How might changing public attitudes influence government policy on health?

The UK government’s narrative about the pandemic has shifted to plans for ‘living with COVID-19’. But the pandemic is still putting major pressure on the NHS in England, and the effects of COVID-19 will be felt by the health system and its patients for many years to come.  

There are currently 6 million people waiting for routine hospital treatment in England, with 300,000 people waiting more than a year. Emergency care is also under extreme strain: 23,000 people waited for more than 12 hours on trolleys in emergency departments for a hospital bed in March – up from 700 in the same month last year. Around 70,000 hospital staff were off sick or self-isolating at the start of April – 29,000 because of COVID-19. These pressures are far from normal and are having a negative effect on people across the country. 

Public attitudes to the NHS 

The public are, unsurprisingly, noticing. Latest data from the British Social Attitudes survey found that public satisfaction with the NHS fell by 17 percentage points between 2020 and 2021– falling to the lowest level since the 1990s and falling faster than in any year since the survey began in 1983. Satisfaction dropped across all services and among most groups. The main reasons people gave for being dissatisfied with the NHS were waiting times for GPs and hospitals, staff shortages, and government not spending enough money on the NHS.  

The findings are similar to our latest round of public polling at the end of 2021 – part of our research programme on public perceptions of health policy and performance in the UK, with Ipsos. Most people in our survey thought the general standard of NHS care had deteriorated in the last year, and only around 1 in 10 thought that government has the right policies for the NHS. People’s top priorities for the NHS were addressing pressures on staff workload, boosting staff numbers, and improving waiting times. You can listen to my colleague Tim Gardner talk about the findings from our research on the latest episode of Ipsos’s podcast. 

Narratives about NHS reform 

What are the implications for policy? The overall message seems clear: people want a health system that has enough staff and resources to deliver the care they need. And they see a system currently struggling to do it. For some – particularly on the right of the political debate – pressures on the NHS are being used to fuel a narrative that the health system needs fundamental, typically unspecified, ‘reform’. But the British Social Attitudes survey found strong public support for the core principles of the NHS: that it should be free of charge when you need it, funded primarily through taxation, and available to everyone.  

Debate about NHS reform should focus on the real problems facing the health system and how they can be addressed by policy. The reasons behind NHS pressures are complex: a decade of austerity in NHS funding, chronic staffing shortages, underinvestment in wider social services that shape health, massive and ongoing disruption from COVID-19, and more. Most of these issues pre-dated COVID-19, as we explore in our newsletter feature on factors that the COVID-19 inquiry must consider when assessing the government’s pandemic response. And the NHS is not alone in struggling to cope with the disruption from COVID-19. Health systems across Europe are facing challenges recovering services and long waiting times for treatment. 

Workforce shortages 

Staffing gaps are likely the biggest issue holding back the NHS’s recovery. The health system is short of around 110,000 doctors, nurses, and other staff. Shortages in adult social care are similar. And the UK has fewer doctors and nurses than most comparable countries. In the latest NHS staff survey, only around 27% of staff said that there were enough staff in their organisation for them to do their job properly. A third of staff reported feeling burnt out. 

Despite this, the government has no long-term plan for addressing chronic staff shortages in the NHS. And MPs voted down an amendment to the Health and Care Bill that would have ensured independent projections of future workforce needs are produced and published to support policy decisions in health and social care. As a result, the latest round of NHS reforms will do little to fix our broken system of workforce planning. But our analysis on these issues will continue. We will soon be publishing our latest assessment of how changing demand for NHS services may affect the workforce we need in the future.  

Narratives about health 

Competing policy narratives aren’t confined to the NHS. In public and political debate about how to improve health, the wider determinants of health – things like education, income, employment, housing, and other social and economic factors that shape the conditions in which people live – are often left out or misunderstood. Dominant thinking about health is highly medicalised and individualised. This can contribute to poor policy decisions that underplay the importance of population-wide interventions to address structural factors shaping health and inequalities. Our new report, published last month, focuses on ways to communicate about health to increase understanding of the wider determinants of health – and includes six practical recommendations for how people can do this more effectively.  

Policy framing plays a central role in the policy process. How policy issues are defined and discussed shapes the policy options considered, the people involved in policy development, and political choices about how (selected) problems should be addressed. Competing narratives about policy issues can interact, gain and lose advocates, and evolve over time. Helping people understand the evidence can counteract damaging narratives about health and the NHS and, ultimately, can help influence government approaches to improving them. 

Hugh Alderwick (@hughalderwick) is Director of Policy at the Health Foundation.

This content originally featured in our email newsletter, which explores perspectives and expert opinion on a different health or health care topic each month.