The public and the NHS

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Why we’re doing this and what we hope to achieve

The relationship between the NHS and the public is complex. Although surveys show us that the public is proud of the NHS, and that most people are satisfied with the services they receive, it’s sometimes said that public expectations of the NHS are rising. But what are those expectations? And what should be expected of the public in return? Moreover, as the NHS approaches its 70th birthday and pressures on the NHS continue to grow, have these expectations changed?

Dan Wellings talks about our work to explore the relationship between the NHS and the public

The NHS forms part of an implicit agreement or ‘deal’ between the public and the state about their respective rights and responsibilities. The population has a set of rights – such as the right to care that is free at the point of need – but there’s an expectation that the population contributes in return, for example by paying taxes or accepting the authority of state institutions.

These principles have underpinned the relationship between the NHS and the public since the NHS was first established, but the precise nature of that relationship has changed. Over time there has been an increasing emphasis on people taking responsibility for keeping healthy and for managing their own health, and a growing recognition of the important role that patients, communities and the public have in shaping health and care services. The NHS Five year forward view highlighted the importance of engaging with these groups, setting out the vision for ‘the NHS as a social movement’.

Against this background, we are carrying out work to explore the relationship between the NHS and the public. We want to understand what this currently looks like, how it has changed over time, and what it might (or should) look like in future. This includes addressing questions such as:

  • what do the public think the NHS is for
  • how has this changed over time?
  • what drives the relationship between the NHS and the public?
  • are public expectations changing?
  • where does the balance of responsibility for health lie between the NHS and the individual?

Through our work we aim to:

  • understand the relationship between the public and the NHS better – what drives it and what might need to change
  • build the case for developing policy that takes account of the public perspective – and ensuring that perspective is properly understood, rather than making assumptions about what it is, or should be
  • support the development of a robust and comprehensive body of evidence on the relationship between the NHS and the public, and public expectations, that can be drawn on by policy-makers, researchers and others.

What have we done so far?

We have:

  • polled the public on some key questions to gain an insight into people's view on the current relationship between the NHS and the public. See polling analysis published September 2017.

  • carried out an in-depth analysis of British Social Attitudes survey health data. The King’s Fund sponsors questions on the survey, which has collected data on public attitudes to health and health services for more than 30 years. We have looked at this historical data to explore how and why public attitudes to health and welfare have shifted. See our analysis published February 2018.

  • commissioned a series of blogs from a range of external contributors including patients, clinicians and others, setting out different perspectives on the relationship between the public and the NHS. Read blogs on NHS and the public.

What next?

We are working in partnership with Ipsos MORI to run a series of discussions with the public around the 70th anniversary of the NHS to find out more about the public's current relationship with the NHS and feed into the wider debate.  

We will be holding three events in March 2018 – in London, Nuneaton and Preston – which will involve a facilitated discussion with members of the public exploring their views on the NHS now and in the future.  

We will be publishing the findings of these events with Ipsos MORI at the end of June 2018. 

How to get involved

We’d like our work to take account of a wide range of views and perspectives. If you have any comments or questions in relation to our work, please leave a comment here or contribute to the debate on Twitter, using #KFpublic.

You can also contact one of the following team members: 

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