What do the public want politicians to do about the NHS?

The findings from the 2023 British Social Attitudes survey on public satisfaction with the NHS make for grim reading – and set politicians a tough exam question for this general election campaign. Overall satisfaction with the NHS was down, with less than a quarter of the public (24%) saying they were satisfied with how the NHS runs nowadays. This was the lowest figure recorded since the BSA survey began in 1983 and has fallen by 29 percentage points in just three years. Satisfaction with individual services was at record lows. 

The findings are bleak, but not surprising. The past few years have seen widespread and sustained problems with NHS waiting times and quality of care coupled with seemingly endless strikes, all while the NHS struggles to recover from the Covid-19 pandemic. It is in a poor state of repair as we embark on an election campaign. Recent polls show the NHS will be the number one issue for voters at the ballot box. So, what do the public want politicians to do?

They do not want a change to the health service’s funding model. Falls in satisfaction are reported by some as a loss of faith in the health service’s principles, but the problem with this analysis is that it wrongly equates a loss of faith in the way the service runs with a loss of faith in the fundamentals of the service per se. If there is one finding from the 2023 survey that showed what unites people it was their support for the principles behind the NHS: free of charge when you need to use it, available to everyone and primarily funded through taxes.   

The public do not want a different model for the NHS, they just want this one to work. People want better access to services, improved waiting times and more staff. For any party that hopes to enter and stay in government, the question is how to deliver this and where the money will come from.

84% of the public believed that the NHS has a major or severe funding problem – a finding that has been consistent for some time. Small to medium-sized increases to the NHS budget over the past few years, in the context of poor performance, have had no effect. And there is little money that could be rerouted from elsewhere in the strained British public sector. So, if the public thinks there is a funding problem and they believe in a system that is tax-funded, the question is are people willing to pay to get the services they want?

When asked about government choices on tax and spending in the NHS 48% chose ‘increase taxes and spend more on the NHS’, 42% chose ‘keep taxes and spending the same’ while only 6% chose ‘reduce taxes and spend less on the NHS’. Those who are better off were more likely to choose increasing taxes, as were older people. 

However, there is a big difference between responding to a survey and the reality of paying more taxes, and this tends to be how politicians see these types of surveys, particularly when the results are as evenly balanced as similar polls have been on this question. Recent Budgets have pushed for tax cuts on the assumption that this is closer to what the public wants. 

However, public opinion does react against the perceived level of tax and spend. When the BSA survey began in 1983 only 32% said that taxes should be increased and more spent on health, education and social benefits. Cuts to spending under the Conservative government saw the proportion backing tax and spend rise to 62% by 1997. It then swung back again as Labour greatly increased public spending. In 2010 only 31% of people surveyed backed more taxation and spending. The difference is that now the country has the largest tax take since the war, yet increasing taxes and spending more is still the most popular option, but it is evenly poised. 

The experience of the last Labour government suggests the public really do notice when more is spent. In 1997 overall satisfaction with the NHS had fallen to a then all-time low of 34%. The election of a Labour government led to an initial bounce in public satisfaction for a couple of years, but satisfaction then sank back again. Satisfaction only really started to improve when Tony Blair’s famous promise in 2000 to meet European average health spending led to significant increases in the NHS budget. It hit high levels later still when that money translated into improved performance. Satisfaction reached an all-time high of 70% in 2010 – an achievement that looks ever more extraordinary with every passing year. 

There is no doubt these issues will take centre stage during the election campaign. The public are deeply unhappy. The major UK political parties are reluctant to be open with the public about the implications of the current plans for public spending after 2025, despite many commentators being clear that the plans just do not add up. In wanting to avoid a debate about tax and spend, politicians have a strong incentive to promise huge improvements at little cost. But this has been tried for the past 15 years and current levels of public satisfaction show it has not worked.     

For whoever wins the general election, the route back to higher satisfaction with the NHS is likely to be paved with difficult political choices about reform, funding and tax. Ducking these issues to get through the door of No 10 will just exacerbate the problem. Politicians need to clearly set out how they intend to recover public satisfaction in the NHS, and how they intend to pay for it.