Nearly 50% say Labour has best approach to health service, according to research by former Tory deputy chairman

The scale of the Conservative party’s NHS problem has been revealed in a poll conducted by the party’s former deputy chairman showing that Labour has a 18-point lead over the Tories on the NHS, and only 15% think the service has improved in the last five years.

Lord Ashcroft surveyed 20,000 voters in November and his research found that Labour’s shadow health secretary, Andy Burnham, was more trusted to tell the truth about the NHS than either David Cameron or Jeremy Hunt, the health secretary.

The findings prompted Ashcroft to claim on the Guardian that the party’s failure to “decontaminate its brand”, and the absence of a clear explanation of the purpose behind the coalition’s health reforms, “led voters to fall back on their assumptions about Tory motivations”.

Voters mostly think the coalition’s flagship health service reforms, piloted by Andrew Lansley in the early years of the government, were designed to save money. They also think they were more likely to be part of a plan to privatise the NHS than to cut bureaucracy or give more choice and control to patients.

When asked which party had the best approach to the NHS, nearly half (47%) said Labour, putting the party 18 points ahead of the Conservatives. Labour was also regarded as more likely to think of the NHS as an important issue than all other parties, except the Scottish National party in Scotland.

Over the past five years of the coalition government, 51% of Britons think the health service has got worse, while 34% believe it has stayed the same. Only 15% think the NHS has got better.

Cameron has been trying to neutralise Labour’s attack on his NHS record by highlighting reported claims that the Labour leader, Ed Miliband, told a private meeting that he wanted to use the NHS as a weapon in the election. But in Ashcroft’s qualitative research based on focus groups, the list of words most associated with the Tories was dominated by “cuts”, “poor” and particularly “privatisation”.

Ashcroft said the Lansley reforms had not helped the party’s reputation. But “in the absence of any clear explanation of how the changes were supposed to benefit patients, people fell back on their assumptions about Tory motivations”.

He asserts: “This is a consequence of the failure to complete the decontamination of the Conservative brand. The party’s modernisation will be complete when it is trusted to sustain and reform the NHS.

“The tragedy is that, in opposition, by campaigning confidently on the NHS the Tories managed to neutralise Labour’s advantage. Though the party may never overtake Labour on health, the NHS does not have to be its perpetual political millstone.”

Although the poll reveals a great pride in the health service among Britons, it also finds despondency about the direction in which it is heading, with only just over half saying they “expect the NHS in 10 years’ time to offer a full range of services to everyone to a high standard”. A total of 86% thought more private providers will be used to provide NHS services and 77% thought charges will be introduced for more services.

Ashcroft said: “We found that although many knew that the last Labour government had encouraged the use of more private providers, the Tories were thought to have an ideological preference for privatisation and would pursue the policy irrespective of whether it was good for patients (possibly even because Tories would have ties to people who stood to profit from private contracts with the NHS).”

The poll also shows the NHS is regarded as one of the three most important issues for voters and their families, with 69% citing the cost of living, 54% improving the NHS and 49% improving the economy.

It is likely public concern will have risen since November because of the recent publicity about A&E admission waiting times and delays in ambulances reaching non-urgent patients.

When asked to rate perceived problems on a scale of zero to 10, the highest by a clear margin was the amount of money being spent on management and bureaucracy, an issue that could be considered to be more favourable for the Conservatives. The next highest concerns were patients being denied drugs, then staff shortages, followed by variations in standards. Despite all the concerns, a majority (54%) thought not enough was being spent on the NHS, even though most knew more had been spent in this parliament.

The quality of nursing care, an issue repeatedly highlighted by Hunt, is the issue least likely to be seen as a serious problem among the 11 issues tested with the sample.

Nor does it appears that the public are listening to statements made by Hunt or ministers highlighting the progress made by the NHS. Only 22% agree that the “NHS has more doctors and more nurses than ever before” or that “fewer people than ever are waiting long periods for their operations”, two claims made by Hunt in his Conservative conference speech in 2014.

The poll shows voters do not regard having a choice of GP or hospital as key to improving the NHS. Instead they favour government targets, one of the reforms most spurned by the government. There is little ideological opposition to the involvement of the private sector as long as conditions are met.