Doing a lot more with only slightly more: the NHS’s Covid-19 recovery and public expectations

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Covid-19 demanded that the government commit massive increases to the health budget: over the past two years it has spent £80 billion on tackling the pandemic, 40 per cent above previous health spending plans. While we all hope that health spending will not need to return to these levels in the near future, the legacy costs of responding to the acute phase of the pandemic are great.  

These legacy costs are not just financial costs; they are also opportunity costs. The NHS went into the pandemic with growing waiting lists, routinely missed performance targets and a severe workforce shortage. Responding to the pandemic has served to divert attention away from tackling these issues and has exacerbated them.  

Public opinion

These opportunity costs may be filtering through to the public, with polling data suggesting that concerns about access and workforce shortages have grown significantly in the past year. What is more, the surge of goodwill toward the NHS that accompanied the first wave of the pandemic in March 2020 has receded and the numbers reporting negative views of the NHS are growing steadily back towards pre-pandemic levels.  

If this, primarily taxpayer-funded, spending increase is not seen to materially improve the quality and accessibility of the NHS, will there be a negative impact on public satisfaction with the NHS? 

In part to help address the backlog of care and drive improvements in access to services, the government has uplifted health spending plans for the years ahead. It has found the resource to do so by levying an increase on National Insurance worth £13 billion per year. 

Putting all this together raises an interesting question. If this, primarily taxpayer-funded, spending increase is not seen to materially improve the quality and accessibility of the NHS, will there be a negative impact on public satisfaction with the NHS? 

If this happens, what implications might it carry for the NHS and for the government?  

A lesson from history…

In the mid-1990s public satisfaction with the NHS hit a nadir. In 1996 just 35 per cent of the British public were ‘very’ or ‘quite’ satisfied with the NHS.  

It was not until the early 2000s and the arrival of significant new investment, alongside new performance targets and an intensive quality improvement regime that the situation began to improve. As a result of this, waiting lists shrunk and overall public satisfaction levels with the NHS began to rise, peaking at a record 70 per cent in 2010. 

While we cannot tie electoral success or failure to any one issue, or prescribe the motivations of voters, the government will know that the NHS is consistently one of the key issues people consider when deciding who to vote for.   

Managing expectations and delivering services

Whether this translates to more persistent and endemic public dissatisfaction, and where that dissatisfaction is directed – be it the NHS at a local or national level, or indeed toward the government – remains to be seen.  

Sajid Javid, Secretary of State for Health and Social Care, has been clear that he expects the current elective backlog to get worse before it gets better.  

Similarly, on workforce numbers, he recently explained that he does not expect to meet the key manifesto target to deliver 6,000 more GPs. Separately, while record numbers have started medical school in recent years, high rates of burnout and exhaustion among existing staff may mean retention rates drop further, thereby casting doubt on other key manifesto pledges on NHS workforce numbers.    

Increasing the size of the NHS workforce and reducing waiting times will take years. While public satisfaction with and appreciation for the NHS relatively remains high in historical terms, there is a risk of dissatisfaction, or even animosity, if services are not seen to improve quickly, potentially leading to charges of inefficiency or wasteful use of taxpayer money.  

Evidence from focus groups suggests this type of attitude may be fermenting among some. Whether this translates to more persistent and endemic public dissatisfaction, and where that dissatisfaction is directed – be it the NHS at a local or national level, or indeed toward the government – remains to be seen.  

With an NHS elective recovery plan expected soon, the government and the NHS will need to be transparent and open about the health service’s short-term prospects to help set realistic public expectations about its recovery.  

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