Health policy has long been regarded as a core Labour issue and this has been especially so since the 1980s. The Conservative Party has faced an uphill task in persuading voters and NHS staff of the merits of its policies. This would scarcely matter if health and health care were minor issues. However, between 1995 and 2007 opinion polls identified health care as one of the top issues for voters. It was the most prominent issue for most of this period, with between half and three quarters of people stating that health care was very important in helping them decide which party to vote for (see, for example, www.ipsos-mori.com). Furthermore, health has often been an issue of contention between the parties, frequently being described as a ‘political football’. Individual cases of alleged health service shortcomings, such as those of David Barber, Mavis Skeet, Margaret Dixon and Rose Addis, have exploded into legendary party-political battles. Health has been prominent at election time, particularly since the late 1980s, as exemplified by the War of Jennifer's Ear in 1992 and Tony Blair's call on the eve of the 1997 election of ‘24 hours to save the NHS’. Furthermore, health care has been an increasingly salient issue for governments since the late 1980s, as reflected in the increasing proportion of the content of Queen's Speeches devoted to it (Hobolt and Klemmemsen, 2005).

Weakness on such a vital issue presented the Conservatives with a significant problem, creating pressures for policy change. This chapter explores these pressures and how they shaped current party policy and, following the formation of the coalition with the Liberal Democrats, government policy. It begins by discussing theories of party politics that have some utility in explaining policy change and continuity. It then explores policy developments between 1997 and 2005, followed by an analysis of health policy under David Cameron's leadership of the party. The final section explores possible future directions in policy under the Conservative–Liberal Democrat Coalition.

Theories of party politics

Within the vast literature on party politics (Montero and Gunther, 2003) lie two main bodies of theory that may further our understanding of the changes and continuities in Conservative health policy. The first concerns the adoption of policy positions by parties. It includes rational choice theories, which conceive parties as positioning themselves on an ideological continuum to maximise public votes and gain office (Downs, 1957).