Powered by love, and disappointment
Public opinion and the NHS
Former Prime Minister Boris Johnson credited the NHS with saving his life during 2020 and described it as “powered by love”. This phrase could equally apply to public opinion which has been steadfastly affectionate towards the country’s “greatest national asset” (another Johnson aphorism); the NHS continues to top of the list of reasons to be proud to be British. But is the nature of that sentiment - that love - changing?
The public stands firmly behind the NHS model. According to Ipsos, 77% believe, ‘The NHS is crucial to British society and we must do everything to maintain it.’ Everything is a big word. So too is maintain, especially at a time when the service faces huge challenges including the ‘ABCD’ priorities identified by former Secretary of State for Health and Social Care Thérèse Coffey (standing for ambulances, backlogs, care, doctors and dentists).
Currently, maintenance is much less a case of fixing the roof while the sun shines, and more about holding up the walls in a storm. Last month’s evocative tweet by Dr. Philip Lee — “When people ask what a collapse of the NHS would look like, it’s this, it’s already here” — raised the spectre of a shell of a service, rationing access to care to sustain itself.
This isn’t a rogue lament of an exasperated clinician but has strong echoes in public opinion. In the same month Dr. Lee took to Twitter, Ipsos found concerns about waiting times to be widespread and strengthening. In December, 59% of people said they were confident that a friend or family member would receive good care from local NHS services, down from 83% in January 2015, a time when there were also warnings about winter pressures on the NHS.
The recent strikes and disruption will have played on people’s minds but, even before they started, the 2022 British Social Attitudes Survey (involving fieldwork in 2021) recorded the lowest level of satisfaction with the NHS since 1997 and the largest year-on-year drop in the survey’s history. Last year, 83% considered their health system to be overstretched, a higher proportion that in any of 34 countries, bar Portugal. These worries reflect long-running concerns about staffing and funding, exacerbated by a trio of factors — Covid, Brexit and the cost-of-living crisis.
Just under two-thirds of Britons, 64%, strongly agreed in December that waiting times are too long for emergency care, up 19 points in 12 months. The equivalent increase was 10 points, to 67%, for non-emergency care.
Concerns about the health service have now displaced economic matters as the most mentioned important issue facing the country, although worries about inflation and hardship remain very salient of course. January’s Issues Index was the first in which the NHS topped the list of concerns in any month since February 2020 when Covid was starting to make the news.
Among Rishi Sunak’s pledges to the public at the start of the year, ensuring people get the NHS care they need more quickly (chosen by 57%) and reducing NHS waiting lists (50%) featured only behind easing the cost of living and giving people financial security (61%) as most important to people. These was significantly ahead of growing the economy, cutting national debt and controlling the country’s borders.
Most Britons love the NHS as an idea but there is a difference between proclaiming love for something or someone, and being in love with the reality. In his 1952 essay, Aneurin Bevan, worrying about the threats the NHS faced, wrote that that the service was working “beyond the expectations of those of us who had most faith in the Service”. What we’re seeing now is unmet expectations and a challenge to that faith.
The NHS continues to be powered by love. But the other dynamic is disappointment. There is a sense that we are letting the NHS down and another that it is letting us down. As Ipsos’ Health team researchers have suggested recently, it will take much honesty, bravery and endeavour to move on from here.
