If it didn’t know it already, the Government is under real pressure on the NHS. Last week’s annual public satisfaction survey showed a remarkable change in public attitudes and hinted at the way forward. In terms of the research, four points:
First, satisfaction in the Service has collapsed.
Overall satisfaction with the NHS fell to 36 per cent – an unprecedented 17 percentage point decrease on 2020. This is the lowest level of satisfaction recorded since 1997. More people (41 per cent) were dissatisfied with the NHS than satisfied.
This fall in satisfaction was seen across all ages, income groups, sexes and supporters of different political parties.
It encompassed every part of the Service – hospitals, general practice and dentistry. Satisfaction with GP services fell by the greatest amount: by 30 percentage points, from 68 per cent satisfied to 38 per cent. This is the lowest level recorded since the survey began in 1983.
Second – the cause was the long waits for consultation or treatment resulting from the pandemic.
The main reason people gave for being dissatisfied with the NHS overall was waiting times for GP and hospital appointments (65 per cent of respondents).
Third – the proportion of people wanting higher tax rises to fund the NHS is falling.
There was a statistically significant fall in the proportion of people that believe that extra funding should come from a separate tax for the NHS – from a high of 35 per cent in 2017 to 26 per cent in 2021.
This is consistent with the British Social Attitudes survey (see graph). From 2010, public support for higher taxes and spending rose, reaching a peak in 2017. Since then, support has declined.
Very likely, the trend in support for higher taxation and spending is now in decline, mirroring the trend between 2002 and 2010. In other words, it will remain in decline for the next two general elections.
Fourth and last – while voters want a massive change in NHS performance, they do not want a wholesale redesign of the service. Around 90 per cent of voters believe that the NHS should “definitely” or “probably” be free at the point of use, be available for everyone and be primarily funded through taxes.
Where does this leave health policy? Three points.
First, some have argued that the NHS should be replaced by a compulsory insurance model on the Swiss or German model. While those systems have advantages in terms of patient choice, they are not going to pass the test of public opinion. Voters want the existing system, working better.
Second, it would be a brave politician who introduced a further NHS-specific tax in this Parliament or the next. The NHS has received very large spending increases since 2018. As in previous cycles, voters now want a period in which the Service lives within its means, and gets full value for its resources.
The Government recently justified the increase in National Insurance Contributions in terms of the extra activity that the money would generate, especially extra diagnostic tests. Ministers are right to link resources and outputs. But they should be much clearer about the specific impacts of their spending increases.
The NHS used to give more attention to the comparative costs of services in different locations than it does now. It should regain the habit.
Ministers would then be able to identify the most productive methods used by NHS teams – and use that information to reassure the public.
Third, the Secretary of State needs to address public dissatisfaction with general practitioners without further degrading their professional competence.
GPs and their teams are the essential foundation of an affordable NHS. They have already achieved major increases in productivity in recent years, doubling numbers of consultations for relatively little extra cost.
But their numbers are limited and they cannot provide face-to-face appointments to all patients. Nor should they. Their professional duty is to prioritise those with the most medical need, not the loudest voices. A practice covering 10,000 patients will be responsible for a key group of 2,000 people with serious long term health problems.
Last year, the Government allowed the debate on general practice to become a political row, which will only have undermined the profession further.
Rather, Ministers and profession together should collect evidence on the difficult choices facing GPs, and communicate those to the public.
Who is actually demanding face-to-face appointments and why? People with injuries should be heading for urgent care centres or A&E, not for the GP. How many of the complainers are frequent attenders with known conditions? Blackpool has set up a special service of health coaches for frequent attenders.
For the future, any changes in GP programmes should be assessed by NICE, rather than be the subject of instant reactions by Ministers.