According to an opinion poll survey undertaken by Ipsos Mori in August, immigration is the biggest concern for people in the UK:
There is a curious dimension to this poll. Concern about immigration was up 8%. Concerns about the NHS was down 8%. It would appear that people flipped.
Meanwhile, YouGov's voting intention tracker shows this:
Reform is gaining as a consequence of making immigration a matter of greater concern than the NHS. This seems to be the obvious thing to conclude, albeit that I accept that drawing obvious inferences from such polls is not always wise.
But, does this flipping of opinion and increased support for Reform make sense?
The Reform UK manifesto for the 2024 general election set out its supposed “critical reforms” for the NHS. Amongst them were these supposed policy measures:
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Zero basic rate tax for all NHS and social care staff for three years.
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20% tax relief on all private healthcare and insurance.
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A voucher scheme for private treatment when NHS waiting times are exceeded.
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Expanded use of private and overseas healthcare capacity.
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Operating theatres must be open on weekends.
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All NHS Private Finance Contracts to be reviewed for significant savings potential.
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Charge those who fail to attend medical appointments without notice.
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Save A&E by cutting waiting times with a campaign of ‘Pharmacy First, GP Second, A&E Last'.
Let me be clear about what this means.
First, treating tax as optional for NHS staff alone is profoundly wrong. Tax is not a perk. It is the foundation of government economic management. It is how we redistribute income. It is how the government regulates inflation. And it is critical within the fiscal cycle that funds public services, even though it itself does not do so.
In that case, to suggest, as Reform does, that NHS staff can be exempted from tax is to pretend that tax is some sort of contractual extra that can be gifted and withdrawn at whim. And this policy would be exactly that: it would be temporary, insecure, and subject to the politics of the moment. NHS staff would be made more vulnerable, not less, because their incomes would be at the mercy of politicians deciding whether to maintain a tax break. That is no incentive at all: pay is what matters, and not tax gimmicks.
Second, cutting taxes in this way would reduce the overall capacity to fund the NHS, even though it is initially paid for with funds created by the Bank of England. In that case, the Reform proposal would deliberately undermine the very service it claims to support. At the same time, it would create distortions in the tax system, inviting special pleading from countless other groups who would demand the same treatment. The coherence of tax — as a universal obligation of citizenship — would collapse, but maybe that is Reform's aim.
Third, the promise of vouchers and tax relief for private medical insurance is simply a diversion of resources into the private sector. That is not costless. Private providers recruit their staff from the NHS. They do not train almost any of their own workforce. Subsidising them with government-created money would drain both funds and people from the NHS. Waiting times in the public system will grow longer as a result, making the voucher scheme self-fulfilling: starve the NHS, then pay the private sector to fill the gaps.
Fourth, charges on patients who do not attend will penalise parents of children and pensioners the most, since they have more NHS appointments than any other group in society, and most often they also have the smallest capacity to pay.
The other issues are simply wallpaper: they make no sense.
The overall outcome would be to increase costs. Running parallel systems — one public, one a subsidised private arrangement — is always more expensive. The United States proves that. And when revenues are simultaneously cut by unnecessary tax reliefs, the inevitable consequence is that resources for the NHS will shrink, not grow. The result is that real issues were ignored by Reform whilst diversionary policies were promoted. Amongst the missed issues were:
- Rising obesity, diabetes and cancer cases, and their causes.
- The 'brain drain' out of the NHS due to staff shortages, creating unreasonable demands on remaining staff.
- The problems of GP services and their underfunding meaning that there is serious unemployment among GPs despite the demand for appointments.
- The failure to tackle the underlying problems creating long-term chronic conditions, inclduing the growing prevalence of ultra-processed food.
- The difficulties in our dental services, and the loss of NHS dental care for many.
- And much more.
The consequences of these failures are obvious.
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NHS staff would be made insecure by temporary gimmicks instead of being given the permanent pay rises they need.
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The tax system would be weakened, reducing government capacity to manage the economy.
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The NHS would lose both funds and people to the private sector.
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Inequalities in access would widen as wealthier patients gained subsidised private care while others faced lengthening waits.
This is not reform, however it is looked at. It is dismantling the NHS in plain sight.
What is needed instead is equally clear:
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Fair, permanent pay settlements for NHS staff, not tax holidays.
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Stable and sufficient revenues for the NHS, not deliberate cuts through tax relief for private medicine intended to undermine it.
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Investment in public capacity, not subsidies for private providers.
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A reaffirmation of the principle that healthcare is a collective public good, provided on the basis of need.
Reform's proposals are a Trojan horse for privatisation. They undermine the tax system, reduce NHS resources, and leave both staff and patients more vulnerable. That is not reform. That is betrayal.
The question is, why would people fall for this? And would they really sacrifice the NHS for control of a migration problem that has little or no impact on most people in the UK?
Action points
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Write to your MP and demand that NHS staff are given fair pay, not insecure tax gimmicks.
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Oppose any policy that offers tax relief for private medical insurance — it weakens both the tax system and the NHS.
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Challenge Reform's voucher scheme: it is privatisation by stealth, and it will drain the NHS of funds and staff.
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Call for investment in NHS capacity — hospitals, training, and pay — as the only sustainable way to reduce waiting lists.
For more on this issue, follow and support the EveryDoctor campaign. I do.
Taking further action
If you want to write a letter to your MP on the issues raised in this blog post, there is a ChatGPT prompt to assist you in doing so, with full instructions, here.
One word of warning, though: please ensure you have the correct MP. ChatGPT can get it wrong.
Comments
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Yougov have conflated illegal and legal immigration and put it into one category, which is a common tactic of neoliberals. If they had divided that into two categories it would or could be interesting.
I see very little of the rise of Reform down to people coming to the UK the legal way, it was only really when we started to get data that 15,000 criminals were coming to the UK on small boats from France that Reform started to pick up in the polls, and also a general feeling that our public administration actively dislikes us by wanting to not run the government of the UK in the interests of those legally in the UK.
Might it be that our children as children and as future citizens have been, and are, brought up and educated to be democracy-subverting gullible?
Might any such deep, unquestioning attitudes, devoid of informed critical thinking, lateral thing and future thinking, be intenstified by a deliberately citizen-limiting main stream media, not least the B. B. C.?
“We all have an enormous responsibility to draw to the attention of others the information they do.not yet have, which can enable them to be better informed about what they feel and think.” (From Howard Zinn)
So well done for doing such!
Racism just helps people to cut their noses off to spite their faces.
It’s simple you see, as Tim Snyder has pointed out. If you want to see brown coloured people dying in boats, it’s worth having to wait longer at your local hospital for your treatment. This is how the brains of people brutalised by austerity and Neo-liberalism work. You get to see people suffering more than you.
On the ‘migrant boats’ issue, for the first time in years, the shrewd Stephen Gethins MP (SNP) asked a question at PMQs that actually brought the PM and Government to account for itself. He pointed out the boats problem began with Brexit, and asked the PM to rejoin the Dublin Regulations.It was the termination of the Dublin Regulations (specifically Dublin III Regulations) with Brexit and the oven-ready deal, that created the ‘migrant boats’ problem (there was nothing in the oven, and the Dublin Regulations were in the bin). The problem simply didn’t exist before Brexit. Look at the facts. Britain voted for Brexit in 2016 (the dumbest decision the British people ever made, with the exception of voting for Neville Chamberlain). Before 2018 there were virtually no migrant crossings. Almost certainly in response to Britain’s vote and the ominous Brexit ‘negotiations’ after 2016, in 2018 there were suddenly around 300 arrivals in boats. In 2019 1,800. In 2020 there were circa 8,500, in 2021 it took off with, 28,500 (Boris Johnson signed the Brexit withdrawal agreement on 24th January, 2020, and Britain left the EU on 31st January, 2020); and by 2022 the migrant boats arrivals reached nearly 46,000. And so it goes on.
The Dublin III Regulations established a uniform policy on migrant boats for Europe that ensured a systematic approach between countries; it determined which country was responsible for processing an asylum seeker’s claim, often the first country of entry. The end of Dublin III created the British migrant boats problem. As usual, the British simply shot themselves in the foot.
And what was Keir Starmer’s response to Gethins question? After an opening cheap riposte – he agreed with Gethins. We should not have left the Dublin Regulations. He then made a dismal attempt to cover the appalling inadequacy of British government, by claiming he had a deal with France. The facts on crossings measure the scale of that achievement; as a comprehensive response to the migrant boats crossings and the political crisis it has created in Britain, the Labour solution is inadequate. We had the solution, and both Labour and Conservatives blew it. And so did the British people. They voted for Brexit.
Thanks John
A good reminder
John,
I’m sure you’re right about the effects of Brexit and the loss of the Dublin agreement, but there is an additional factor which might be worth mentioning; the fact that land routes were effectively closed off in the years preceding Brexit. An unknown number of refugees entered the UK in vehicles as stowaways or were transported here illegally by the ‘gangs’ by various methods. Once these routes were closed, the ‘gangs’ resorted to more dangerous sea crossings.
Mr Surtees, you may well be right. I am not claiming globalism in a dysfunctional world has not had an adverse impact on the whole of Europe, adjusting to a major shift in world population migrancy. But the problem in the UK is the reluctance of British authorities to provide an adequately funded, resourced and planned asylum process system. Britain is the lest likely to be any migrant’s ‘point of entry’ to Europe. I surmise the Britiah, from the start, played on that natural offshore, North West isolation from mainland Europe to solve the problem for them; and hand the cost, problem and solution for everyone else in Europe to fix it, on the cheap for Britain. That is just how we are; and the aspiration has always been the undercurrent of the whole, unspoken principle of the Reform enterprise.
It was the same with Brexit. Britain is to operate as a buccaneering, piratical opportunist on the fringe of Europe; leaving the problems and costs of Europe with the EU. It forgot that the EU was Britain’s biggest security in a fast changing world, that the EU was its biggest, and most reliable market: and that the EU was, first and foremost: a peace project with the aim to secure and defend all Europeans in a democratic arc of common prosperity for all its citizens.
UK meja have told (groomed) UK serfs that immigration is a big big problem. So guess what – that is what they think. The whole thing is confected nonsense.
I am reminded of the way in which mainstream media drove EU membership from being an issue almost nobody cared about to being the number one concern of most of the British public. We are all being played!
Just to clarify the central point here. Dublin III Regulations meant Britain could send back migrants arriving on boats. Brexit and the end of Dublin III robbed us of that facility. Britain created the mess through its own stupidity. Since we are a north-west offshore island, we had, broadly the smallest problem with migration. But we are Britain. We are exceptional. Yes, we are. We blew it. We created the risis, out of nothing.
Thank the Labour-Conservative Single Transferable Party, Westminster cartel. You know …. the one people keep voting for.
Dublin agreement has never effectively worked. There never was an enforcement procedure since EU countries remained sovereign when it comes to immigration policy. Merkel declared it to be broken in 2015. I think, since then Europe has stopped trying to distribute refugees according to fairness but have a single policy. This type of policy is not compatible with the desire of the British government to not take rules from Brussels.
The problem with your argument is that the boats do not start crossing until 2018. In the UK the boat crossings do not follow the internal problems in Europe. They follow the Brexit decision, and accelerate from 2019-20 when Brexit was finalised. It is quite clear. Look at the graphs. See the Migration Observatory, Graph small boat crossings 2018-2025 (https://migrationobservatory.ox.ac.uk/resources/briefings/people-crossing-the-english-channel-in-small-boats/#:~:text=Between%202018%20and%202024%2C%20citizens%20of%20six,the%20grant%20rate%20for%20asylum%20applicants%20overall.).
The Dublin III Regulations applied until September, 2020; and in the EU was replaced by ‘the Pact on Migration and Asylum’. This is a systematic plan for screening and border procedures, applicable to all signatories. It applies screening, an EU identification database, and defined, uniform border procedures and returns protocols. The screening, with uniform EU rules (maximum 7 day process) takes place at the border (and there is mandatory independent monitoring required in every country); there is then an asylum border procedure (broadly where there are security risks), and an accelerated border procedure (broadly where there is no security risk). See https://home-affairs.ec.europa.eu/policies/migration-and-asylum/pact-migration-and-asylum/questions-and-answers-pact-migration-and-asylum_en#paragraph_5903 – for a fuller explanation of the details); in border procedures both cases there is a maximum 3 month process, including appeals; and finally there is a Returns procedure.
I am sure there are problems in Europe; after all the tectonic plates of the world population is shifting. But there is system, process and uniformity. Then there is Britain. There is no system, no uniformity (except bottlenecks. delay, inaction, waste and bad decision making). The “process” in Britain is, in short …….. what exactly?
It is an own goal by Starmer & Co. They wanted immigration to the the number one priority and thus supported Reform. They have failed to develop an alternative narrative. Trade unions are missing in action and the left isn’t organised enough to dismantle the right-wing claims.
The real cause of many economic and social problems in inequitable distribution of income and wealth and failure of successive governments to tackle it.
Real wage and benefit cuts, rising water and energy costs, unchecked profiteering, absence of rent controls, lack of investment in housing and infrastructure, insecure employment and short-termism in the City has eroded living standards. Just 1% of the population has more wealth than 70% of the UK population put together. The bottom 50% of the UK population has less than 5% of wealth. The poorest 20% of households in Slovenia and Malta are better off than the equivalent in the UK. Successive governments have failed to address discontent of the low/middle income families who feel that no one cares and become easy recruitment fodder for right-wingers who blame minorities for economic/social woes rather than the grip of neoliberal policies. The government has big majority in the Commons and can pursue progressive policies, if it can get-off its knees to giant corporations and the super rich.
A great deal to agree with there, Prem. I will keep addressing those themes, as you know.
Thanks.
Perhaps you have seen the graphic of Europe that showed the ten most wealthiest cities, and the 10 poorest. The wealthiest city was London, and the other 9 dotted around Europe. 9 of the 10 poorest were all in Britain.
Says it all really.
Correct
And it shows, after three weeks of travelling in France,and Italy it is notable how much care is taken on the roads, trains, facilities like public loos, litter picking and general maintenance of everything we have come across so far. I am so looking forward to veering around the potholes on our return to the shabby ruins we call home. If we get through the queue at the customs in Calais that is.
Apologies for posting twice:
https://www.theguardian.com/world/ng-interactive/2025/feb/18/europes-population-crisis-see-how-your-country-compares-visualised
NHS – UK share of foreign trained doctors, 32%.
What happens if Deform gets in? – fewer doctors & longer queues.
Deform plans to train more Doctors? Zero.
See a post in the morning, Mike.
And not one of the existential,environmental crisis we face even gets a mention in the poll any more it would seem. Absolutely insane.
A view from the inside: every day at work in the NHS feels like crisis management. We view the onset of the coming winter with trepidation, because winter illnesses make everything a lot worse. Everyone is doing their best but in a stressful, gloomy environment. The wheels have been coming off for years (by design), and we are now well past the point that anyone could reasonably claim that management wheezes and efficiencies can compensate for lack of resources. I wish the UK public would just wake up and realise how much damage the NHS-wreckers have already done. Will they only miss it when it’s gone? Farage’s vouchers will be a very poor substitute! It feels like the NHS really is entering a critical and possibly terminal phase. If the NHS was a patient, it would be rushed straight into resus (provided it survived the 10 hour wait in an ambulance outside the hospital), followed by a long stay in ICU!
Thank you, and good luck.
I simply can’t get past the fact that the biggest issue to people in this country is immigration. My generous side thinks that the media have done a good job distracting us, my cynical side thinks that deep down, hurt people want to hurt people in return. It feels better to hate someone you can get at, punish someone directly, than it does to go after the faceless rulers ruining this country.
Agreed.
Three points, hopefully of interest.
1) Immigration. 24/7 media news on the subject, relentless. The polls do not surprise me. Sucking up to “man of the people” Farage.
2) Compare 1 above, with green issues. Not even mentioned. Not a concern of the public at all, considering that poll. It doesn’t even register. I wonder why? Is it because it hardly registers with the media? I think so.
Needless to say, Farage and Reform, climate deniers, don’t want to be questioned on that. It is their Achilles heel, if only it were to be discussed! And what is more important to our future? Stopping some boats or climate change?
3) Farage, Reform and the NHS. It is clear that Reform’s policy re the NHS is a little like Turkeys for Christmas. You fatten them up, kill them, and then sell them.
Reform would spend initially on the NHS (the fattening up), then once it is ready, sell it off to their mates, probably from the USA, and kill it off.
People might get some tax back from Reform, but they will be paying far more for private health insurance in the future. If, like Farage, you are a drinker and a smoker, your premiums for private healthcare will be through the roof.
Not that people will be able to afford a roof over their head when Reform get power.
Immigration and climate change are intrinsically linked. Someone needs to explain that to Reform’s supporters. As the equator heats up, people will migrate en masse. The Syrian war and subsequent migrant crisis, the one where people were able to ignore a dead toddler washed up on our beaches, was all about climate change at its roots. You want to stop the boats, stop the heating. But no, Reform is captured by fossil fuel interests as well.
I have no idea what will happen then.
I have already lost/unfriended friends discussing the issue.
By 2040 40% of the population of the U.K. will be 65 and older. Without immigration and/or a change to neoliberal economics, who will pay for the state pension? I guess nobody, so no state pension!
See tomorrow morning’s post.
No way would I be paying for private health insurance. I very much doubt if I’d be able to get it. And if my GP practice announced they were going to be taken over by some US conglomerate, I hope I’d have the guts to resign from their list on principle. Might be painful, though.
Further to JW’s points that in the EU we had agreements to return migrants , its thanks to Farage and co’ who are screaming ever louder about migrants and boats that we have this ‘crisis’ at all.
But their tactics work very well – Trump vetoed Biden’s measures to slow migration from Mexico because he wanted migration to continue to be in the headlines.
The BBC have headlined migration every single day for the last 6 weeks so if that’s all people are hearing, its not surprising it comes top of their ‘concerns’.
I never ever remember before , having to switch from radio 4 news, current affairs, ‘briefing room’, ‘moral maze’, ‘woman’s hour’ . to seek refuge on radio 3 to get away from migrant propaganda.
I think migration has tended to be in the top 6 concerns over the last few years but often cost of living and NHS have been top, but its pretty inevitable migration rises as a concern after a summer of blanket relentless coverage.
One tries not to be drawn into conspiracy thinking. But with BBC Starmer Badenoch Jenrick all shouting ‘migration’, ‘hotels’, ‘island of strangers’, ‘get out of human rights treaty’ from the rooftops , and some of them actually inciting more rioting, going to hotels, then getting themselves on the media for doing so – in what Jane Martinson has called an unvirtuous circle, what else is it other than an orchestrated conspiracy?
The UK dose NOT want a US style healthcare system.
The US healthcare system is NOT fair and does NOT work for all.
You can take my comment to the bank!
🙂
Excellent dismantling of Reform’s hopeless approach to how health care might be provided. In addition to EveryDoctor, I would also recommend Keep Our NHS Public, the 99% Organisation, We Own it and Just Treatment – all of whom argue for a publicly funded and delivered NHS, and together with EveryDoctor, are part of the ‘SOS NHS’ coalition.
Thanks
This is surely a dodgy survey as these topics are of different, overlapping categories and are not distinct. Unless respondents are somehow able to isolate their pure, intrinsic racism, the category of concerns over immigration significantly overlaps with concerns over NHS, economy (esp. training & employment), housing and education – much of which are, more generally, concerns over the adequacy of state service provision.
I would challenge anyone who claims an ability to analyse their concerns over these categories such that they can separate and quantify the extent to which those concerns are related to immigration vs other causes like staff numbers and competence, infrastructure, etc.. Such ‘ability’ is just the influence of mass media reporting right-wing racist groupthink to deflect our attention away from the more obvious solution that if we increase spending to improve/expand the services, build affordable houses, etc, we reduce our concerns over the NHS, housing, etc, AND immigration (even if we have not reduced immigration itself).
I think we have to break the grip of the right wing press on the news agenda and hence the political agenda. But I am not sure how. “Whats in the papers” as brodcast by BBC and Sky – only explore what those papers headline. Can we campaign to those major news organisations that “What matters to people today” might be a better starting point – and use an array of social media to determine what those issues might be… (so long as we can exclude the troll/bot effects…)
I wish they would do ‘What the blogs said’