NHS at 70: Public Affection but Funding and Waste a Concern

Peter Russell

June 28, 2018

Public support for the NHS in England remains strong but as the health service turns 70, users are concerned it is underfunded and often wasteful, according to research.

They also thought that individuals had a responsibility to try and keep healthy as part of a 'deal' with the system where healthcare was available free at the point of delivery.

The report by health think tank The King's Fund and Ipsos MORI set out to understand people's relationship with the NHS and what they expected from it at a time of severe financial and performance pressure.

"You just can't overstate how much affection people have for the NHS and they talk about how lucky we are to have it, that we shouldn't take it for granted," said Kate Duxbury, research director at Ipsos MORI. "Also, they have a massive amount of respect for staff working in the NHS, so where things do go wrong they tend to blame that on the system and on lack of funding."

NHS Funding and Taxation

To reach their findings, researchers held three 'facilitated' workshops in London, Nuneaton, and Preston, each involving around 25 people chosen to reflect the population as a whole. Participants were given background information on issues including challenges faced by the health service and on how responsibility for health was shared between the NHS, government, and the individual.

The workshops were conducted in March 2018, shortly after the NHS experienced severe winter pressures and before the recent funding announcement by the Government.

"What did come up very early on, before we even started prompting people on it, was an understanding that the NHS does need more funding and a willingness – possibly more a resignation – that it might be necessary to give it more funding and obtain more taxes for that," Kate Duxbury told Medscape News UK.

Some participants were in favour of a ring-fenced levy to ensure that money was channelled directly to health so they could check what it was spent on.

The report, The Public and the NHS, What's the Deal? found patients were most likely to be unhappy with the NHS because of problems getting GP appointments, poor interactions with staff and a feeling that the system was wasteful and inefficient and not managed as well as it could be. Outsourcing NHS care to the private sector and the legacy of private finance initiatives (PPIs) were cited as examples of waste.

Some people felt that because the NHS was free at the point of delivery, patient expectations were too low.

However, there was also a widespread perception that some people were placing additional pressures on the service by, for example, attending A&E after drinking too much alcohol. Participants were also critical of patients who missed appointments. There was considerable support for imposing consequences on people who misused services but a lack of agreement on what form any penalties should take and concerns about where such a policy might end.

A 'Deal' Between the NHS, Government and Patients

The report also explored the concept of a 'deal' between the public and the health service and how individuals might balance rights and responsibilities between both sides. "They accepted that they needed to do more of x, y, z to keep the NHS going and that was things like staying healthy, using appropriate services and providing the funding through taxes," said Duxbury. "It felt like, perhaps more so than before, people accept that they also have got a role to play and it's not just about expecting the NHS and the Government to do things differently."

A new briefing produced by The King's Fund, the Health Foundation, the Institute for Fiscal Studies and the Nuffield Trust, found that 86% of people thought they had 'a great deal of responsibility' for keeping healthy. However, the authors cautioned that 7 out of 10 adults in England do not meet government guidelines in relation to two or more risk factors of poor diet, physical inactivity, excessive alcohol consumption, and smoking.

The polling suggested majority support among 2,083 adults polled for the effective use of tax and regulation to improve public health. For instance, 63% of people supported or tended to support the soft drinks levy and 54% backed a minimum unit price for alcohol, a measure already implemented in Scotland and soon to be introduced in Wales. Seven out of 10 people said they wanted to see a limit on fast food outlets close to schools.

Separately, a new poll found that providing care based on need and free at the point of delivery was voted the NHS's greatest achievement in its 70-year history.

Among 5,513 readers of The BMJ who voted on a shortlist of 12 contenders, the proportion of votes went to:

  • Providing care based on need and free at the point of delivery (23%)

  • Limiting commercial influence on patient care (18%)

  • General practice as the foundation for patient care (10%)

  • Comprehensive childhood vaccination programme (9%)

  • Raising the status of anaesthesia as a specialty (9%)

  • Staff working for a common good (7%)

  • Championing evidence-based medicine (6%)

  • Leading the world in cost effective healthcare (5%)

  • Free contraception for all women (4%)

  • Promoting patient centred care (4%)

  • Access to in vitro fertilisation (1%)

  • Encouraging and supporting research and innovation (1%)

Commenting on the results, the journal's Editor-in-Chief, Dr Fiona Godlee, said: "It is deeply heartening to see a founding and fundamental principle of the NHS topping a list of achievements that makes us most proud."

Providing care based on need and free at point of delivery is NHS’s greatest achievement, say BMJ readers. BMJ 2018; 361 doi: https://doi.org/10.1136/bmj.k2770 (Published 27 June 2018)

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