The NHS: even more cherished than the monarchy and the army

New polling by British Future shows that while attitudes to the NHS have fluctuated, commitment to its founding principles has remained remarkably consistent.

January often heralds a couple of weeks of absent mindedly getting the year wrong, but it has been easier than usual to remember that it is not 2012 anymore. 2013 feels like an altogether more ordinary year, after the exuberance of the Olympics, as attention returns to the long slog through the economic crunch.

Yet it turns out that the national events of 2012, gently satirised as the year of the "Jubilympics", do not represent the main sources of national pride in Britain.

The NHS beat both the monarchy and the Olympics to take gold in the patriotism stakes, as Ipsos-Mori's polling for British Future's new State of the Nation 2013 report, published today, shows. The army ranked second, when pollsters asked people which institutions made people proudest to be British, with Team GB taking bronze, nudging the royals off the podium altogether.

The NHS was most popular with Britons from all backgrounds, being top for both white and non-white Britons, and across social classes, though the oldest segment of the population put the monarchy first, and the under-24s the army.

Seventy two per cent of people declared the NHS to be "a symbol of what is great about Britain and we must do everything we can to maintain it" while one in five (21 per cent) saw it as "a great project for its time, but we probably can not maintain its current form".

That helps to explain why the 65th birthday of the NHS also provides the anniversary of 2013 which is most cherished by the public, proving more popular (on 54 per cent) than the 60th anniversary of the Coronation (43 per cent) with the discovery of the structure of DNA (29 per cent). Anniversaries of the London Underground  (15 per cent), the Beatles (15 per cent), Jane Austen's Pride and Prejudice (11 per cent) and the Football Association (eight per cent) and Doctor Who (seven per cent) trailed. The 40th anniversary of EEC membership did worst of all, with just three per cent of people choosing that as a source of British pride.

Firstly, the NHS fully merited its place in Danny Boyle's Olympic opening ceremony. While attitudes on the performance of the NHS have fluctuated a great deal - affected by events, funding and political controversies -  commitment to its founding principles has remained remarkably consistent.

Secondly, there is a message for politicians here too. Politicians or wonks who want a radical overhaul of the NHS often express frustration at the level of public sentiment behind it, reflected in Nigel Lawson's famous rueful description of the NHS as "the closest thing the English have to a religion". The debate has echoes of that over the monarchy, with many of the roles reversed, as liberal-left defenders draw on a reservoir of symbolic sentiment, while right-of-centre wonks mutter about the difficulty of breaking through with a "rational debate" given the resonance of that frame.

The poll shows why it made a lot of sense for David Cameron to seek to define himself, in opposition, as a champion of the NHS, though the polarised controversy over the motives and outcomes of the coalition's NHS reforms made that a deeply contested question. The breadth of support for the NHS as a symbol in this poll underlines the lesson that support for change to the NHS depends on securing trust about motivation and intention. Any reform, from whatever poltical perspective, will have a chance of public support if changes are understood to be upholding the core NHS principles. They will be treated with suspicion if thought to be subverting them.  Those who want to change the NHS may need to learn to love it first.

But if the NHS represents a now deeply entrenched fairness ideal - that healthcare should not depend on the ability to pay - I suspect the strength of attachment to the NHS goes well beyond the politics of healthcare, and is much more personal, reflecting its presence on some of the most important days of our lives.

I am a child of the NHS. I feel a particular connection to it because I wouldn't exist without it.  I was born in a hospital, the Doncaster Royal Infirmary, in spring 1974, under the care of the NHS, because my parents, born 4,000 miles apart in Guajarat, India and Cork, Ireland, had both come to this country to work for the NHS. That is also the everyday story of how our most cherished national institution has always depended on immigration, and integration, to be able to offer its public service.

But my main memories of the NHS are that its hospitals are also where my children were born. It is where we have the serenity of knowing that we can go - once or twice on an  adventure to drive out to see the "night doctor" in the middle of the night - to check everything is OK. We cherish the NHS because it turns the idea of "cradle to grave" from a metaphor into a reality.

The only cloud on the horizon was a dip in support among the under-24s, who placed the army ahead of the NHS as a source of pride. That reflects a broader inter-generational erosion of support for ideas of welfare and social solidarity more generally, set out in Ipsos-Mori's work on attitudes shifts across generations.

There will be wide support for celebrating the 65th birthday of the NHS this year - but it may be an open question whether the moment could be used to extend its appeal for several more generations to come.

British Futures's new report, State of the Nation: Where is bittersweet Britain heading?, can be read here.

"The NHS fully merited its place in Danny Boyle's Olympic opening ceremony". Photograph: Getty Images.

Sunder Katwala is director of British Future and former general secretary of the Fabian Society.

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Why Angela Merkel's comments about the UK and US shouldn't be given too much weight

The Chancellor's comments are aimed at a domestic and European audience, and she won't be abandoning Anglo-German relationships just yet.

Angela Merkel’s latest remarks do not seem well-judged but should not be given undue significance. Speaking as part of a rally in Munich for her sister party, the CSU, the German Chancellor claimed “we Europeans must really take our own fate into our hands”.

The comments should be read in the context of September's German elections and Merkel’s determination to restrain the fortune of her main political rival, Martin Schulz – obviously a strong Europhile and a committed Trump critic. Sigmar Gabriel - previously seen as a candidate to lead the left-wing SPD - has for some time been pressing for Germany and Europe to have “enough self-confidence” to stand up to Trump. He called for a “self-confident position, not just on behalf of us Germans but all Europeans”. Merkel is in part responding to this pressure.

Her words were well received by her audience. The beer hall crowd erupted into sustained applause. But taking an implicit pop at Donald Trump is hardly likely to be a divisive tactic at such a gathering. Criticising the UK post-Brexit and the US under Trump is the sort of virtue signalling guaranteed to ensure a good clap.

It’s not clear that the comments represent that much of a new departure, as she herself has since claimed. She said something similar earlier this year. In January, after the publication of Donald Trump’s interview with The Times and Bild, she said that “we Europeans have our fate in our own hands”.

At one level what Merkel said is something of a truism: in two year’s time Britain will no longer be directly deciding the fate of the EU. In future no British Prime Minister will attend the European Council, and British MEPs will leave the Parliament at the next round of European elections in 2019. Yet Merkel’s words “we Europeans”, conflate Europe and the EU, something she has previously rejected. Back in July last year, at a joint press conference with Theresa May, she said: “the UK after all remains part of Europe, if not of the Union”.

At the same press conference, Merkel also confirmed that the EU and the UK would need to continue to work together. At that time she even used the first person plural to include Britain, saying “we have certain missions also to fulfil with the rest of the world” – there the ‘we’ meant Britain and the EU, now the 'we' excludes Britain.

Her comments surely also mark a frustration born of difficulties at the G7 summit over climate change, but Britain and Germany agreed at the meeting in Sicily on the Paris Accord. More broadly, the next few months will be crucial for determining the future relationship between Britain and the EU. There will be many difficult negotiations ahead.

Merkel is widely expected to remain the German Chancellor after this autumn’s election. As the single most powerful individual in the EU27, she is the most crucial person in determining future relations between the UK and the EU. Indeed, to some extent, it was her intransigence during Cameron’s ‘renegotiation’ which precipitated Brexit itself. She also needs to watch with care growing irritation across the EU at the (perceived) extent of German influence and control over the institutions and direction of the European project. Recent reports in the Frankfurter Allgemeine Zeitung which suggested a Merkel plan for Jens Weidmann of the Bundesbank to succeed Mario Draghi at the ECB have not gone down well across southern Europe. For those critics, the hands controlling the fate of Europe are Merkel’s.

Brexit remains a crucial challenge for the EU. How the issue is handled will shape the future of the Union. Many across Europe’s capitals are worried that Brussels risks driving Britain further away than Brexit will require; they are worried lest the Channel becomes metaphorically wider and Britain turns its back on the continent. On the UK side, Theresa May has accepted the EU, and particularly Merkel’s, insistence, that there can be no cherry picking, and therefore she has committed to leaving the single market as well as the EU. May has offered a “deep and special” partnership and a comprehensive free trading arrangement. Merkel should welcome Britain’s clarity. She must work with new French President Emmanuel Macron and others to lead the EU towards a new relationship with Britain – a close partnership which protects free trade, security and the other forms of cooperation which benefit all Europeans.

Henry Newman is the director of Open Europe. He tweets @henrynewman.

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