Mind the gap: public perceptions of the NHS and social care

Labour’s policy agenda for health and care has started to take shape. The broad direction set out in the 10-Year Health Plan – moving more care from hospitals to communities, better use of technology and more focus on preventing ill health – are broadly positive. However, none are new and progress will not be easy – there’s little detail on how changes will be delivered, resources are tight and the government is embarking on a structural reorganisation that risks distracting local service leaders.

NHS performance has been a mixed bag in Labour’s first year in power. While patient experience of general practice notably improved, hospital waiting lists fell more slowly than hoped and the health service endured a very difficult winter. The government’s own ‘reform or die’ rhetoric has raised the political stakes of not delivering on its promises. 

While ministers have been hands-on in developing plans for the health service, the task of shaping the future of adult social care has been handed to an independent commission. With the final report due to publish uncomfortably close to the next general election, social care reform risks being kicked into the long grass. In the meantime, the system remains a threadbare safety net, with care only available to people with the highest needs and lowest means.

The financial situation for health and social care remains tight. Extra funding for social care will not be enough to improve access to care or enable meaningful reform to the funding system. While the NHS was one of the main winners from June’s Spending Review, below-average funding increases and prospects of industrial action over staff pay leave the government facing tough choices. 

Does the public think the health service is headed in the right direction? Are there signs that public support for a universal, tax-funded health system is being undermined by the state of the NHS? And where do people stand on the ongoing question of how to reform social care? Every 6 months, we poll a representative sample of the UK public using the UK KnowledgePanel – Ipsos’ random probability online panel (see Box 1 for further details). The latest in our series of surveys with Ipsos, conducted in May 2025, takes stock of public attitudes to health and care. 

During Labour’s first year in power, NHS performance has been a mixed bag. Patient experience of general practice is slightly improved, and the waiting list for routine hospital treatment has reached the lowest level in over 2 years. But public satisfaction fell to a new low and the health service endured a punishing winter.

Public views on NHS performance

Overall, there are some signs that perceptions of NHS performance are slowly improving. 13% think that the general standard of care got better in the last 12 months (slightly up from 9% in May 2024), which is the highest percentage since 2020. While 38% think standards got worse, similar to our last survey in November 2024, this is considerably lower than a year ago (55% in May 2024). People living in Northern Ireland (60%) or Wales (50%), and those intending to vote for Reform UK (53%), are more likely to think that standards got worse. People who voted Labour at the last election and still intend to vote for the party are most likely to think standards had got better (30%), which is up from 9% in November 2024. 

Looking to the future, expectations remain pessimistic overall – essentially unchanged from our last survey in November 2024 but still notably less negative than before the election. 18% think the general standard of NHS care will improve in the next 12 months, up from 11% in May 2024. 41% expect standards to get worse, down from 52% in May 2024. Committed Labour voters are more likely to think the health service will improve (41%). But people intending to vote Reform UK (54%), people not intending to vote (62%) and those with a health problem or disability (46%) are all more likely to think that standards will get worse. 

People’s experiences of their local NHS services are notably more positive than views of how the health service is performing overall. Views of local services are net positive, with 46% agreeing their local NHS is providing them with a good service (unchanged from November 2024) and 28% who disagree (down from 32%). People with recent experience of using the NHS are more likely to be positive about their local services – 48% of those who used any service in the last 12 months and 52% of those who used three or more different services in that time hold positive views. Those aged 65 years and older (54%), and Conservative (55%) or Labour voters (54%) are also more likely to be positive.

By contrast, the public’s view of the NHS overall is net negative – 32% agree the NHS is providing a good service nationally, while 43% disagree. These views have been fairly stable over time, having been negative overall since November 2022. 

Perceptions of government policy on the NHS are even more negative. Only 16% agree the government responsible for the NHS in the part of the UK where they live has the right policies, while 53% disagree. This is no different to our last survey in November 2024 but remains more positive than immediately before the election – when just 8% agreed and 69% disagreed. Perhaps unsurprisingly, Labour voters are more likely to agree (36%) that the government has the right policies on the NHS, while those planning to vote Conservative (62%) or Reform UK (73%) are among those most likely to disagree. 

What are the public’s priorities for the NHS?

The new government has offered a vision for the future of the health service – shifting care into communities, better use of technology and more focus on prevention. Ministers also have plans to redistribute general practice funding and improve urgent and emergency care. But the sole target on the NHS the prime minister committed to in his Plan for Change is recovering the 18-week standard by 2029, which puts waiting lists for routine hospital treatment at the very top of the government’s agenda. 

By contrast, the public’s top priority is making it easier to get appointments at GP practices (39%), followed by improving A&E waiting times (34%) and reducing the number of staff leaving the NHS by improving working conditions (29%). Improving waiting times for routine hospital services – the focus of the government’s flagship commitment on the health service – ranks only fifth (25%) for the public. This is unchanged from our last survey in November 2024. 

Priorities differ by voting intention. Labour voters are more likely to prioritise improving A&E waiting times (40% compared with 34% among the public overall) and expanding services aimed at preventing ill health (23% compared with 16%). People intending to vote Conservative (48%) or Reform UK (45%) are more likely to prioritise easier access to general practice (compared with 39% overall). People intending to vote Green (46%) or Liberal Democrat (38%) are more likely to prioritise reducing the number of staff leaving the NHS by improving working conditions (compared with 29% overall). 

In the 12 months since the election was called in May 2024, the waiting list in England fell from 7.6 million to 7.4 million – putting the government on track to meet its commitment to recover the 18-week standard by the end of the parliament. However, perceptions do not reflect performance (Figure 1): people in England are more likely to think that the waiting list increased over this period (37%) than to think it decreased (24%), with another 24% thinking it stayed the same. People who intend to vote Labour are more likely to think that the waiting list has decreased (41%), while those who intend to vote Reform UK are more likely to think that it has increased (51%).

The high priority the UK public places on improving access may be influenced by awareness of the pressures on local GP services. 82% of the public are concerned about the level of pressure that GP practices are facing (up from 78% in May 2024 and 73% in May 2022), while 13% are not concerned and only 2% think practices are not under pressure.

As shown in Figure 2, the public thinks the top three challenges facing GP practices are:

• not enough doctors (41%)
• looking after more patients because of the ageing population (29%)
• lack of funding (27%).

Practices having more patients to look after is seen as an issue across the political spectrum, but voters differ on the causes. Labour voters are more likely to highlight long waiting lists (29% vs 23% overall), Liberal Democrat voters are more likely to pinpoint the ageing population (44% vs 29%) and Reform UK voters are more likely to mention immigration (51% vs 20%).

The NHS’s founding principles should still apply

Politicians are using dramatic rhetoric in discussing the challenges facing the health service. While Labour emphasises its commitment to the founding principles of the NHS, the 10-year health plan suggests the ‘NHS is broken’. Criticism of the NHS model has been particularly sharp on the right of the political spectrum – Sir Sajid Javid, a Conservative health secretary from 2021 to 2022, has spearheaded calls to consider fundamental change and Nigel Farage has said the current model ‘does not work’. But is this reflected in public opinion?

A large majority of the public thinks the founding principles of the NHS should still apply today (Figure 3). 86% think the NHS should be free at the point of delivery, 85% think the NHS should provide a comprehensive service available to everyone and 83% think it should be primarily funded through taxation. This is essentially unchanged from November 2023, although there has been a slight (but statistically significant) fall in support for the NHS being free at point of delivery and providing a comprehensive service from earlier surveys in November 2022 and November 2021.

Support for the founding principles is higher among people who intend to vote Labour, Liberal Democrat or Green. Support is lower among those intending to vote for Reform UK, 30% of whom think the NHS should not provide a comprehensive service available to everyone (compared with 13% overall). However, Reform UK voters are still more likely than not to believe that each of the founding principles should continue to apply. 

For the 13% who think the NHS should no longer provide a comprehensive service, this is largely driven by concerns about the financial sustainability of the current system, rather than an active preference for a different approach. 61% think it is not financially sustainable for the NHS to provide every possible service, 51% that the NHS should only provide a comprehensive service to people born in the UK or to British citizens and 49% believe it is not financially sustainable for the NHS to provide a comprehensive service to everyone. Few think a different model of health care would be more efficient (19%) or more effective (17%). 

While the public is strongly supportive of the founding principles, fewer people think these will still be in place in 5 years’ time than want that to be the case. 59% think the NHS will still be free at the point of delivery in 5 years (21% disagree), 54% think it will still provide a comprehensive service available to everyone (26% disagree) and 62% think it will continue to be primarily funded through taxation (16% disagree). There are few signs that the public is becoming more pessimistic. Since November 2023, there has been no change in the proportion of people who think the NHS will continue to be free at point of delivery and primarily funded from tax (Figure 4), and more now believe that the NHS will continue to provide a comprehensive service available to everyone (up from 49%).

People intending to vote Reform UK are more likely to be sceptical – 40% think the NHS won’t provide a comprehensive service in 5 years’ time (compared with 26% overall), 26% believe the NHS won’t be free at the point of delivery (21% overall), and 20% believe the NHS won’t be primarily funded through taxation in 5 years’ time (16% overall). Women – who spend more of their lives in poor health and are more likely to wait longer for care – are less likely to think that each of the founding principles will still apply in 5 years’ time, and people aged 65 and over also tend to be more negative. However, the survey responses suggest these views are largely concerns about what the future will bring, rather than what people want to happen.

Public undecided about the government’s role in the NHS

The decision to abolish NHS England is set to give ministers far more direct control over the day-to-day running of the health service. But what does the public think the government’s role should be? 

Our survey found that people think government should be involved in most areas of the NHS (Figure 5). 81% think the government should have a great deal or fair amount of involvement in holding local NHS services to account for providing a good service for patients and good value for taxpayers. 77% believe the government should be involved in setting the overall annual budget for the NHS. Slightly fewer people see the government as having a major role in decisions about how that overall budget is divided between different parts of the country (65%) and different NHS services (60%). 

The public tends to be more divided on decisions that impact patient care more directly. When it comes to setting targets and priorities for local NHS services, 58% and 55% respectively think the government should have at least a fair amount of involvement – but around 4 in 10 of the public believe ministers should have little to no role. And, in decisions about whether the NHS should fund a new medicine/treatment or make major service changes, opinion is split on whether the government should be involved. In general, people who plan to vote Labour tend to be more likely to think the government should play a significant role, while those intending to vote for Reform UK seem to want less government involvement.

Reducing waste is a high priority

Improving efficiency and reducing waste is one of the public’s top four priorities for the NHS. This is reflected in perceptions that the health service is not making the most effective use of funding. 66% think the NHS often wastes money, while 20% believe it generally doesn't and just 6% think it almost never wastes money. The view that the NHS often wastes money is unchanged from 12 months ago but remains more prevalent than in November 2022 (53%). People aged 55 years and older (77%) and those who have not used NHS services in the last 12 months (76%) are more likely to think the NHS often wastes money, as are people intending to vote Reform UK (80%) or Conservative (79%). 

However, as identified in our previous research, what the public sees as waste and causes of inefficiency may not be the same as what policymakers and service leaders perceive to be the biggest issues. As shown in Figure 6, the main changes the public wants to see the NHS make (in order to reduce waste) are:

• improving coordination between services (38%)
• better management of services and staff (36%)
• reducing reliance on temporary or agency staff (33%).

Measures that are part of the government’s current strategy – such as reducing inappropriate prescribing (18%), delivering more surgeries as day cases (17%) and providing more care remotely (16%) – are seen as lower priorities for reducing waste. 

Regarding efficiency improvements, public perceptions show some important differences by age group and voting intention. Reducing the use of temporary or agency staff is the biggest priority for people aged 55 years and older (43%), which may reflect growing issues with continuity of care among a group who tend to make more frequent use of the NHS. People aged 25 to 34 are more likely to highlight the need for NHS staff to have better technology and more reliable equipment (32%), while those aged 16 to 24 are more likely to highlight the need for better communication about appointments, referrals and test results (30%). Better management of services and staff is the top issue among Conservative (43%) and Reform UK (44%) voters, while improving coordination is the main priority for Labour and Liberal Democrat voters (both 43%).

With the Casey Commission tasked with ‘holding a national conversation about what adult social care should deliver for citizens’ and ‘building consensus with the public’, what do people currently think about social care performance and options for reform? 

What does the public think about standards of social care?

The public is largely pessimistic about social care. Only 5% think the general standard of social care got better over the last 12 months, while 43% think standards got worse – similar to November 2024. People who have used social care services personally in the past 12 months are more likely to think standards have improved (22% vs 5% for people who haven’t). 

Views on the performance of local social care services are also negative overall and essentially unchanged from our last survey. 13% of the public agree their local care services are good (12% in November 2024), while 31% disagree (30% in November 2024) – but many people don’t know (24%) or have no strong view either way (31%). Those who have used a social care service personally in the last 12 months are more likely to agree (26%) that their services are good. However, people with family or friends who have used a social care service in the last 12 months (36%) and those with a health problem or disability (42%) are more likely to disagree. 

Expectations about social care for the next 12 months are now more pessimistic than 6 months ago, which had been the least negative since this series of surveys began in November 2021 (Figure 7). Only 8% of the public think the standard of social care will get better in the next 12 months (down from 11% in November 2024), while 45% think standards will get worse (up from 36% in November 2024). People with family or friends who have used a social care service in the past 12 months are more likely to think standards will get worse (50%). 

Perceptions of government policies on social care are more negative than in Labour’s early months in power. Only 8% agree that the government has the right policies for social care (9% in November 2024). 51% of the public disagree that the government has the right policies for social care, compared with 43% in November 2024. This is still less negative than in May 2024 under the Conservatives, when 63% disagreed that the government had the right policies. People aged 55 and over (62%) and those who have had family or friends use any social care services in the past 12 months (57%) are more likely to disagree.

There’s limited public awareness of how social care is funded and provided 

Unlike the NHS, which is mostly free at the point of use, access to publicly funded social care in England is heavily means- and needs-tested. Our latest survey shows that public awareness of how social care is funded and provided is limited (Figure 8). 31% of people in England incorrectly believe that the NHS provides the majority of social care services and 19% don’t know, compared with 32% and 18% respectively in May 2022. 33% of the public in England incorrectly believe that social care services are free at the point of need and 18% don’t know – in line with May 2022 responses (37% and 17% respectively). 

Public views on social care funding reform

The Casey Commission is considering different funding models for a fair and affordable adult social care system. How much should fall to the individual (versus the state) will be a critical issue, and the public has strong opinions about this (Figure 9).

Only 2% of people in England think individuals should be responsible for paying for all the care they need. 15% think individuals should be responsible for paying for all the care they need, but the state should pay for those who can't afford it – which broadly describes the status quo.

56% think that the state should be responsible for paying for some care for everyone who needs it regardless of what they can afford, but people who can afford it should also pay towards their care. This broadly describes the Scottish system, where the state provides free personal and nursing care.

Finally, 21% think that the state should be responsible for paying for all the care individuals need. People who intend to vote Green (30%) or Reform UK (28%) are more likely to think the state should be entirely responsible, there are few other notable differences between different population groups.

On social care funding reform, these findings broadly mirror those from our November 2023 survey. It’s still the case that most people in England think the current means-tested system is unfair, and favour a system where the state takes more responsibility for the costs of care – either through some universal entitlement with additional means-tested services, or an NHS-style system with care that is free at the point of use. 

Labour’s manifesto promised to get the NHS back on its feet, build a health service that is fit for the future and create a National Care Service. But, as it begins its second year in power, the public mood on health and care remains largely downbeat. 

On the health service, there are some signs that perceptions have slightly improved – despite the government’s priorities still being out of step with what the public wants to see. People are largely positive about their local services, especially among those with recent experience of using multiple NHS services. But the overall public mood remains mostly gloomy about how the health service is performing overall and prospects of improvement for the year ahead. And, even where some progress has been made, such as on tackling hospital waiting lists, few people believe that things are actually going in the right direction. 

Labour’s prospects of re-election could hinge on the public seeing and feeling the benefits of the government’s vision for the health service. Telling people that the NHS stands ‘on an existential brink’ is unlikely to narrow the gap between performance and perceptions – or make people more optimistic. Making progress on delivering the vision in the 10-year plan and a more positive narrative that shows how services are improving in the areas most valued by the public just might.

A steady flow of incremental gains would, if sustained throughout this parliament, put the NHS in a far stronger position than at the last election. But voters may be reluctant to credit their own largely positive experiences as being part of a wider recovery – as was the case under the 1997–2010 Labour government. And, while there are some tentative signs that performance has improved, the government’s decision to embark on a major reorganisation risks creating an unnecessary distraction and constraining the NHS’ ability to make further progress. 

Record low levels of public satisfaction do not signify a rapid loss of faith with a universal, tax-funded health service. Support for the founding principles of the NHS remains strong overall and has been stable over the last 12 months, despite a slight decline in some areas over the longer term – similar to the latest British Social Attitudes survey. 

Our latest polling should be a wake-up call to those talking up the need for radical change despite growing evidence that no one type of health system systematically outperforms the others. Nigel Farage’s belief the NHS funding model should be rethought is not shared by a majority of Reform UK voters or the wider electorate. Calls from elsewhere on the right to introduce more patient charges and social insurance have already been tested and decisively rejected by the public. These latest findings align with our deliberative research from May 2024, where participants overwhelmingly preferred keeping the NHS model, over introducing more patient charges or switching to social health insurance.

On reforming the NHS, the public’s views about the role of government seem to broadly chime with Labour’s current policy approach of recasting the role of the centre while slashing ‘unnecessary bureaucracy’ and giving ‘more power and resources to the front line’. However, our findings suggest the government needs to strike a careful balance to avoid appearing to micromanage local NHS services. This may be especially challenging as the Department of Health and Social Care takes on more direct control, including implementing a new ‘failure regime’ in those areas where local services are underperforming. 

Increased pessimism about social care is more likely to reflect general discontent with the government than an informed rejection of Labour’s approach so far. People generally see the current system as unfair when it is described to them, but low public awareness and understanding of social care – including about who is responsible for paying for it – remain significant barriers to reform. If the government wants to have a ‘a national conversation about what adult social care should deliver for citizens’, this needs to start by improving awareness of how the current system works. With a lack of trust in the government’s leadership of the reform process, ministers could consider directly involving the public in taking policy decisions through deliberative engagement akin to the programme that informed the 10-year health plan.

Only time will tell whether recent signs of services recovering can be sustained and, if so, whether policymakers can successfully close the gap between public perceptions and how health and care services are actually performing.