Health

Health care in Britain: is there a problem 

and what needs to change?

  • Health services are subject to a real-terms expenditure freeze and are under unprecedented pressure to improve productivity during a period of sweeping organisational reforms. How satisfied is the public with the NHS and does it share the government’s enthusiasm for change?

    SS_Health _Intro _Right

    Highlights

  • Satisfaction with the NHS

    Public satisfaction with the NHS has fallen sharply since 2010 when it reached a record high, while most people think the standard of health care has improved or stayed the same in the past five years.

    Nearly six in ten people are “very” or “quite” satisfied with how the NHS runs nowadays, a sharp drop from 2010 when seven in ten were satisfied.

    SS_Health _Fact1

    Highlights

  • Satisfaction with the NHS

    Public satisfaction with the NHS has fallen sharply since 2010 when it reached a record high, while most people think the standard of health care has improved or stayed the same in the past five years.

    Around a third of people think the standard of care in the NHS has been getting better in the last five years, only just higher than the proportion who think it has got worse.

    SS_Health _Fact2

    Highlights

  • Attitudes to change

    People tend to think the health care system needs to change, but there is little appetite for fundamental reform of the NHS. There is some, though not overwhelming, support for the government’s policy of giving GPs control over local NHS budgets.

    The majority of people (87%) think the health care system in Britain needs some (“a few” or “many”) changes.

    SS_Health _Fact3

    Highlights

  • Attitudes to change

    People tend to think the health care system needs to change, but there is little appetite for fundamental reform of the NHS. There is some, though not overwhelming, support for the government’s policy of giving GPs control over local NHS budgets.

    34% say family doctors should set local NHS spending priorities, compared with 30% who say the government, and 17% each saying local people and local councils.

    SS_Health _Fact4

    Highlights

Introduction

Health care in Britain - and the National Health Service (NHS) in particular - has been affected by significant shifts in the policy and economic landscapes in recent years. In 2011-2012, as the country grappled with the economic standstill and the coalition government's austerity policies started to bite, the NHS began the year with virtually no increase in real funding. After a decade when real spending doubled, the NHS has been allocated little extra funding over and above inflation until April 2015, with the prospect of a continuing freeze for some years beyond that. The productivity task that the NHS has been set in response to this squeeze
 on its finances is unprecedented. By 2015, a virtually unchanged NHS budget will have to generate an extra 20 per cent more value - the equivalent of around £20 billion of extra funding for the NHS in England alone. Given that there has been little or no improvement in productivity during the past decade and a half (Appleby, 2012a), this represents a huge challenge.

Pullquote _Health _1The timing of the latest British Social Attitudes survey was also significant in wider policy terms as interviews took place when the government was pursuing its controversial Health and Social Care Bill through Parliament. Now an Act of Parliament (2012), this provides for what the Chief Executive of the NHS in England has memorably described as reforms so big "they could be seen from space" (Timmins, 2010). At the heart of the changes lies the abolition of Primary Care 
Trusts and the transfer of the budgets and responsibility for commissioning most NHS services to local clinical commissioning groups (CCGs) led by general practitioners (GPs).

The challenges in terms of both increasing productivity and reforming services rest on an understanding that the NHS is experiencing a 'problem' that needs 'fixing'. Regarding the former, the problem is fairly easy to perceive: how to maintain a quality service with virtually zero real growth in funding and growing needs. However, regarding reform - while acknowledging that performance and organisation in health care can always be improved to some degree - the problem has been less easy to identify. A central criticism of the Coalition's reform plans for the English NHS has been not just that they lack a persuasive narrative about the need for change, but also that they lack evidence that change is necessary on the scale proposed. Indeed, the previous British Social Attitudes survey carried out in 2010 seemed to provide evidence to the contrary by showing that 70 per cent of people were satisfied with the way the NHS runs - the highest level recorded since the survey began in 1983 (Clery, 2011).

How, in the context of an impassioned debate about the future of the NHS, have public attitudes towards the NHS changed since then? This chapter firstly explores the public's views about how the NHS is performing, looking at satisfaction with services and perceptions of change over recent years, and seeks to explain why opinion has shifted. Secondly, in the light of the wider debate about whether the fundamental nature of the NHS will - or should - change in response to the intensifying pressure on funding, the chapter looks to the future, exploring public attitudes to radical changes in the way the NHS is funded and accessed as well as its priorities for spending.

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Notes
  1. The International Social Survey Programme is conducted annually in 48 countries. In Britain it is carried out as part of the British Social Attitudes study, with funding from the Economic and Social Research Council. For more details see the website: www.issp.org/index.php
  2. People with experience include those answering "Yes, just me", "Yes, not me, but a close family member or friend", and "Yes, both me and a close family member or friend" to questions about use of inpatients and/or outpatients in the last 12 months
  3. The bases for Table 5.4 are as follows:

    NT_chapter _5.4
  4. There have been minor variations to this question over the years. From 1983 to 1994 the answer options were "support" and "oppose"; from 1995 to 2010 the answer options were "support a lot", "support a little", "oppose a lot" and "oppose a little", with respondents being prompted to say "a little" or "a lot". In 2011 the same four answer options were retained but presented to respondents on a showcard.
  5. Readings are indicated by data marker; the line indicates an overall pattern but where there is no data marker the line cannot be taken as a reading for that year.