Things can only get better?

Public perceptions of health and care under the new government

Introduction

Our survey of the UK public’s views on health and care, conducted in November 2024, marks the first in our series of surveys with Ipsos under the new Labour government. More broadly, the survey is the first comprehensive look at public attitudes to health and care under the new government – including the biggest issues the public want to see prioritised.  

On his first day as the new Secretary of State for Health and Social Care, Wes Streeting declared ‘the NHS is broken’ and promised the new government would be ‘honest about the challenges facing our country, and serious about tackling them’. 

The new government has set out bold ambitions for improving the NHS. With the prime minister warning there would be ‘no extra NHS funding without reform’, a new 10-Year Health Plan has been announced for spring 2025, informed by ‘the biggest national conversation about the future of the NHS since its birth’. The detail of what these reforms will look like is yet to be seen. But the prime minister has pledged to make substantial improvements in waiting times for routine hospital treatment by the end of the parliament.

Plans for adult social care have been more modest. Labour's manifesto promised a new National Care Service. But while new legislation has been introduced to improve pay and conditions for care workers, implementation of a cap on how much individuals need to pay for social care over their lifetimes has been cancelled. Consideration of options for longer term reform has been passed to an independent commission, due to report by 2028. 

What does the public make of the new government’s early agenda for the NHS and social care? Have perceptions and expectations of NHS and care services changed? And have the public’s priorities shifted in light of the new government and its promises?

This analysis presents findings from the seventh wave of our programme of public perceptions research with Ipsos that tracks the UK public’s views on health and social care every 6 months. Our survey was conducted via Ipsos’ UK KnowledgePanel between 21 and 27 November 2024 with 2,198 UK adults aged 16 years and older (see Box 1 for methodology). The survey took place after the announcements of the 10-Year Health Plan, the launch of the ChangeNHS public consultation and the extra spending on the NHS and social care in the Autumn Budget. Fieldwork was completed before the NHS began experiencing severe winter pressures and the announcement of a new commission for adult social care.

Views on NHS and social care performance 

While there has been little material change in the performance of NHS and social care services since our last survey in May 2024, public perceptions of services are likely to be influenced by other factors, including people’s views of the government. For example, public satisfaction with the NHS increased for 2 years in a row following the 1997 Labour victory, and a smaller, short-lived rise in satisfaction was observed in 2010 with the new coalition government. Is a similar optimism bump in store under the new government?  

Views on the general standards of care over the past 12 months and expectations for next 12 months

The public is less negative about NHS services than they were in May 2024, before the election. 4 in 10 (41%) think the general standard of NHS care has got worse over the past 12 months, compared with over half (55%) in May 2024. However, just 8% think services have got better, consistent with May 2024 (Figure 1). 

Views on standards differ by voting intention. For example, people intending to vote Reform UK are more likely to think the standard of NHS care got much worse over the past 12 months (25%) compared with those intending to vote Conservative (17%) or Labour (8%).  

When asked about expectations for the general standard of NHS care in the next 12 months, the public is again less negative than in May 2024. 39% think standards of care will get worse, compared with 52% in May 2024 (Figure 2). 21% think standards will get better over the next 12 months, compared with 11% in May 2024. Women are more likely to think standards will get worse (43%) than men (35%). People intending to vote Labour are most likely to think standards will get better (41%), while those intending to vote Conservative (14%) or Reform UK (11%) are more negative. 

The public is less negative about social care services than before the election. 44% think the general standard of social care got worse over the past 12 months, compared with 50% in May 2024. However, still only 3% think the standard of care has got better, consistent with our previous surveys.

The public is also less pessimistic about the standard of social care over the next 12 months, with 36% thinking standards will get worse – down from 49% in May 2024. While just 11% expect social care services to improve over the next 12 months, people are more optimistic than in May 2024, when only 5% thought this. 

Views on local and national NHS and social care services 

The public is more positive about local NHS services than in May 2024. 45% agree that their local NHS is providing them with a good service, compared with 37% in May 2024 (Figure 3). However, around a third (32%) still disagree, consistent with May 2024 (32%). People who have used the NHS in the past 12 months are more likely to agree that local NHS services are good (47%) than those who have not used any service (27%). 

Views on NHS performance nationally have remained stable, with 29% agreeing it provides a good service, in line with May 2024 (28%). This means the gap has widened between people’s perceptions of local and national service standards in the past 6 months.  

People’s views on whether social care services are good in their local area have also remained stable since 2022, with 30% disagreeing and just 12% agreeing. Overall, the public’s views of NHS and social care performance are less negative across most questions under the new government, but still more negative than positive. 

The public’s priorities for the NHS

How do public priorities compare with the government’s?

The Labour government has started signalling its priorities for the NHS. Ministers unveiled new measures to improve general practice and promised a strategy to address long waits for urgent and emergency care. But the prime minister, through the Plan for Change, has put waiting lists for routine hospital treatment squarely at the top of the NHS’s agenda, with an ambitious commitment to recovering the 18-week standard by the end of the parliament.

By contrast, for the first time in our survey series, the public’s top priority for the NHS is making it easier to get appointments at GP practices (38%). This is followed by improving waiting times for A&E (33%) and reducing the number of staff leaving the NHS by improving working conditions (29%) (Figure 4). Improving waiting times for routine hospital services – the focus of the government’s flagship commitment on the health service – ranks fifth (27%) in the public’s priorities. 

Shifts since May 2024

Some of the public’s priorities for the NHS have shifted since May 2024. While access to general practice has always been among people’s top priorities, it is now their most important issue. Even though our survey took place before the worst of this year’s winter crisis, reducing waiting times for A&E moved sharply up the public’s agenda – from 25% thinking it should be prioritised in May 2024 to 33%. The public now also places a higher priority on reducing waste and improving the efficiency of services (up from 24% in May 2024 to 29%). 

The public now sees workforce issues as less of a priority. The proportion prioritising reducing the number of staff leaving the NHS by improving working conditions – the public’s top priority in May 2024 – has decreased 10 percentage points (from 39% in May 2024 to 29%). Increasing the number of NHS staff by increasing recruitment has decreased 8 percentage points (from 32% in May 2024 to 24%). These shifts potentially reflect the early decision made by the new government to settle the long-running strike action by junior doctors, a prominent national issue around the time of our May 2024 survey. 

Variations by voting intention

People intending to vote Conservative or Reform UK are more likely to prioritise making it easier to get appointments at GP practices than the public overall (46% and 47%, respectively). Those intending to vote Labour or Green Party are more likely to prioritise reducing the number of staff leaving the NHS by improving working conditions than the public overall (39% and 49%, respectively). 

Views on the government’s plans for the NHS and social care 

Views on NHS reform plans 

The new government has said that the 10-Year Health Plan, due to be published in May 2025, will focus on achieving three big shifts for the NHS in England: moving more care from hospitals to communities, making better use of technology and focusing on preventing illness rather than just treating sickness. In the meantime, the government has sought to secure public support for its long-term approach to NHS reform through being frank about the poor state of the health service and the deep-seated challenges it faces. 

Only 17% of the public think the government has the right policies for the NHS (Figure 3). While this is low, it has more than doubled since May 2024, when just 8% thought the government had the right policies. People are also less likely to disagree (51% compared with 69% in May 2024). 

There are stark differences by political allegiance. For example, people who voted Labour in the 2024 general election and intend to vote Labour again are far more likely to agree the government has the right policies for the NHS (42%) than the average (17%). 

Despite the government widely publicising their 10-Year Health Plan, around 3 in 4 of the English public (73%) were unaware of the plan over a month after its announcement. People in older age groups (55–64 years, 65–74 years and 75 years and older) are more likely to be aware of the plan than those in younger age groups (aged 55 years and younger). The highest awareness is among those aged 65–74 years (41%), and the lowest awareness among those aged 16–24 years (14%). 

Once informed of the 10-Year Health Plan, the English public has limited confidence it will lead to improvements in the NHS, with more than half not confident (59%) and just over a third confident (35%). This may be more a reflection of the public’s general pessimism about prospects for improvements in NHS care, lack of confidence in the government and limited awareness of the plan rather than a fundamental rejection of the approach. For example, people intending to vote Labour – who are generally more optimistic about services and more aware of the plan – are far more confident the plan will lead to improvements in the NHS than the public overall (65%). 

While awareness of the 10-Year Health Plan is low, the public supports the ‘three shifts’ that form its backbone as top priorities for the government. Focusing on preventing sickness rather than just treating it is the most popular shift (86% support this being a top priority), followed by moving more care from hospitals to communities (82%). Making better use of technology has the least support, although support is high overall (73% support). The information given to survey participants on each of these shifts mirrored the descriptions on the public consultation website, so the government’s framing of these changes seems to resonate well with the public.  

People in older age groups (55–64 years, 65–74 years and 75 years and older) are more likely to support making better use of technology being a top priority, with the highest support among those aged 65–74 years (81%). People in older age groups are also more likely to support moving more care from hospitals to communities than the public overall, with 92% of those aged 75 years and older supporting this shift as a top priority. Health care needs generally increase with age, so framing these shifts in terms of improving coordination between services and providing more care close to home may have particularly resonated with these groups.

Views on social care reform plans 

Labour’s election manifesto promised a new National Care Service to improve the consistency of social care standards across the country. However, at the time of our survey in November 2024, the government had provided little detail on what such a service would entail. Meanwhile, ministers stated they would seek cross-party consensus on the long-term reform of social care, with reports of an independent commission to facilitate this circulating for several months before being confirmed in January 2024. 

Fewer than 1 in 10 (9%) of the UK public thinks the government has the right policies for social care. Like with the NHS, people are now more likely to agree the government has the right policies for social care than under the previous government in May 2024 (when 5% agreed) and less likely to disagree (43% compared with 63% in May 2024). People who voted Labour in the 2024 general election and intend to vote Labour again are more than twice as likely as the population overall to agree the government has the right policies for social care (20%). Those who voted Labour but intend to switch are no more likely to agree (5%) than the population overall (9%). 

Only around 1 in 5 (22%) of the English public were aware of the government’s commitment to create a National Care Service at the time of our November 2024 survey, while 76% were unaware. People who voted Labour in the 2024 general election and intend to vote Labour again are more likely to be aware of the National Care Service (37%), while those who voted Labour but intend to switch are no more likely to be aware than the population overall. 

We asked the English public its view on the trade-off between delivering social care reform quickly but potentially without cross-party consensus and building cross-party consensus, which may mean social care reform takes longer. On this issue the public is split, with 43% agreeing more that the government should prioritise building cross-party consensus and 40% agreeing more that the government should prioritise delivering social care reform quickly to improve care services (Figure 6). The public is mostly divided rather than conflicted on this choice, as just 12% agree equally or do not agree with either, and only 5% do not know. 

Those intending to vote Conservative are more likely to agree the government should prioritise delivering social care reform quickly to improve care services (50% compared with 40% overall), even if this means not all parties agree with their plans. Those intending to vote for the other parties are no more likely to align with one position over another.

Views on public spending and funding for the NHS 

Having criticised the Conservatives for leaving a ‘£22 billion black hole’ in the public finances, the Chancellor used her first Budget to unveil major tax rises and modest increases in public spending. This saw health spending growth return to near the long-term average in 2024/25 and 2025/26 – enough for some progress on the government’s NHS plans. However, this was limited by the costs of new pay settlements and other pressures. While social care received an extra £600m for 2025/26, this falls short of the £1bn needed to meet growing demand – even before changes to National Insurance and the National Living Wage added to cost pressures in the sector. Attention now turns to the Spending Review, which will set budgets for 2026/27 and beyond. Between economic headwinds, the state of the public finances and the need to address past underinvestment across the public sector, the government faces difficult decisions about how to prioritise the available spending. 

Despite already being one of the biggest winners at the Autumn Budget, the NHS is the UK public’s top priority for extra spending by a substantial margin compared with other areas. Nearly two-thirds (65%) think the NHS/health care should be prioritised to receive more public spending in the future – ahead of social care for older people (26%), housing (23%) and social services for children and vulnerable adults (21%) (Figure 7). While this view is strongest among people intending to vote Labour (76%), the NHS/health care is also seen as the top priority among those voting for all but one of the other main parties. Border and immigration control (54%) is the top priority for people intending to vote Reform UK, although the NHS/health care is still a close second (50%). People intending to vote Conservative (37%) are more likely to see social care for older people as a spending priority than the public overall – which aligns with higher support among this group for the government delivering social care reform quickly, even if without cross-party consensus.

The public is divided about how, if at all, to pay for the extra spending needed to meet growing demand. Of those who want to increase funding to maintain the current level of care and services provided by the NHS, 42% would prefer to increase taxes and 13% would prefer to reduce spending on other services such as education and welfare. While a higher proportion of people continue to support higher taxes to maintain the current level of care and services than reducing spending on other services or reducing the level of care and services, support for tax increases has consistently fallen over time – down from 53% in November 2022 and 48% in November 2023. This support is highest among people in older age groups (55 years and older), those with higher annual household incomes (£52,000 and over), those intending to vote Labour and those who have used NHS services in the past 12 months. 

The reduction in support for increasing taxes has not led to greater support for cuts to other public services or reducing NHS services. More people now reject all three of these options – 34% in our latest survey, up from 25% in November 2022. People intending to vote Conservative (40%) or Reform UK (47%) or those who are undecided (44%) are all more likely to reject all three options compared with the average.

Fewer than 1 in 10 (6%) people would prefer to reduce the level of care and services provided by the NHS so taxes do not need to increase – the same as November 2022 (6%) and less than in November 2023 (9%). People most likely to prefer this option are those intending to vote for Reform UK (15%), but even then, slightly more would favour maintaining the standard of NHS care and services through higher taxes (18%) or cuts to other services (18%).

Implications 

While Labour won a landslide election victory, the public mood on the NHS and social care is more 'wait and see' than 'things can only get better'. People are less pessimistic about the immediate prospects for the NHS and social care compared with before the general election, but relatively few feel optimistic – though this varies with voting intention. While confidence has improved in government having the right policies for both the NHS and social care, this is compared with record low levels in our survey series under the previous government and remains low by historic standards. And, with the NHS experiencing severe pressures over a difficult winter following our survey, improved perceptions of local NHS services may prove temporary.

On the NHS, the 10-Year Health Plan is a chance to change perceptions and set the direction for an improved NHS. The three shifts intended to form the heart of the plan are widely seen by the public as important priorities for the government. While only a minority feel confident the plan will lead to improvements, this should be seen in the context of negative expectations and a general lack of confidence in government overall. But public awareness of the commitment to a long-term approach for the NHS is low. Only slightly fewer people are aware of the far less prominent pledge to create a National Care Service. 

As the 10-Year Health Plan develops, the government needs to articulate a more hopeful vision for the NHS’ future to balance negative messages about its current state. Continuing to emphasise the extent of the problems inherited from the Conservatives is unlikely to build confidence that Labour – now responsible for tackling these problems – can put the NHS back on its feet. Separate polling found that while declaring the NHS 'broken' resonates with the public, it does not instil confidence in Labour's ability to fix it and could lead some to avoid seeking care when they need it. To help shift the narrative, policymakers should seek to build on the broad support for the government's overall ambitions on the NHS with more tangible descriptions of the improvements people can expect as a result. This should include reassuring people’s concerns over digital exclusion.

But there is a potential misalignment between the new government's priorities for the NHS and what is most important to the public. Our polling suggests that improving access to general practice is set to be a litmus test of Labour’s record on the NHS – currently the public’s top priority for the health service. Making this happen will require action across a range of areas, such as improving how people navigate and experience services, not just increasing the supply of appointments. People are also likely to back the government’s wider ambitions to shift care out of hospitals and boost investment in primary care. But the prime minister has made reducing waiting times for routine hospital treatment the overriding political target on the NHS for this parliament. Achieving the 18-week target will require substantial resources and likely mean slower progress on improving care elsewhere, such as in primary and community services. Recent history shows that NHS resources tend to flow towards hospitals, even when government has promised to shift resources in the opposite direction.

Labour came into government emphasising the importance of NHS reform over investment. Policy change is no doubt needed – for instance, to change the way NHS funding flows to boost investment outside hospitals. But the health service is the public’s top priority for extra spending – a view largely shared by the public despite wider political differences. And, following the decade of underinvestment before the pandemic, there is no escaping the need for additional spending to meet growing demand for care and help drive improvement. The challenge facing the government is less about making the case for extra investment and more about how to fund the additional spending needed given commitments not to raise taxes, competing demands from other public services and a difficult fiscal environment. 

Finally, our survey raises questions about the government’s approach to social care reform. The new government has established an independent commission to advise on its plans for a National Care Service – due to deliver recommendations for long-term reform by 2028. This could offer an opportunity to build public awareness and support for much needed policy change. But the public’s divided views on whether Labour should use its majority to go full speed ahead or go slower with the aim of forging political consensus highlights the need to combine immediate action with a commitment to long-term solutions. Wes Streeting is right that ‘general elections are where plans for social care go to die’ but, as things stand, the commission’s timeline risks its final recommendations coming dangerously close to the next general election. The risk is that reform is ducked or delayed – again. Improving the lives of millions of people who rely on social care needs political will now more than ever.