But what about the NHS in Wales?

A good defensive line isn’t always a good attack line

What do you know about how well or badly the NHS is doing at the moment? Wherever you are in the UK, the likely answer is that you’re very well aware it’s under pressure and performing poorly, with long waits for patients to be seen and treated. I say “wherever you are in the UK” because healthcare is devolved, and so if you’re in England the NHS is the responsibility of the Conservatives, if you’re in Scotland the NHS is the responsibility of the SNP, and if you’re in Wales the NHS is the responsibility of Labour. (Northern Ireland is… more complicated.) It’s performing below many of the standards its leaders set for it in all of those places.

Of course, the overall spending envelope from which the devolved administrations have to set their NHS budgets is decided in Westminster, which means that the Conservatives can reasonably be said to have some responsibility for the resources available for, and the performance of, healthcare systems across the UK. But nevertheless the Scottish and Welsh Governments have significant autonomy in how they choose to run their health services, and are legitimately accountable for their performance.

All of which is a very basic preamble to this tweet and this graphic posted by the Conservative Party on Thursday, with the caption “The Labour Welsh Government have had a humiliating climb down after it is revealed their claims about doing better than NHS England, on A&E figures, were wrong”.

On a technical level, this tweet/graphic combination doesn’t work very well: if you don’t know what the story is when you start reading the tweet you still won’t know what it is at the end, and you have to do a fair amount of digging to find the BBC story referenced in the graphic - there’s no link (the Tories can’t be bothered to post it so I’m not going to either: do your own research if you want to, and if you don’t want to then draw your own conclusions about how important this is to you). Is it really a cover-up rather than a mistake? Is it even being alleged to be a cover-up rather than a mistake? Honestly, you don’t have enough information here to know, but you do have enough information to know that it isn’t obvious.

But I’m not highlighting this attack to debunk it, or really to discuss it at all, except as a jumping-off point for thinking about what the Conservatives are trying to do when they talk about the NHS in Wales, which is something they’ve done quite often throughout their time in government, and about when and why it works and when and why it doesn’t. The key points are: it’s not about Wales, it’s about England, and it’s not about attack, it’s about defence.

When I worked in Labour’s PMQs prep team (read all about that here) we got very used to David Cameron responding to questions about the state of the NHS in England by talking about the NHS in Wales - something he did over and over and over again. It wasn’t just Cameron. Long after I stopped being involved in PMQs, Theresa May was using the Welsh NHS as a defensive shield when attacked on the NHS at PMQs, and Rishi Sunak still does.

This was and is, from a Labour perspective, annoying, but it was and is tactically effective in a PMQs setting: it eats up time and provides the Prime Minister with something to talk about that isn’t the NHS in England. In my experience, during Ed Miliband’s time as Labour leader it was a genuine deterrent against asking questions about the NHS. (I want to be precise about what “deterrent” means: it didn’t stop Miliband asking about the NHS - he did, a lot. It was one of the factors we took into account in deciding whether to ask about the NHS on any given occasion, and in weighing whether other topics might be more productive, which tended to make asking about the NHS look less attractive.) We had a number of stock responses, from the confusing and ineffective (pointing to different selected Welsh NHS statistics) to the robust (“Every time he points to the NHS in Wales, it’s because he knows he can’t defend his record on the NHS in England”), but they were stock responses designed to deal with the fact that we knew the discussion would inevitably move away from the subject we wanted to talk about.

To understand when talking about the NHS in Wales works for the Tories and when it doesn’t, though, you need to think about how arguments are structured. PMQs is an adversarial set-piece event in which one leader is asking questions and the other is responding to them. The accusation (the NHS in England is failing under the Conservatives) is met by a counter-accusation (the NHS in Wales is failing under Labour). It’s a deflection, and it’s not an ineffective one. But think about how it would work the other way around. If the Conservatives spontaneously raise the state of the NHS in Wales as a reason not to vote Labour, Labour can make the equivalent response: look at the state of the NHS in England. And this is a much more powerful response, for the very obvious reason that England is a lot bigger than Wales, and that most of the voters who will decide the next election know first-hand about the state of the English NHS while knowing and caring little about its Welsh equivalent. 

For Labour to decide to attack the Tories on the English NHS, despite knowing that part of the Tory response will be to talk about Wales, is to make a tactical decision that the damage they will inflict will strongly outweigh the damage they will take on the way. For the Tories to proactively attack Labour on the Welsh NHS, despite knowing that the state of the English NHS is a weak point for them and that talking about any NHS failings raises the salience of NHS failings in general, is simply to choose to walk into a massive punch in the face. Which is why, generally, they don’t - and why tweets like the one above are the exception rather than the rule.

There are two bigger challenges for the Tories here. One is that their attack on the NHS in Wales largely concedes the initial charge against them. The argument isn’t “actually the English NHS is doing brilliantly, it’s just the Welsh NHS that’s bad”; it’s “OK so the English NHS is doing badly, but the Welsh NHS is doing at least as badly and arguably worse and Labour is responsible for that, so there”. An argument that starts with “the English NHS is doing badly” and continues with “governments are responsible when health services do badly” is not a brilliant one for an incumbent government to run with.

The other is that most people in the UK are not hugely aware of, or invested in, the state of the NHS in Wales, because they don’t need to be: they don’t live in Wales. An attack on Labour’s stewardship of NHS Wales requires a lot of heavy lifting for audiences outside Wales: first, explain that the Welsh NHS is different, then explain it’s worse (not an uncontested claim), then explain it’s all down to Labour (again, not an uncontested claim), then ask them if they’re still listening and tell them to stop complaining about their own inability to get a GP appointment in England.

And meanwhile, the people who actually use the NHS in Wales and elect the Welsh Government - which is to say, the people who live there - keep voting Labour, and are more likely to blame the UK Government than the Welsh Government for the state of the Welsh NHS. If the Tory argument on the Welsh NHS is working on anyone, it isn’t working on them.

I’m really pleased at how many people have subscribed to Dividing Lines since I started it last weekend, and grateful to everyone who’s shared and recommended it. (It’s hundreds, not thousands, but it was none before last weekend so I’m happy with where we are so far.) If you’re enjoying it, do subscribe if you haven’t already, and do tell your friends. The good thing about not charging for this - and I’m not going to charge for it: I don’t need to, it’s not my livelihood and I’m conscious that there are more paid newsletters out there than most people can realistically commit to even if they’d like to read more than they do - is that I can post when I want to rather than feeling pressure to write something to provide value for money. It’ll probably be about once a week, we’ll see.

If you have an example of political attack you’d like me to write about, let me know. If you’re the person who got in touch after the last post to suggest something which is in fact not the topic of this post, well, I might well get to it at some point. As with almost all media, interactivity is more exciting in theory than practice.