The public and the NHS

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 celebrates its 70th birthday and pressures on the NHS continue to grow, does the relationship between the NHS and the public need to change?

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

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.

Key milestones

What did we do?

  • 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 the polling analysis published in September 2017.

  • Carried out an in-depth analysis of British Social Attitudes survey health data. The King’s Fund sponsors questions on the survey (see box below), 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 in 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 the blogs.

  • Analysed public attitudes to NHS funding to establish whether the public see tax rises as the answer to NHS funding pressures. Read the analysis published in April 2018.

  • Run a series of discussion workshops with the public around the 70th anniversary of the NHS, the findings of which were published in a joint report with Ipsos MORI. Read the report published in June 2018. 

The British Social Attitudes Survey has been carried out annually since 1983. The survey is conducted by NatCen, and is one of the largest and most authoritative surveys of its type. Since 2011, when government funding for the survey was reduced, funding has been provided by a variety of charitable and government sources.

The King’s Fund has provided funding for and reported on the questions on public satisfaction with the NHS since 2011. In 2017, the Nuffield Trust also contributed funding for these questions and we worked in partnership to report the findings. Since 2011, The King’s Fund has also funded a small number of other questions on health and care, which change periodically, and address current policy issues such as NHS funding and how to address the pressures facing services. 

All questions on the survey undergo robust testing with members of the public, conducted as part of NatCen’s survey design process, to ensure that questions are understood by the public and capture their opinions.

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: 

Guest blogs

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