On 27th February 2017, the Government debated an e-petition which had received 117,344 signatures through the Parliamentary website. The petition noted that there are 193 attacks on NHS staff per day in England, and called for it to become a specific offence to attack a member of NHS staff, in line with legislation specifically prohibiting violence against police officers. Following Parliamentary debate, the Ministry of Justice argued that ‘assaults again NHS staff are completely unacceptable’, but also that there were already sufficient offences which criminalised assault and violent behaviour. The example of this recent petition raises broader historical questions – who has created petitions about the NHS over time? Have these been effective, and in what ways? How do such petitions fit in to a broader model of NHS-related campaigning?
The first known petitions to Parliament date back as early as the fourteenth century, and petitions have emerged as a popular way for members of the public to try and influence Parliamentarians, particularly since the 1600s, initially about personal grievances and later seeking to change policy. The historian Richard Huzzey has demonstrated that popular petitions in the late eighteenth century ‘transformed the fortunes of the anti-slavery cause, which had little prospect for political attention before them.’ Huzzey argues that these petitions were effective because of their reach (attracting signatures from as many as 1 in 5 adult men), and because political elites genuinely feared that they marked a sign of impending revolution.
The first petitions which I have found in relation to the National Health Service – and I’d be keen to hear if you know of earlier examples – were created in the 1960s and 1970s, usually by doctors as a tool during industrial dispute. For example, in 1975 the Daily Mail reported that sixty ‘militant hospital doctors’ from Hillingdon Hospital had a petition signed by 600 patients to support their mass resignations (over the Government’s refusal to increase overtime pay). An increasing number of petitions on every topic, including the NHS, were presented to Parliament in the early 1980s. The House of Commons Information Office has attributed this to the emergence of several highly contested issues in debate at this time, many of which were related to health such as contraception, abortion, and embryo research.
This increase in the numbers of petitions also perhaps reflected a less deferential electorate, who were mobilising politically in a variety of ways, and concerned about the future of the welfare state under Thatcher’s reforms. Certainly, NHS petitions were now created by members of the public, as well as NHS staff, and petitions began to challenge government cuts and the perceived privatisation of the NHS, both nationally and locally. In December 1989, 4.5 million people signed a petition in defence of ambulance crews. The physical content of these petitions filled 100 boxes, only 25 of which were allowed in to the House of Commons by the Speaker Bernard Weatherill. Petitions were in part seen as a tool of specifically left-wing revival at this time: in 1991 Dr Clive Froggatt, of the Conservative Medical Society, argued that a petition created by the NHS Support Federation, calling for a halt to NHS reforms, was a barely concealed ‘political message…telling people to support Labour.’
From the mid-2000s, e-petition sites were created by the UK’s Parliaments and private –e-petition companies such as Change.org and 38 Degrees were founded. Analysing the petitions on these websites allows us to look more closely at the relative popularity of the NHS as a topic of petitioning. Considering the Government’s e-petition website (running from July 2015 – March 2017 so far), health issues are well-represented as a topic. Of the top ten most popular petitions ever created on this website, the third most popular called to provide the meningitis B vaccine for all children, the seventh was a vote of no confidence in Jeremy Hunt, and the eighth called to lower the age of cervical screening to 16.
Looking at all petitions on this website, 1,852 out of 28,831 (6%) mention the NHS. This seems significant. Of these petitions, 40 received over 10,000 signatures, and thus a response from the government. Nineteen of these petitions were about the treatment of specific diseases in the NHS – such as meningitis and cervical health – and one was about the firing of a particular member of staff. These petitions, arguably, tell us more about concerns about the nation’s health than about NHS provision (although perhaps that preventative services are seen as part of the mandate of the NHS is also significant). Nonetheless, half of these popular petitions – 20 – were about the NHS specifically and, like the petitions from the 1980s, the aims of these reflected a fear that the NHS was ‘in crisis’ due to cuts and privatisation wrought by a Conservative government.
Looking at the topics of popular petitions suggests a high level of public interest in the NHS and in health, which is played out on a national and a local level. In terms of NHS campaigning, petitioning has been particularly prominent during periods of right-wing Government – the 1980s and 2010 to present – in which campaigners have sought to use petitions to criticise changing policy. The extent to which petitions have been successful in this regard is difficult to assess. Some petitions can be linked to change. In 2007, Cancer Research UK presented a petition signed by over a quarter of a million people to Parliament, calling for cancer to be placed at the top of the Government agenda. Soon after, the Government launched a new cancer plan for England. In 2008, the British Medical Association presented a petition of 1.2 million signatures against the emergence of ‘polyclinics’, combining primary and secondary care. The plans for such clinics were put on hold in 2010 by the new incoming Government. The responses to the former petition, however, may have been merely rhetorical; or the changes wrought following both petitions, if real, could have been part of a new or changing government strategy anyway.
Something easy to find in newspaper archives and amongst campaigners is irritation and sadness that petitions do not affect change. Prime Minister Margaret Thatcher did not even feel that it was politically necessary to meet the parents behind a petition to increase funding to Birmingham Children’s Hospital, simply telling the media that the NHS would not be given a ‘blank cheque’. Campaigners in the 1980s and today suggest that various petitions against hospital closures meant that ‘barely an eyelid was batted’ (Daily Mail, 2002), and that the ‘voice of the people’ was ignored (The Times, 1994) or ‘very ineffective’ (own survey of NHS campaigners, 152 responses). Nonetheless, however, despite this cynicism about the effect of surveys from both the political science literature and from campaigners themselves, we continue to create and sign surveys in mass numbers.
This may be for several reasons. Perhaps those establishing surveys are inspired and hopeful, having noticed the success of some high-profile surveys (for example one which postponed the instatement of a new Road Tax in 2006, another which lead to an apology for the treatment of Alan Turing in 2009). Research suggests that 19 out of 20 e-petitions (on the Downing Street petition website, 2006-9) were launched by individuals, rather than by groups or organisations – perhaps these individuals do not have the cynicism about petitions mentioned by the weary long-term campaigners above. Petitions may also carry a higher function than merely calling for political change. Some campaigners in my survey mention that promoting a petition is an easy way to bring members of the public into their groups, where they can also become involved with other forms of activism such as leafleting, discussion, and writing to MPs. For others, signing a petition may enable them to feel like part of a particular ideological or moral community, or a way of perhaps may be a way in which they construct and understand their identity or position in society.
If you’ve ever signed a petition about the NHS, I’d be very interested to hear more. Why, when, how did you do this, and what happened next? Please do either comment below, respond to my survey for campaigners, or email me at firstname.lastname@example.org (Jenny Crane).