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As the May 2015 UK General Election approaches, party campaigns have swung into motion, manifestos launched, party lines drawn and political rhetoric ramped up.
Some voters will be loyal party supporters. But many people are swing voters and receptive to the politicians’ promises in the run-up to the general election — if indeed they visit the polls at all.
In spite of manifestos being a matter of record, there is no mechanism to hold a government to account over broken campaign commitments — and there ought to be an onus on parties to explain how they plan to deliver on costly pledges. A dissatisfied voter will only have their say in five years’ time, yet there are limited options: a vote for the status quo or a vote for a change of government.
The 2015 election sees a marked change in the UK political landscape: with the third largest party, the Liberal Democrats, as part of the present Conservative-led coalition government, and Labour’s previous term still residing in recent memory, other smaller parties including UKIP and the Greens have filled a void for protest voters. Notwithstanding, depending on the area in which you live, a well intentioned vote for one of the smaller parties could be helping a party you would rather not see in power.
As ever, the NHS is a key issue in the parties’ manifestos. And this is understandable, because the future of the NHS is something the British public cares a great deal about.
Politicians have been criticised for using the NHS to score points though, and a recent campaign from the British Medical Association (BMA) is calling for #NoMoreGames with the NHS. According to the BMA, headline-grabbing pledges of funding for the NHS are often too good to be true.
The public would be forgiven for being sceptical of election promises regarding the NHS. The Conservative promise in the last election of “no top-down reorganisation” of the NHS was broken within months of the coalition government coming to power, with the publication of the White Paper ‘Equity and excellence: liberating the NHS’. The health and social care bill, which followed in 2011, sparked arguably the most far-reaching overhaul of the NHS in England since its inception and was widely criticised by healthcare bodies including the BMA, the Royal College of Nursing and the Royal College of General Practitioners. Somehow, despite widespread condemnation, the Health and Social Care Act 2012 became law.
Informed policy
Policy positions should be based on the best available evidence, but they are often formed on personal views or moral judgements. A recent survey conducted by the social research organisation Ipsos MORI for the charity Sense About Science found that 70% of MPs questioned have used their personal experiences to back up policy decisions; 73% used their own principles. In the same survey of 104 MPs, however, 34% believed that politicians should pay most attention to their principles and just 8% to personal experiences.
Sense About Science wants politicians to have a better understanding of how controlled trials can assist with policymaking. Randomising a sample of a population to take part in a pilot scheme and another sample not to take part, and then comparing the two groups, may not always be feasible for testing social policy. But this approach may be more appropriate than testing a pilot study in a subgroup population and then rolling it out in full without evaluation, as commonly takes place in healthcare. The recently adopted lingo “vanguard sites” would indicate that even the government is aware that so often pilots are just early adopters as opposed to test sites.
Yet even when randomised controlled trials are invested in, those findings must be reflected in policy decisions — not ignored if they are inconvenient, or if the results are not available soon enough. One notable example is the Whole System Demonstrator (WSD) study, a two-year research programme funded by the Department of Health, designed to provide an evidence base to inform investment in telehealth. It was launched in May 2008, with the results due to be published in late 2010. By the end of 2011, the data had still not been published, but interim findings suggested that the intervention — use of equipment to monitor people’s health in their own homes — reduced hospital admissions and even cut deaths.
Then, in January 2012, somewhat prematurely, the Department of Health launched a so-called 3millionlives campaign — described as an “ambitious plan to bring the benefits of telehealth and telecare technologies to three million people with long-term conditions and social care needs over the next five years” — owing to the success of the WSD sites. When The
BMJ finally published the economic analysis in March 2013, the investigators reported that the telehealth interventions did not seem to be a cost-effective addition to standard care.
Fast forward to 2014 and 3millionlives had been scrapped.
Public perceptions
Solid evidence should inform smart policymaking. And the scientific community can do more to educate MPs and the public about the significance of research. But public opinions, although these may not be aligned with the best available evidence, remain valid.
The recent Ipsos MORI survey found that 75% of MP respondents have used the views of constituents to back up policy decisions; 45% thought that constituents’ views ought to be paid attention to most. It is a difficult job indeed to strike the balance between being a political representative on the one hand and a responsible lawmaker on the other. Yet politicians must be brave in backing evidence-based policies that may at first appear unpalatable to the public or could court controversial media coverage. In 2009, the head of the Advisory Council on the Misuse of Drugs, David Nutt, was sacked for his criticism of the UK government’s reclassification of cannabis from class C to class B. Nutt sought to separate his scientific advice from moral messages about drug misuse. Ultimately, Nutt was dismissed because his advice — based on the available evidence — was considered out of sync with public opinion.
Casting one’s vote is often an emotional choice rather than a logical one, even with all the necessary information. As the election draws near, the political parties will be making emotional pleas. Time will tell which of those promises the new government will deliver. Since they are rarely held to account, we hope that any breaking of promises are, at the very least, based on evidence.
