As the NHS marks its 75th anniversary, the founding principles of the health service – that care would be free at point of delivery, available to all and funded from tax – are largely the same. But how care is delivered and how the system is organised have changed significantly since 1948.
This anniversary presents a moment to reflect on how far the NHS has come and to look to the future. Recent years have seen the NHS face unparalleled challenges. The COVID-19 pandemic followed a decade of austerity, driving waiting lists to new heights and exacerbating longstanding workforce shortages. Amid record low public satisfaction and unprecedented industrial action, the health service is in crisis. So what does the public think about the NHS now and the challenges that lie ahead?
Our polling programme tracks public perceptions of the NHS every 6 months. This wave surveyed a representative sample of 2,450 UK adults aged 16 years and older between 5 and 10 May 2023, online via the Ipsos UK KnowledgePanel – the gold standard in UK survey research. Fieldwork started the day after local elections in England and covered the coronation of King Charles III.
Here we present six findings about how the public views the NHS at 75 and perceptions of what the future may bring.
1. The health service makes more people proud to be British than our history, our culture, our system of democracy or the royal family
Among people who self-identify as British citizens, over half (54%) say the NHS makes them most proud to be British (Figure 1). More see the NHS as a source of pride than our history (32%), our culture (26%) or our system of democracy (25%). This is similar to Ipsos’ previous research, although comparison is only indicative due to methodology differences.
While the NHS’s founding principles command majority support across the party political spectrum, our survey finds that people intending to vote Labour are more than twice as likely to say the NHS makes them most proud to be British (71%) than people intending to vote Conservative (31%).
2. Pride in the NHS is largely related to the NHS model – it being free at the point of use, affordable and paid for through taxation – but only 1 in 4 expect this to survive the next 10 years
Among people who say the NHS makes them most proud to be British, we asked what it is about the health service they are most proud of. Analysis of free text responses found the NHS being free at the point of use, affordable and paid for via tax (55%) is the aspect that make people most proud, followed by it being available to all and treating everyone equally (36%) (Figure 2). Around 1 in 7 (14%) identified the quality of NHS care and the dedication of health service staff.
Despite being the main reason for pride in the NHS, only 25% of the public believes health care will still be largely free at point of delivery in 10 years’ time (Figure 3). Half (51%) expect to pay for some services currently free at point of use, while 13% think most services will need to be paid for upfront and 7% anticipate user charges for all services. People intending to vote Conservative are more likely to expect user charges for some services (66% versus 51% of people intending to vote Labour). Those planning to vote Labour are more likely to expect to pay for most (15% versus 7% of Conservative voters) or all services (8% versus 2%) that are currently free at point of use.
3. The public is not confident the health service is prepared to meet key future challenges
Overall, people are not confident the NHS is equipped for the major challenges it will face in the coming years.
Despite the disruption caused by COVID-19, the public are divided on whether the NHS is prepared to respond to future pandemics – 47% think it is prepared, while 46% think it is not (Figure 4). 28% think the NHS is prepared to use new technologies, such as artificial intelligence, to improve treatment and care (51% not). People are least likely to think the NHS is ready for the impacts of climate change (19% prepared, 61% not) and to meet the demands of an ageing population (17% prepared, 77% not).
Compared with the general public, people intending to vote Conservative are more optimistic – 59% think the NHS is prepared for future pandemics, 28% believe it is ready for the effects of climate change and 24% are confident about meeting the needs of an ageing population.
4. Concern about the current state of the NHS crosses political divides, but people are split on what is causing pressures
Overall, the public sees lack of funding (40%), staff shortages (38%) and government policy (35%) as the main causes of current pressures on the health service. Concern about staff shortages spans the political spectrum, but breaking down views by voting intention reveals important differences in what people perceive as causing the strain on health services. People intending to vote Conservative are more likely to blame perceived NHS failings, with ‘poor NHS management’ (43%) and NHS ‘inefficiency’ (32%) among their top five suggested causes (Figure 5). In contrast, those intending to vote Labour are more likely to identify perceived government failures, such as a ‘lack of funding’ (58%) and ‘poor government policy’ (52%). Undecided voters emphasise a different set of factors again, with ‘staffing shortages’ and ‘poor NHS management’ cited as the leading causes.
5. Almost three-quarters of the public still think the NHS is crucial to British society and we must try to maintain it
A majority of the public (72%) believe, ‘The NHS is crucial to British society and we must do everything to maintain it’, although this is 5 percentage points lower than a year ago (Figure 6). Around 1 in 4 (26%) think, ‘The NHS was a great project, but we probably can’t maintain it in its current form’, an increase from 21% a year ago. People aged 75 years and older are more likely to think the health service cannot be maintained in its current form compared with other age groups.
6. There is strong support for increasing NHS funding, with an additional tax the preferred option for raising it
Most people (80%) continue to think that the NHS needs an increase in funding, compared with just 17% who think that the NHS should operate within its current budget. People aged 25–34 years are more likely to think that the NHS needs additional funding, whereas those aged 55 years and older 55–74 years and those aged 75 years and older are more likely to think it should operate within its current budget.
But the public remains split on how the government should fund any further increases in spending. The most popular options are an additional tax earmarked specifically for the NHS (31%), an increase in National Insurance (22%) and an increase in Income Tax (21%).
The crisis in the NHS means its 75th anniversary will be marked with mixed emotions. But concerns about the state of the health service should not be mistaken for an appetite for radical change. The public clearly wants a better health service not a different health system, and recognition of the impact of staff shortages is one of few issues that cuts across political divides. The belated workforce strategy, recently published by government, represents a down payment towards addressing these. But protecting what people value most about the health service, and building public confidence in its ability to meet future challenges, needs a sustained process of investment and improvement – not just a long overdue anniversary present.