More Cash For The NHS

This week, perhaps for the first time since September 11, the focus of the media's attention has switched from foreign affairs and terrorism to domestic affairs, and particularly to the National Health Service. The Wanless report on funding the NHS was published, and on the same day the Chancellor, Gordon Brown, made his pre-budget statement, promising an extra 1631bn for the NHS with a commitment to higher long-term investment.

The public, too, are worrying about the NHS again: in our poll for The Times published yesterday and conducted last weekend, the NHS resumed its customary place at the head of the public's list of the most important issues facing the country, after two months when more people mentioned their concern about defence, foreign affairs or international terrorism. [Political Attitudes in Great Britain for November 2001]

When the present government was elected in 1997, an important factor was the perception that it would be more committed to the health service than the outgoing Tories had been, and Labour voters were undoubtedly optimistic that Blair and his colleagues could achieve improvements in NHS standards, and considered it one of the highest priorities for the next government. (In a pre-election poll this year for The Sun, 69% said cutting hospital waiting lists should be a top priority, compared to 39% who preferred putting more policemen on the beat and 38% reducing class sizes in schools.)

The public also claimed to be prepared to pay higher taxes to achieve this (in a survey for the Economist in April 1997, 76% said they felt "Government services such as health, education and welfare should be extended, even if it means some increases in taxes".) Commentators tend to decry such poll findings as these: voters lie to pollsters when they say they want higher taxes, it is argued ? in the privacy of the polling booths they vote against, which is why Neil Kinnock lost in 1992 while Tony Blair, promising no tax rises, was able to win in 1997. I have discussed the fallacy in this argument before in this column ["Hit and Myth" [18/02/00]] These old canards have been resurrected again this week in the light of Mr Brown's statement, but the truth seems to be that the voting public will tolerate reasonable tax rises so long as they feel confident in how the government will use the money.

So where do we stand, four-and-a-half years on from that first election? In our poll for The Times, we measured the public's overall satisfaction with the NHS, and found very little change in attitudes since this time last year when we asked the same question in a survey for the BMA. While three in five say they are satisfied, three in ten are not.

Q Overall, how satisfied or dissatisfied are you with the NHS?

There is something of a paradox that persistently shows up in polls about the NHS ? considerably more of the public say they are satisfied with their own experience of the NHS than they are with the NHS as a whole. Dissatisfaction seems to be driven not simply by the public's own contact with it, but by their rather gloomier perceptions of its general state.

Even if overall satisfaction is still relatively high, this by no means implies that the public is not concerned. There is a widespread belief that the standard of the service is deteriorating. A survey by MORI Scotland for the Scottish Executive in September and October found that although about half (48%) of people in Scotland think the NHS has stayed 'about the same' over the past few years, of the remainder twice as many think it has got worse (30%) than better (14%).

Past surveys have shown that dissatisfaction is with the management of the health service and its level of funding, not with the healthcare professionals. Doctors and nurses remain highly respected ? in March (MORI survey for the BMA -link) 95% said they were satisfied with the way nurses do their jobs and 89% with doctors. This is so despite the fact that many of the most damaging media stories about the NHS over the last few years (Harold Shipman, the Alder Hey body parts controversy, the Bristol heart surgery enquiry) have involved accusations against doctors, not administrators. (Even when explicitly reminded of these cases, the overwhelming majority of the public say that they think most doctors do their job well.)

The blame for the state of the NHS tends to be put squarely on the shoulders of politicians and, to a lesser extent, managers. Asked a year ago (MORI/BMA, November 2000) who or what was most responsible for the current state of the NHS (without being prompted with possible answers), 44% named "the government" and 11% specifically "the Labour government", while 20% blamed the last Conservative government. At the same time, 16% mentioned "people running hospitals" or "NHS managers". The next highest categories (the rising cost of healthcare, greater demand and people abusing the service) occurred to just 3% in each case.

Even when we showed respondents a list of possible causes, reminding them of the possibility of attributing the main blame to changing conditions, the Conservative government (51%), current Labour government (48%) and NHS managers (46%) still topped the list, followed by people abusing the service. The public are reluctant to concede that the problems of the NHS are inherent in increasing demand through an aging population, higher costs through ever-continuing medical advances requiring new technology, or the rising expectations of the public.

One concern, of course, is pay, which will inevitably be a major part of the burden of funding the NHS as well as, perhaps, a key element in recruitment. Almost all the public, 86%, thought in March that nurses were underpaid, and 30% said the same of doctors. (The public's concern extends to other public sector services, with 53% feeling that teachers and 35% the Police are also underpaid.)

What next? In Scotland, at least, there seems to be a degree of optimism about the future, with 44% thinking the NHS will become 'much' (14%) or 'a bit' better (30%) over the next few years. This presumably reflects confidence in the Scottish Executive, and the Labour-Lib Dem coalition administration, being committed to spending what is needed to do so. (The NHS in Scotland, of course, is funded from Holyrood and not directly from the Westminster budget.) At the time of the general election, too, more than half the public across Britain (55%) said they expected that if Labour were to be re-elected it would improve the NHS. Now Gordon Brown has to prove they are right; doing so, without making the rise in the tax burden seem too inordinately painful, will be a vital step towards Labour's third election victory. If he fails, the government will find it very hard to shift the blame.

If you would like further information about MORI's research services in NHS and Public Health, please call Ben Page on 020-7347 3000 or email: [email protected]

For further information on our Science & Medicine research, please contact Michele Corrado on 020-7347 3000 or email: [email protected]