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 often 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?

The NHS forms part of a ‘social compact’, or an implicit agreement about rights and responsibilities, between the public and the state. This compact guarantees the population a set of rights – such as the right to care that is free at the point of need – but it also asks that the population contribute 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 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, The King’s Fund is undertaking 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 will include 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.

The King’s Fund will also consider this approach across its work more broadly, where appropriate taking the time to understand the public’s perspective on a particular issue or topic, before seeking to bring about change.

What we're doing

We will be taking this work forward in a number of ways, including:

  • Polling the public on some key questions to gain an insight into the public’s view on the current relationship between the NHS and the public. Some of these questions have been asked before, allowing us to track changes in responses over time and understand how attitudes may be shifting.
  • Carrying out an in-depth analysis of British 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 will be looking at this historical data to explore how and why public attitudes have shifted.
  • Commissioning a series of short articles setting out different perspectives on the relationship between the public and the NHS. These articles will be written by external contributors, including patients, clinicians, policy-makers and others.

We will provide updates as our project develops, including any plans for further work in this area.

Key milestones

The results of the polling work were published in September 2017. 

The article series will begin in autumn 2017 and continue until early 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:

Dan Wellings:

Harry Evans:

Lillie Wenzel:

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