Dan Wellings, Senior Fellow (Policy) at The King’s Fund, offers his insight into the public’s expectations of the NHS…
In the run-up to the 70th anniversary of the NHS, we’ve been talking with the public to better understand their relationship with and expectations of the service and their views on who is responsible for keeping people healthy.
It almost goes without saying that there is huge support for the NHS, with the vast majority of people supporting the founding principles of a service free at the point of delivery, available to all and funded largely by taxation. As one participant at our recent discussion events said, “I do have a love for the NHS, it’s part of our heritage.”
We hear views like this so often that it’s easy to take public support for the NHS for granted, but our findings throw up interesting questions about what the relationship between the public and the NHS means for our wider health. Could our love for the NHS actually be bad for our health?
There are signs that this may indeed be the case. 
First, there’s an argument that our attachment to the NHS means that we don’t demand enough of the NHS and that we sometimes tolerate a level of service that would be unacceptable in other areas of our lives. Although ‘rising patient expectations’ is often cited as one of the pressures currently facing the service, there is little solid evidence to back this up. The premise is that in other areas of our lives we have become a ‘right here, right now’ society and we bring these increasing demands to bear on what we expect from the NHS, but this work raises serious questions over how true this is.
People we spoke to were aware that they moderate their demands because NHS staff are under intense pressure and because their expectations are largely rooted in their previous experiences of the NHS. Some people also felt that because the NHS is so well liked, people were less critical of it even when their experience was not as good as it could be:
“We give private companies much more of a hard time because they make so much more profit and have more money to play with.”
This begs the question: should we ask more of the NHS and does our affection for it limit our ability to be sufficiently critical of the service we receive?
Second, there is an argument that if government funding follows popular support, then other areas that don’t top the polls are left struggling with the NHS crowding out the case for increased spending in other areas.
Sarah Wollaston, chair of the Health and Care Select Committee, speaking at a recent King’s Fund event, was asked what led to the government’s seeming about-turn on NHS funding and the answer was telling: they had listened to the polling over the past year showing rising concern for the future of the NHS, with increasing numbers of people willing to pay more tax to fund it. Does the public and subsequent political support for the NHS blind us to the need for greater investment in other areas – such as social care and public health – that would arguably have a greater impact on our health and wellbeing?
In work undertaken in partnership with the Health Foundation, we asked the public about its views on the future funding of social care. The contrast with the NHS was stark – most people were unclear what social care is and even less clear on how it is funded, which goes a long way to explaining why there has not been the public clamour to fix what is an increasingly broken system and why politicians have managed to avoid dealing with it. When the current system was explained to them they were shocked and understood the case for change. At our event, Paul Burstow, former minister of state for care services, said that this year is also the 70th birthday of social care but it is not clear whether there will be a cake, what the recipe is or indeed who will be paying for the ingredients.
On public health, a recent poll conducted by Ipsos MORI asked people which areas they would prioritise if the government were to devote more money to health and health care services. Number one was urgent and emergency care, followed by spending on mental health – a considerable achievement for all those who have been making the case for increased spending to improve parity of esteem. Bottom of the list was spending on prevention, arguably the area that would have the biggest effect on the overall health of the nation. Spending on public health has endured significant cuts in recent years and Jacqui Smith, former home secretary, argued at our event that the government needs to step up to the mark. People we spoke to at our events clearly understood the case for greater investment in prevention but it was not top of mind in the same way the NHS is.
There is no doubt that public support and concern for the NHS has been a significant driver behind the recent offer of more money to the system. However, once the birthday celebrations have died down it is time for the debate to shift to greater investment in public health and social care. If not, our support for the NHS will come at a price and one that could ultimately impact directly on the object of our affections.
