The National Centre for Social Research’s British Social Attitudes (BSA) Survey is the gold standard of polls, recognised for its thoroughness and the significant efforts it makes to use a representative sample of the wider UK public. Its most recent research, released last week, found more than 9 in 10 people (93%) say the NHS has a funding problem, with nearly a third believing it is a serious one. That seems unsurprising given that NHS trust deficits have rarely been out of the news.
What’s odd though is that this concern does not appear to have fed through more significantly into dissatisfaction with services. Just under a quarter of people (23%) are now dissatisfied with the NHS, up significantly from 2014. They typically cite issues to do with resourcing – waiting times (55%), not enough staff (44%) and underspending (39%) - for their unhappiness.
These numbers are low when considered in a historical perspective. A glance at the data charts shows that dissatisfaction with the NHS rose during the 1980s, peaking at 50% in 1997, but since then it has fallen fairly steadily. The 2015 rise does no more than take it back to the same level as it was in 2008.
That’s also true of individual services. Dissatisfaction with inpatient, outpatient and A&E has followed a similar trend as overall figures and levels of dissatisfaction remain fairly low. Trends for GP services have been more consistently low and, again, dissatisfaction is similar to where it was a decade ago. Only social care shows a clear downward trend, with dissatisfaction rising fairly steadily since it was first recorded in 2005 and now standing at 33% (and – since many people skipped this question - almost half of those who expressed a view).
On the evidence of the BSA survey then, in terms of dissatisfaction, there appears to be no real ‘burning platform’ of public concern for improving NHS funding at the moment.
But is that really true? Well, it may be significant that the BSA focus on quality comes at a cost of topicality. Fieldwork for this poll ended in May 2015, well before the growing problems with hospital A&E services and delayed transfers had really taken off and, of course, well before the NHS performance lows over the 2015/2016 winter. It may also be that delays in getting GP appointments will have become more noticeable by then.
It’s harder to predict what will happen to dissatisfaction with social care however, not least because it’s difficult to know what drives the BSA figures in the first place. Relatively fewer people use social care yet most are willing to venture an opinion on its quality. That opinion may be shaped by family and friends who do use social care but is likely to be even more shaped by media coverage. The last few years have seen an explosion of negative coverage for care homes and home care, fuelled by often horrific images recorded on hidden cameras. It would be hardly surprising if the public had seen these and concluded that something is very wrong indeed with social care. They would be right – budget cuts have driven severe cutbacks in services in many areas – but not necessarily for that reason.
However those of us who want to see more funding for the NHS and social care cannot simply expect rising public dissatisfaction – even if that is what we see in the next couple of years – to lead inevitably to increases in NHS and social care budgets. Even leaving aside the overall state of the economy post-Brexit (and therefore the amount of money available to spend on the NHS), there are two issues, one of which is contained in BSA and one which isn’t, which will make a strong case slightly harder to make.
The first is the number of people saying the NHS wastes money. At 35% of those who are dissatisfied, this is the fourth biggest reason cited for being dissatisfied with the NHS. Though this represents only eight percent of all survey respondents, it is nonetheless a significant group of people who think the NHS could use its existing money more effectively than it does.
Secondly there is the new Office of National Statistics data about the UK’s spending on health services as a percentage of our GDP. Last year, that number was reported as 8.8% which put us around the average for all OECD countries and a long way behind France and Germany. However the way the ONS calculates this figure has now changed to put it in more in line with those other countries, mainly by including more private expenditure on social care. As a result, the ‘new’ figure is 9.9%, which pushes us well up the expenditure league table (though still well behind France and Germany).
All of which suggests that while there remains a very strong case for more money to go to health and care, the debate will need to be about how we use that extra money as well as how much we need to spend.