Great expectations: the changing nature of the public’s relationship with the NHS

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Despite the NHS and the challenges it faces rarely being far from the headlines in recent years, there has been relatively little research done into whether – and how – the public’s priorities are changing and what people expect from the NHS in the 21st century.

With 2018 marking the 70th anniversary of the NHS, at The King’s Fund we’re just starting a project that will explore the public’s relationship with our health service. We hope to gain a better understanding of what people currently think about the NHS and how opinions and expectations have changed over time; spark debate about patient rights and responsibilities; and help to develop a body of evidence to inform future decision-making about the NHS. 

In undertaking this work we hope to reach as wide an audience as possible, and we started our research by asking people to contribute ideas on social media (Twitter and Facebook) using the hashtag #KFpublic. The Fund’s sizeable and varied audience made this a good place to begin, and as the lead on our social media strategy I was pleased to be able to use this as an opportunity to increase engagement and conversation on our social media platforms. We asked two key questions.

  • What do you think the main issues are for the NHS?
  • If you could ask the public one question about their relationship with – and expectations of – the NHS, what would it be?

We’ve had a really good response with many insightful contributions from people with a range of backgrounds and experience (directors, managers, clinicians, allied health professionals, students, service users and carers, to name but a few) – which in itself shows that the NHS is important to many people. Thank you to all who contributed. We were struck by the breadth of issues raised, although several common themes emerged.   

One of the most frequently raised issues was the problems arising from a complex and fragmented health and social care system. Many people feel that excessive bureaucracy and inadequate or confusing communication – both between organisations or departments and between services and their users – is often hindering timely access to treatment.

"Medical records in primary and secondary care not joined up. Poor comms = inadequate care."

There was inevitably some discussion around politics, with government policy linked to the funding and staffing issues currently faced by the NHS. Political involvement was blamed for a lack of stability, with ‘constant political interference and reorganisation wasting time and resource’. Some also mentioned the role of the media, namely the impact of inaccurate or biased reporting and how this can sway public opinion.

"Constant deliberate misinformation about the NHS in the media."

Probably the most frequently raised issues – ones that we at the Fund often talk about – were those of funding and the capacity needed to manage current levels of demand for NHS services, closely linked with workforce and staffing issues. Insufficient service provision, limited access and postcode lotteries, quality of care, waiting times and delays, understaffing, too many managers, staff working conditions and pay were all mentioned. Not only do these appear to be the most pressing issues for the public as service users but also, understandably, for those who work in the NHS.

"At the moment we can't get recovered elderly patients out of medical hospital because social care can't put in place a package of care - because there aren't enough carers, due to low pay. We have a huge elderly population. Also nurses are leaving because they are underpaid and highly stressed due to staff shortages. Furthermore there aren't enough mental health inpatient beds or supported accommodation to discharge patients to when they are well, so they remain on the wards."

And finally, there was much discussion around the expectations of those who use the NHS, and the extent to which people should be expected to take responsibility for their own health.

"A lack of public health education- it should be in the primary and secondary school curriculums. People don't know how to look after themselves or when they should seek help, either demanding treatment for minor self limiting conditions or ignoring serious symptoms."

This last point was echoed in what people said they would like to ask the public about their relationship with the NHS, which in turn raised many bigger questions around the breadth of the NHS remit, personal responsibility for one’s own health (and the mitigating factors of social context, public health and education in this), collective responsibility for the NHS, digital technology and its role in information and communications, equality of access and quality of care – and the extent to which the NHS is valued as an essential institution.

"What about - if you ran the NHS, what would you keep and what would you change?"
"Would you be prepared to pay higher taxes if it meant a higher standard of care?"

These are all well-known issues, but what the priorities are and how best to tackle them is somewhat subjective and everyone’s personal experience is different. It’s also likely that opinions change over time. Of course, the comments we have collated so far are just a sample of views from people who follow The King’s Fund on social media. Our next step will be to poll a representative sample of the public to find out more about what they think of the NHS and their expectations of the service – and we’ll be continuing the discussion on social media throughout the course of this project. 

It is vital that policy is informed by the views of a wide cross-section of society, to ensure that individuals have the opportunity to put forward their opinions, and that these opinions are listened to, understood and taken into account as the health and social care system evolves. Society has changed since the NHS was established in 1948 – and so have people’s circumstances, needs and expectations. Now seems an appropriate time to step back and consider the public’s changing relationship with the NHS, and what impact this might have on its future. 

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Harry Buckland

Long retired GP,
Comment date
19 August 2017
Public consultation is a sick joke perpetrated by a host of expensive quangos on taxpayers and patients who fund the salaries and pensions of NHS managers.
The Treasury has far too large a role in telling us how we may spend our own money.
The National Debt, at 90% of GDP is ridiculously overblown and costing us £8,000,000 every hour. We should be asked our view on a one off repayment of that debt and use the interest saved to fund NHS improvements, as happened during the last war with Post War Credits.

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