of doctors and nurses
16 Ipsos MORI Delivery Index 2001–2007
Q Thinking about the NHS over the next few years do you expect it to get better/worse?
% net better
15
14
8
9
5
1
1
–2
–2
–5
–7
–5
–3 –4 –2
–10 –12
–11
–15
–16
–22 –23
–25
–27
–32
–30
–35
Mar-May-Sep-Dec-Mar-Jun-Sep-Dec-Mar-Jun-Sep-Nov-Feb-May-Sep-Nov-Mar-May-Sep-Nov-Mar02
02
02
02
03
03
03
03
04
04
04
04
05
05
05
05
06
06
06
06
07
Figure 20.15. Long-term decline in expectations of the NHS
Base: c. 1,000 British adults
and that the NHS suffered from bureaucracy. Some of these views were
strongly linked to political beliefs – Conservative voters were far more
likely to feel the issue was bureaucracy, for example – but voters of all persuasions were worried about staffing levels.
How much was the overall public mood based on reality? The challenge facing anyone in charge of the NHS is that in terms of public and
patient confidence, the national picture is nearly always much worse than
the local one. If one moves from looking at anxieties about the direction
of the health service nationally, patient satisfaction with actual healthcare
told a more positive story. From winter 2002, overall public satisfaction
with the NHS averaged around 60% and was rising gradually. The proportion satisfied with GPs was even higher, averaging around 81%. The
news was also positive for hospitals: net satisfaction (percentage satisfied
minus percentage dissatisfied) with out-patient, in-patient and accident
and emergency services all showed positive trends.
Furthermore, the trends showed consistently that the people who
actually used NHS services were more positive than the public in general:
when Blair left office some 91% of patients experiencing in-patient services cited it as excellent or very good.7 Nor were the public negative
about Labour’s health policies per se. Despite the furore in the Labour
Party and the health professions about many NHS reforms, in particular
17 MORI and Ipsos MORI Tracking Research for the Department of Health 2000 –2006: see
www.dh.gov.uk. See also patient satisfaction data recorded by individual Trusts at
www.healthcarecommission.org.uk.
Foundation Hospitals, and the involvement of private sector providers in
the NHS, the public broadly backed Blair’s reforms. Numerous studies by
Ipsos MORI found that people were happy to be treated in the private
sector provided the NHS paid, and that most believed that increasing
choice would have a positive impact on the quality of healthcare.
However, ‘choice’, while central to Blair’s plans for using contestability to
drive improvements, was not embraced with open arms by the public.
While it was not seen as a bad thing per se, it was a long way down most of
the public’s list of desired improvements, and not received in the same
almost totemic way that it was used by the government.
Indeed one of the problems for Blair was a lack of clarity about whether
‘choice’ was a moral good in its own right, something deeply valued by the
public, or a means to an end – i.e. of introducing competition where the
state was the monopoly supplier of a service. At the time of Blair’s departure, it was still the case that the majority of patients being referred into the
acute sector by GPs were NOT being offered a choice of specific hospitals,
but this was not a reason for dissatisfaction.
So why the public gloom about the NHS? It was, in part, the ‘perception gap’ which plagued Labour as it attempted, not just to turn round
public services, but also be seen to have done so. Tony Blair explained it to
Labour’s Spring Conference in March 2004:
There is much scratching of the head in political circles over this apparent
paradox. People who feel personally optimistic in Britain; but collectively pes-
simistic. They say their own health care in the NHS is good; but the NHS in
general is bad. Their schools are good; but education is bad. They are safer; but
the country is less safe. Their future is bright; but the nation’s is dark.
The Prime Minister may well have been specifically referring to a
MORI survey for the Department of Health conducted between
November 2003 and February 2004. This found that while 67% of the
public agreed that ‘My local NHS is providing me with a good service’,
only 48% would admit that ‘The NHS is providing a good service nationally’. This translated to 59% of the sample saying they were ‘satisfied’ with
the NHS, and yet only 30% agreeing that ‘The government has the right
policies for the NHS’.
This gap between local experience and perception of how a key service
was performing nationally was to bedevil the later years of Blair’s government. It was particularly acute over issues around crime and immigration, and reflected the government’s problems in persuading the media to
take any assertions it made about its achievements at face value. The
Q What do you see as the main/other important issues facing Britain today?
Howard
Cameron
Blair
Blair activates civil
becomes
becomes
announces
contingencies machinery to
Tory Leader
Tory Leader departure
45
deal with spiralling street crime
Tory election pledge
Foreign prisoners
40
–40,000 more police
scandal – Clarke is
Murder of Sarah
sacked
May day riots
35
Payne
30
25
20
Prison
overcrowding
15
reaches
£53million
record levels
Fuel
10
stolen from
Protests
9/11
depot in Kent
5
0
May
May
May
May
May
May
May
May
May
May
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
&nbs
p; Figure 20.16. Concern about crime/law and order
Base: c. 1,000 British adults each month age 18ϩ. Source: Ipsos MORI
public, who were basing their attitudes more on what they heard from the
media and from people who worked in public services, were not just
judging actual services they received, but their impressions of them everywhere else as well.
On crime, there were very mixed results. It grew in prominence during
Blair’s decade, even as statistics suggested it was down. In 1992, following
a clear focus on crime by the Labour Party and Tony Blair (‘tough on
crime, tough on the causes of crime’), the perceived gap between the two
parties narrowed and indeed Labour took a slight lead. And yet, by 2000,
the familiar pattern had been restored and once again, Labour was viewed
as second-best on crime (Figure 20.16).
Indeed crime and violence remained a higher priority for the British
public than in many other European countries and the US, and was consistently since 1997.
At the same time, the government spent an unprecedented amount on
the Criminal Justice System (CJS) and by 2007 spent more per head on
law and order than any other country in the OECD. And to a large extent,
Blair spent this money on areas and issues that, it would seem, would
meet public demand. There were, for example, more police officers than
ever before, neighbourhood policing was a priority, average sentences
were increased and greater powers introduced to help tackle anti-social
behaviour.
The outcome was that actual crime rates have fallen since 1997, with
crime overall reduced by 35% – but no one believed the government: only
one in five were willing to accept that crime was falling and less than half
(43%) believed there are more police.8 Blair left office with confidence in
the government on crime lower in this country than in any of the five
major countries included in Ipsos MORI’s regular international tracking
study, including the USA, France, Germany and Spain. And this was not
simply a result of an unpopular government in the UK not being trusted
on all its activities – the public had a higher level of confidence than these
same countries in other areas including, for example, education.
As with the NHS, there was a perception gap – the public had more
confidence in how crime was managed locally than nationally. The
explanation is partly media coverage: coverage on crime is biased
towards the negative, a fact that is likely both to explain why perceptions
are more negative than actual trends and influence national rather than
local opinion. Other reasons for misconceptions between local and
national opinion include a natural ‘hometown favouritism’, where
people tend to believe that those who live in their local area share values
and behaviours.
But as importantly, there are high-profile or ‘signal crimes’ that have a
greater impact on perceptions than other crimes, and these did not
decrease. For example, during Blair’s watch, crimes resulting in injury
from firearms went up over four-fold and homicides up 23%. Although
the numbers directly affected by these were very small, media coverage
was enormous.
Finally, back on the issue of contested statistics, it seems likely that the
definition of crime in the public’s mind incorporates far wider issues than
the official definition, with for example, some being influenced by their
views on terrorism and ASB (anti-social behaviour). As these rose in
prominence, then crime was also seen to have increased. Indeed one of the
marked trends in public opinion during this period was around anti-social
behaviour. Local surveys repeatedly showed that what people most saw as
a key issue was facilities for teenagers, and low-level disorder. Initiatives
like ASBOs were supported by the public (82% agreed with their use), but
overall had little impact on feelings of safety. Indeed Blair’s Respect
Campaign, while working at a local level, and campaigns around zero tolerance, while appealing to widespread concerns, also served to remind
people of the issue. At the end of 2006, right across England, ASB and
18 ICM and MORI research for the Cabinet Office 2004/5.
activities for teenagers remained the number one local concern in the government’s BVPI surveys in every English local authority.
It was in one of the areas where there were fewer targets (an early tenyear plan was publicly abandoned) and less direct involvement by the
Prime Minister that in fact public opinion became more optimistic rather
than pessimistic during his term in office – public transport. Here there
was an early disaster with the inherited privatised rail network, the
Hatfield crash, and the renationalisation of Railtrack, but in the meantime, led by London, real investment in bus services and new rolling stock
and renewal of the rail network gradually saw transport recede as a key
public concern. Indeed in London the proportion of people citing it as
one of the worst things about the city fell from 35% in 2001 to 15% by late
2006,9 and the same series saw a rise, to 81% in the proportion of
Londoners describing it as an easy city to get around. By the end of Blair’s
term in office, only three people in a hundred were citing it as a key
national issue, whereas five years earlier 22% had done so. From 2003,
there was a rise in public optimism about public transport. Traffic congestion remained seen as a key issue, and surging fuel prices remained a
‘feel bad’ factor, but it was not anywhere near the challenge that reforming the NHS posed Blair (Figure 20.17).
Finally, one of the biggest shifts in public opinion during the Blair
years was rising concern, initially about asylum-seekers, legal and illegal,
and then race, multi-culturalism and immigration of all sorts (Figure
20.18). By the end of Blair’s premiership this was frequently seen as the
biggest issue facing Britain, although how much was driven by media
coverage as opposed to actual experience was unclear – while only 18%
per cent saw it as a big problem in their own area, some 76% saw it as a
national problem. But nevertheless, the pace of change was unsettling in
some communities, such as Barking and Dagenham – the local authority
which became more diverse more quickly than anywhere else in the UK
and voted BNP in large numbers. The whole debate around immigration
was media-led, with the average Briton estimating that 22% of the
UK population was born abroad (in 2003 the actual figure was 6%), and
with 78% disagreeing that the government was open and honest about
migration.
The government was more criticised on this issue than virtually
any other, and the British became more concerned than any other
19 Ipsos MORI/GLA Annual London Surveys 2001–2006: see http://www.london.gov.uk/
mayor/annual_survey.
Q Thinking about public transport over the next few years do you expect it to get
better/worse?
% net better
10
5
5
2
2
0
0
–3
–3
–4
–5
–4
–5
–6
–5
–5
–6
–8
–7 –9
–10
–10
–11
–11
–11
–15
–16
–20
Mar-May-Sep-Dec-Mar-Jun-Sep-Dec-Mar-Jun-Sep-Nov-Feb-May-Sep-Nov-Mar-May-Sep-Nov-Mar02
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06
06
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06
07
Figure 20.17. Public transport: overall trend is up since 2002
Base: c. 1,000 British adults
Q What do you see as the main/other important issues facing Britain today?
Howard
Cameron
Blair
becomes
becomes
announces
Tory Leader
Tory Leader departure
50
The Met publishes its first Race
Foreign
Sangatte detention
Equality Scheme underthe terms of the
prisoners
centre constantly
the legislative response to the Stephen
furore
40
in the news
Lawrence Inquiry.
throughout 2002.
Race riots in
Burnley,
30
Oldham, and
Bradford
20
Anthony
Walker
murdered in
10
Liverpool
9/11
0
May
May
May
May
May
May
May
May
May
May
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
Figure 20.18. Concern about race relations/immigration
Base: c. 1,000 British adults each month age 18ϩ. Source: Ipsos MORI
Q Which three of the following eleven topics do you find the most worrying in your
country? – Immigration control
Most cause for concern
United Kingdom
44%
Spain
42%