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Has the public fallen out of love with the NHS?


Earlier this year The King’s Fund and The Nuffield Trust published the results of the 2021 British Social Attitudes survey, which asked members of the public about their views on health and care services. The results were stark, with unprecedented drops in satisfaction across the board. But can we conclude that there has been a fundamental rupture in the relationship between the NHS and the public?

Overall satisfaction with the NHS fell to 36 per cent – a fall of 17 percentage points from 2020 to 2021. This was the lowest level of satisfaction recorded since 1997. Satisfaction with individual services fell to their lowest levels recorded since the survey began in 1983. The sharpest decline was seen in satisfaction with GP services which fell to 38 per cent – a 30 percentage point decrease compared to 2019. Survey after survey conducted since has told a similar story. Work conducted by Ipsos MORI for the Health Foundation found that less than half of respondents thought the NHS is providing a good service nationally (43 per cent) or locally (42 per cent). The latest data in a YouGov tracker suggests that things have got considerably worse since the British Social Attitudes survey was conducted last year.

'Sometimes the blizzard of data can numb us to the stories behind the numbers. There are people suffering, and getting worse, because they cannot get the treatment they need.'

The results shouldn’t be surprising. The picture for many users of NHS services right now is dire. There are now more than 7 million people (or roughly 1 in 10 of the population) England on a hospital waiting list for treatment. In September 2022 nearly 33,000 people waited over 12 hours in A&E for a hospital bed, a figure which is nearly 7 times higher than this time last year and the challenges around access to primary care have been well-documented.

Sometimes the blizzard of data can numb us to the stories behind the numbers. There are people suffering, and getting worse, because they cannot get the treatment they need. As The King’s Fund said recently in response to the latest set of depressing NHS statistics

'…NHS services are facing a range of really serious challenges that impact on patients and the quality and timeliness of care they receive – including crumbling buildings and outdated equipment, long waiting lists for care, high levels of Covid-19 and growing staff shortages.'

These worsening NHS performance statistics combined with the large drops in public satisfaction with the NHS and its services have led some commentators to conclude that the public has fallen out of love with the NHS and that now is the time to consider what an alternative might look like. The problem with this narrative is that is does not reflect what the public are actually telling us.

There is real frustration and anger out there at the state of NHS right now. Much of this frustration is focused on the lack of access to timely treatment. There is also a clear recognition that the NHS and its staff are under pressure in ways never experienced before and that the NHS does not have the workforce it needs to deliver the care that people expect. However, none of this is translating into a desire for a different funding model.

The British Social Attitudes survey showed that the overwhelming majority of respondents agreed that the NHS should be free of charge when you need it (94 per cent), the NHS should primarily be funded through taxes (86 per cent) and the NHS should be available to everyone (84 per cent). The Health Foundation recorded very similar data for the same question in addition to finding that 77 per cent of people believe ‘the NHS is crucial to British society and we must do everything to maintain it’. The data is clear the public does not want a different funding model for the NHS, they just want the system we already have in place to work and currently that is not happening.

2023 sees the 75th birthday of the NHS and no doubt many column inches will be devoted to whether it is time for a different model, but to argue that this is because the public has fallen out of love with the NHS is wrong. In April 2022 Ipsos MORI asked the public what makes them most proud to be British. The top answer given by 62 per cent of people was the NHS, an increase of 12 percentage points since July 2016. The public’s love for the NHS is being severely tested but it is far from broken.

'The public’s love for the NHS is being severely tested but it is far from broken.'

None of this is to suggest that a debate on the future of the NHS is not needed nor that it should be uncritical. Our work with the Nuffield Trust and the Health Foundation for the 70th birthday concluded that ‘the NHS performs neither as well as its supporters sometimes claim nor as badly as its critics often allege. Compared with health systems in similar countries, it has some significant strengths but also some notable weaknesses’.

A far more constructive debate would be on how the NHS can be sustained, what a future workforce should look like and how demand can be reduced by preventing ill health in the first place. A debate on the nation’s health not just its health service would be far more valuable than one on whether it is time for an alternative funding model.