News and Comment

Are the public really as unhappy with the NHS as reports would lead us to believe?

Tuesday 18 September 2012

In 2010 respondents to the 28th annual British Social Attitudes survey recorded the highest level of satisfaction with the NHS in the study’s history. 70 percent of the public said they were either “very” or “quite” satisfied with how the NHS was run. One year later, leafing through BSA 29, it is startling to note that the same question has seen a 12 percentage point decline to just 58 percent. GPs, inpatients, outpatients and A&E services have all been rated less favourably by the British public than they were at this time last year – begging the question ‘what is going on in the NHS?’

As the BSA report judiciously points out, other recent surveys – including those by the Care Quality Commission and the Department of Health – “have not recorded a decline in the public’s actual experience of the NHS”. Furthermore, most of the changes legislated for in the politically divisive Health and Social Care Act won’t come into effect until next April; leaving us to assume that the decidedly less satisfying NHS of 2011, cannot have been that different to the very popular NHS of 2010. Instead, it would seem that public’s perception of NHS standards has fallen disproportionately to the reality.

There are numerous possible reasons for this shift in attitudes, many of which are explored in the report, but a theory that particularly interests me is the idea that people’s perception of the NHS has become increasingly negative because they oppose the extent of changes being made to the service. As the report points out “while many feel the NHS needs to change to some degree, radical changes…are not generally the kind of change they have in mind. Even so, a large minority think this is what will, in fact, happen”. This quote and the statistics that underpin it, make clear three facts:

  1. The public, while in favour of small changes to the NHS, are opposed to radical reform.
  2. A significant minority believe that despite their opposition, radical reform will take place anyway.
  3. An underlying assumption of this minority is that such radical reforms would be bad for the NHS.

At OPM we have direct experience of encountering these attitudes in the field. We are currently working in South West London, North West London and the South East Midlands, where we are tasked with explaining to the public why radical changes are being proposed. We are finding that when the case for change is explained the public are willing to go along with it if they feel that the proposed changes will lead to a better quality of care. The public increasingly understand that in light of an increasing and ageing population, hospitals having too few specialists to provide round the clock care and the NHS having to operate within tighter financial constraints, maintaining the status quo is not an option.

Although this is by no means an easy journey to take the public on, failure to have these transparent and grown-up conversations will only contribute to the insidious atmosphere in which public sector reforms and consultations are viewed with hard-nosed cynicism.

The public are, quite rightly, proud and protective of the NHS and the report confirms this strong emotional attachment the nation has to its health service. Since the BSA began in 1983, the NHS has consistently been voted the most popular recipient of additional spending. But the public are also realists – only 5 percent of people believe that the NHS needs no changes whatsoever. The key for policy makers and NHS management is to establish a public mandate for the type of changes the health service needs to remain efficient in the 21st century. And reading the findings of yesterday’s study, it is evident there is much work to be done.