Issues & Ideas | 1st October 2014

Why Cameron is ring-fencing the NHS

Perhaps the most fundamental task of any government is to allocate the money it collects in […]

Photo: Getty


Perhaps the most fundamental task of any government is to allocate the money it collects in taxes. What should it all be spent on?

Looking at data from the British Social Attitudes survey, now in its thirty-second year, gives us a clear answer: health and education.

These are the two areas of spending which have been selected far more than any other when the public have been asked “What should be the priority for extra government spending?” over the past three decades.

Roughly two-thirds of all respondents have always focused on these two areas. No other issues – policing, help for industry, housing, defence – has garnered even a third as much support as far as the data goes back (the mid-1980s).

This is why Tony Blair ploughed money into health and education in the early 2000s, and why both party leaders are now committing to “saving” (Miliband) or “securing” (Cameron) the NHS. It is also why Andy Burnham was given such prominence at Labour’s conference, and David Cameron quickly replaced Andrew Lansley with Jeremy Hunt in 2012 when the former’s reforms were seen to threaten the institution.

The NHS was at the centre of Cameron’s speech this morning. As he put it, “you can only have a strong NHS if you have a strong economy”, twinning the public’s biggest spending concern with the issue on which elections are typically won.

What else does the data indicate Cameron should support? Not foreign aid and not welfare. Support for benefits has collapsed over the past twenty-five years, as waves of Daily Mail rhetoric on the umpteenth scrounger deterred the public. And aid has never found support – just 1 per cent of the public think it should be a priority for spending.

But this says about more welfare than aid. The aid budget is small (£11 million in 2013), whereas welfare is one of the three big areas of spending, along with health and education. The three are forecast to account for 30 per cent, 19 per cent and 13 per cent of all government spending in 2014-15.

This helps explain why George Osborne committed to a real terms benefits cut on Monday. The government spends most of its money on three things, but only two of them are endorsed by the public.

One other avenue of spending is becoming increasingly demanded: housing. Nearly a fifth of respondents choose the issue as a “priority”, making it the third most popular area. In London it is considered a more important issue facing the country than not just welfare but health and education.

Support for homebuyers is another area George Osborne has tried to address, mainly through his “Right to Buy” scheme; the Chancellor seems to have often acted in a populist way.

But curtailing benefits is not as obviously beneficial as these numbers suggest. The Tory party’s biggest problem is their image. More than other party, they are still seen as a group that represents only “one section of society”. As Lord Ashcroft told his party this weekend, only one in five voters who have defected from the Tories since 2010 think the party stands for “fairness”.

To some fairness could mean bringing benefits in line with the salaries earned by those on lower incomes, but the image of another Tory Chancellor wielding the benefits axe is unlikely to play well in affluent areas like Hampstead & Kilburn, where the Tories lost by 42 votes in 2010.

If they can’t win in the seat where Labour hold their narrowest lead they will struggle to improve on the 307 seats they managed at the last election, and can hope for little more than another coalition at best.