While support for the NHS remains rock solid, confidence in government’s handling of the service has fallen to a new low

News of the NHS in crisis is all pervasive. Alongside it runs heated media commentary infused with demands that ‘something must be done’. Yet, serious suggestions for reform are vanishingly few. Ideas such as charging patients to see their GP, slashing management or switching to a different funding model, like social insurance, are simple tropes long discounted by evidence and experience. So, if these are not the answers, where else should we look?

Asking the public is a good place to start. The Health Foundation’s latest polling, conducted by Ipsos, shows deepening public concern about the NHS. Only a third of more than 2,000 people surveyed think the NHS is providing a good service nationally, while nearly two-thirds think the standard of care has deteriorated in the last 12 months. Yet, despite this, public support for the founding principles of the NHS is unwavering. 90% of people believe it should remain free at the point of use and offer a comprehensive service, while 84% think it should still be funded through taxation.

While public support for the NHS remains rock solid, their confidence in the government’s handling of the service has fallen to a new low. Just 10% of people across the UK agree that their government has the right policies for the NHS (falling to a tiny 8% in England, compared with 28% in Scotland and 19% in Wales). While ministers claim ‘the NHS has the funding it needs’, more than 80% of the public think it needs more (including nearly two-thirds of Conservative voters), and over half are prepared to see their taxes rise to pay for it. Alongside more funding, increasing the number of staff and cutting waiting times are the public’s priorities.

The public are right to highlight the need for more investment. After a decade of historically low funding settlements, our analysis shows that if the UK health system had benefited from the same per capita investment as Germany, it would have received more than £70bn a year in extra funding in the decade leading up to the pandemic. And the difference shows: Germany has around 40% more doctors and nurses per head than the UK.

To those who say that current levels of taxation are too high, the truth is that the UK still has a relatively low tax burden by international standards. Investing in our health also makes economic sense – poor health is a key reason for the rising economic inactivity currently holding back economic growth. It is no coincidence that life expectancy improvements have slowed more in the UK than other European countries, that we experienced a comparatively high death toll from COVID-19 and that we are currently the only G7 nation with a smaller economy than before the pandemic.

Despite the gloomy headlines, there are hints of a brighter future. First, the pandemic saw widespread and rapid innovation in front-line care, extraordinary commitment from NHS staff and world class science to generate new vaccines and therapies. Second, new technologies, particularly digital, artificial intelligence and genomics, are now becoming available to improve treatment and reshape care. Third, we have the unique national asset of a single payer health system providing cradle to grave data, expert regulatory bodies that can test and license new treatments fast, and extraordinarily strong academic science. It is essential to build on these foundations, yet even now, the NHS’s technology budget is being slashed, slowing the changes needed to modernise services.

While innovation, technology and data offer hope for the future, there are no quick fixes to the challenges currently facing services. A long-term strategy is needed to grow the health and care workforce and deliver essential but unglamorous reforms to improve the delivery of care. This should include strengthening general practice, prioritising prevention, moving more services out of hospitals and into local communities and, underpinning it all, ramping up the digitisation of services. And no strategy for improving the NHS will succeed without the fundamental reform of social care that successive governments have promised but so conspicuously failed to deliver.

The public do not view the NHS through rose-tinted glasses. Our polling shows that more than half think the NHS often wastes money. Political frustration with this and a perceived slowness to innovate has spurred numerous reforms in the past. Yet, from the market-style incentives introduced in the 1990s and early 2000s, to Ofsted-style ratings for hospitals in the 2010s, and the almost constant stream of administrative reorganisations (aptly described by one former minister as ‘casual vandalism’), previous NHS reforms have mostly focused on administration, not improving front-line care. Almost all have failed to deliver the benefits promised despite vast costs.

Like other industries, the NHS is in the shadow of two mountains ahead: a rapidly shrinking labour market as baby boomers retire over the next 20 years; and a steep rise in ill health due to an ageing population, rising levels of poverty, a shortage of high-quality employment and high levels of obesity. Reforms to meet these challenges need to be serious.

Jennifer Dixon (@JenniferTHF) is Chief Executive of the Health Foundation.

This blog was originally published in the Times Red Box on Thursday 23 February 2023.