March 28, 2024 - 7:00am

For all that politicians and commentators find endless things to talk about in the stretches between elections, there are only a few issues which really matter to most voters. Crime and the economy are two stand-out candidates for this select list. A third is the NHS.

So it is not good news for the Conservatives that, according to new polling, public satisfaction with the Health Service has fallen to its lowest ever level.

Labour nearly always has the edge in public perception when it comes to the NHS, of course; it probably matters more for the Tories’ prospects at the election that the Opposition now leads on almost everything else too.

But the struggling Health Service will, for many people who are themselves affected or know people who are, be one of the most palpable signs of a country that feels as though it’s fraying at the edges. And, having been office since 2010, the Government cannot evade the blame.

Not all of that blame is fair. For starters, and contrary to public perceptions, the Conservatives have hardly starved the NHS of cash. According to the King’s Fund, real terms spending is up 25% since 2010, from £130 billion to £180 billion. During the pandemic, it was even higher.

Yes, the rate of growth was faster under New Labour. But Tony Blair had a specific commitment to raise NHS spending to a target point. Its real terms budget doubled between 1997 and 2009; there is obviously not enough cash to have doubled it again. The excuses only go so far, however. Much of the current crisis can be laid at ministers’ feet.

For example, it was the Government’s decision to lock down as long and as strictly as we did. That caused huge disruption to the Health Service (alongside everything else), with millions of people having appointments and operations pushed back. There are now millions of people on waiting lists, many of whom (such as cancer patients) will have seen their condition worsen due to the delay.

Those in power at the time can defend that decision — we will never know how costly, in financial and human terms, the alternative would have been. But they must still own the consequences.

Less forgivable is the state of NHS hospitals. While the Conservatives have increased the budget in cash terms, George Osborne squandered the opportunity presented by a long period of near-zero interest rates to borrow for capital investment.

In fact, the Coalition went so far as to allow the NHS to start drawing on its capital budgets to meet day-to-day running costs — just as ministers are doing now in local government, with councils being authorised to sell assets to stave off bankruptcy. This is the definition of an insolvency spiral.

Finally, it’s worth remembering Andrew Lansley’s botched reforms from 2010, which saw the Tories burn all their political capital for NHS reform to merely saddle the Health Service with more complexity, for little gain. (Contra to mythology, they did not lead to significant privatisation.)

As a result, the final sin is one of omission. After 14 years in office, the Conservatives have done nothing substantial to reform the NHS and put it on a more sustainable footing.

Now neither party has an easy way out. That Labour isn’t proposing to turn the taps back on, and has Wes Streeting talking about reform instead, gives lie to the idea that it would all work if it wasn’t for those nasty Tories. Still, there is truth enough in the charge that voters will give the Tories a kicking all the same.

Henry Hill is Deputy Editor of ConservativeHome.