How Can the New Labour Government Win a Second Term? Fix the NHS

On July 4, the Labour Party secured a decisive victory in the elections, but now comes the hard part. At a time when trust in politics is low and voters’ desire for change is high, Labour needs to deliver. 

Much of voters' discontent is centered around the bad state of the state-funded National Health Service (NHS). Yet, restoring confidence in the NHS will be difficult and take time. As Labour is trying to act, the leader of the insurgent populist right Reform party, Nigel Farage will try to exploit widespread public discontent over the state of broken public services to win more seats in the next election. 

Much of the focus has been on immigration and whether a Labour government can address voters’ concerns with growing immigration.  On the night of the election, Farage predicted that the Labour government will soon be in trouble. Reform won an unprecedented 14% of the vote by appealing mainly to disgruntled Conservative voters, but Farage warned that he “will now be targeting Labour voters”.  

Even the former Labour Prime Minister Tony Blair has come out arguing that the new government will need to be tough on immigration to stay popular with voters, especially those on the right, who are worried about immigration.

But immigration is not the only issue voters care about.  A key area of frustration for voters on both the left and the right is the poor performance of the NHS. With ever-longer waiting lists for hospital appointments and declining local services, voters are deeply concerned about the state of their beloved health service. 

Yet, reforming the NHS will be difficult and take time. As Labour is trying to act, Nigel Farage and his Reform Party will try to exploit widespread public discontent over the state of broken public services to win more seats in the next election. This might not bode well for the future of centrist politics in Britain.

High Expectations 

Keir Starmer is the first centre-left leader to win a UK election since Tony Blair’s successive victories in 1997, 2001, and 2005. Blair won power on a sweeping mandate to modernize Britain. This time is different. 

While Labour gained two-thirds of the seats, it only won just over a third of the votes, and much of the party’s success came from widespread discontent with 14 years of Tory rule. The roots of discontent are manifold: from “party-gate” scandals during the COVID pandemic to mismanagement of the economy; from a crumbling infrastructure to an NHS in crisis.

As he entered Downing Street, Starmer promised British voters that change begins now, but when it comes to the NHS Labour faces a daunting task: how to restore faith in the state-funded health system when faced with a difficult mix of sluggish growth, labour shortages and weak public finances. During the campaign, Starmer and his team stressed a growth-led strategy that would allow for increased spending, rather than tax rises or more public borrowing. But this will not be a quick fix. 

Labour thus finds itself in a situation where expectations are high, but with limited tools at their disposal to meet them. Anti-establishment parties, like Reform, will be waiting in the wings to reap the electoral benefits of failed expectations. 

We have examined the political consequences of declining NHS performance in a recent study. By analyzing government data on local healthcare facilities closures and linking it to data on public preferences and voting intention, we find that closures increase people’s dissatisfaction with the health service and their support for Reform (and its predecessors). The link between the closures of local healthcare facilities and Reform support is highest in areas that have experienced increased immigration and registrations of migrants at local practices. 

Reform, like many populist right parties in Europe, frames access to public service as a zero-sum game between ‘native’ and ‘migrant’ populations, and makes immigrants the target for attributing blame for deteriorating public service delivery. Fixing the most urgent problems in the NHS will be key to stopping the tide of the populist right in Britain. The problem for Labour is that there isn’t a quick or easy solution to the challenges faced by the NHS.

The problem of a landslide win, albeit with a relatively low number of votes, is that it constitutes somewhat of a double-edged sword. It may give Labour enough seats to get things done in parliament, but at the same time, it does not give the party the luxury to blame slow progress on difficult backbenchers, or unruly coalition partners. 

Starmer, and his team, know this full well. Over the weekend, he declared that reforming the NHS was not going to be an “overnight exercise”.

Do not Underestimate Electoral Volatility

 Developments in British politics of late may complicate matters even further for Labour. Electoral volatility is on the rise. Four years ago, Boris Johnson’s Conservative Party won their biggest election victory in 30 years by promising to “get Brexit done”.  

At the time, many were convinced that Johnson’s new electoral coalition would secure him at least a decade in power. 

Today, this distant memory of Johnson’s fleeting triumph is a poignant reminder that a large share of British voters do not display much loyalty to one party or another. Rather they look closely to judge how their everyday lives have improved (or not) by those in government.

Concerns about the lack of quality of public services, most notably the NHS, may have helped Starmer beat the Tories, but as our research shows, it also boosted the popularity of the anti-establishment politics of Reform. 

Starmer needs to find ways to calm this discontent. As long as mainstream parties cannot show that they can safeguard public services, populist parties will continue to attract the votes of the disgruntled and ignored. 

Yet, providing good quality health services, and keeping up with public investment in general, is a tall order in a time when the economic growth stalls and society ages. 

Whether Starmer’s government can satisfy public expectations, will be the key question during his tenure as prime minister, and could be decisive for his ability to win a second term in office.

IEP@BU does not express opinions of its own. The opinions expressed in this publication are those of the authors. Any errors or omissions are the responsibility of the authors.

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