The NHS is nowhere near crisis point yet

The public loves the NHS. Despite the frequent headlines proclaiming that the NHS has reached a crisis point, it is routinely cited as one of the things that makes the British proud. Some 77% of us agree it is so important that we must do everything we can to maintain it, a figure unchanged for decades.¹ It is always top of the list for extra funding and for protection from necessary cuts whenever we at Ipsos ask the public.

So far, so good. The challenge is that the NHS does need more money—as acknowledged this week by the prime minister²—and 66% of us say that we would personally pay more taxes to help fund it.³ However, it’s easy to say one thing to pollsters and then act differently in private. Around half of us, despite our love for the NHS, agree that it often wastes money. And in terms of how it manages its vast workforce, my view is that too often those in charge of individual trusts worry most about being fired over money management or killing too many people through medical error with staff or patient satisfaction a long way down their list of priorities. Some 38% of NHS staff report having been unwell because of work related stress, and only 34% rate communications with senior managers as good.⁴ The NHS could do many things to improve its own culture.

The public’s overall satisfaction with the NHS is drifting downwards—and satisfaction with GP services has fallen to one of the lowest recorded levels. Yet satisfaction remains much higher than in the 1990s and still compares well with many other public services. Some 49% of British adults currently describe the state of the NHS as one of the key issues facing the country.⁵ But to give you an idea of what “crisis” really looks like, on a comparable basis concern about unemployment was at 87% in the winter of 1982. It is only when more than six in 10 people regularly mention an issue that we can safely say it is truly "in crisis". We are some way from a tipping point in perception about the NHS, but a few bad winters could bring one. This is because there is a non-linear relation between our perceptions of NHS services and actual waiting times and clinical outcomes. As resources poured into the NHS after 2002, when Gordon Brown, then chancellor of the exchequer, announced national insurance rises specifically for the NHS in the Budget that year, it took some time for actual cuts in waiting times to feed through into overall improved ratings of the service.⁶ As standards deteriorate, there will be a similar perceptual lag—but we are not there yet.

Meanwhile there are so many things that the NHS could do better. Changing people’s attitude to their health and their bodies is fundamental. Progress in moving from a flashing blue lights illness service to a wellness service is too slow. The health service has to help society make the sort of shift we have seen in other areas in my lifetime. When I was born, practising homosexuality was illegal. Now, some 53 years later, 66% of us say that it would be fine if Prince Harry had married a man rather than Meghan Markle.⁷

We need to make similar changes in how we regard ageing and illness. If the NHS is not going to be perpetually pronounced as being in crisis or about to be in one, we need to shift from seeing illness as inevitable and largely down to fate towards seeing it as something for which we take active responsibility. Until society itself has changed its attitude and behaviour and the NHS has changed alongside it, it will never have "enough" money, but the NHS itself has to provide the "nudge" to help make this happen.

Note: this article first appeared in the British Medical Journal (BMJ)

References

1. Ipsos. What do the public think about the NHS? Sep 2017
2. Iacobucci G. News story details to come. BMJ
3. Ipsos. NHS at 70: Public attitudes to the health and care system. May 2018
4. National NHS Staff Survey Co-ordination Centre. 2017 results
5. Ipsos. May 2018 Issues Index
6. Robertson R, Appleby J, Evans H. Public satisfaction with the NHS and social care in 2017. King’s Fund. Feb 2018.
7. Ipsos. Most Britons would have no concerns about a royal same-sex marriage. Apr 2018