The general election is upon us and once again the NHS is expected to be at the centre of the debate. Over the last 20 years, no government has ever managed to convince a majority of the public that its prescription for the health service was the right one. With the NHS consistently ranking as a top priority among voters, whichever party can garner confidence in their policies arguably has pulling power with the voters.
The Health Foundation’s latest polling with Ipsos shows that the number in England who think Rishi Sunak’s government has the right policies for the NHS is just 9% – historically low, even allowing for changes in polling methods. By contrast, Labour peaked at 37% under Gordon Brown. Despite the upheaval of the Lansley reforms, where primary care was overhauled to put GPs in charge, the Conservatives managed 28% in 2015.
So how did the government lose the public’s trust on the NHS? Much like Ernest Hemingway on bankruptcy: gradually, then suddenly. Hospital waiting times and access to GPs have been slowly going in the wrong direction since the early 2010s, well before the pandemic. Then, when Covid-19 arrived in 2020, scandals surrounding PPE and maternity services, political instability and unkept promises to cut waiting lists have further fuelled the fire. But this won’t be turned around by installing (another) new prime minister or even with an entirely new government.
Let’s be frank – no government is ever going to persuade everyone to love its policies. Policymaking involves making difficult choices which often upsets far more people than they genuinely please. But the next government will need to improve the perception that they are doing the right things to bring about a better NHS.
This won’t be easy. The NHS is arguably experiencing the worst crisis in its 75-year history and there are no quick or easy solutions. A decade of low spending growth and a focus on relieving short-term pressures at the expense of long-term investment has left staffing gaps, crumbling buildings and outdated equipment. Delivering tangible improvements to the NHS is likely to prove a long, difficult process – it certainly was in the 2000s, with levels of funding growth far higher than we can reasonably expect during the next Parliament.
Public confidence in policy matters and its absence can draw policymakers into focusing on sticking plaster solutions to relieve short-term pressures, at the expense of long-term solutions. Regular changes of policy direction are generally counterproductive – even if politically they can be seen as a ‘quick fix’. Reorganisations take years to implement and risk diverting attention from the real job of improving patient care. So, what to do?
First, the next government must be frank about the state of the NHS – our recent deliberative research shows the public already has a relatively nuanced understanding of the problems, but are still visibly shocked when given a more detailed picture of growing health needs and the constraints on delivering care needed to meet those needs. The government will need to be open about the scale of the challenge and the length of time it will take to address it.
Secondly, the next government will need some quick wins to reassure people that they are on the right track. They would be wise to focus on the services people use the most – primary and community care, which includes around 350m consultations in general practice a year, over 100m contacts in community health services and over 30m courses of dental treatment. But the new government will need to walk and chew gum, they can’t afford to neglect hospital services either.
Another fruitful area for action is to address ‘waste’ – people at our workshops talked about failures of administration, of communication, and other visible signs that suggest the system is not working well. The public may never love NHS management, but they absolutely hate the inefficiencies caused by not having enough of it.
Third, focus on the experience of NHS staff – the public notices when the professionals who are there to look after them are overstretched, demoralised and exhausted. If the next government can improve the working lives of the 1.5m people employed in the NHS, that’s potentially 1.5m voices indirectly communicating to the public that things are headed in the right direction.
Our research also suggests there may be a case for revisiting the government’s relationship with the NHS – without unleashing another reorganisation. Policymakers have an important role to play in shaping the direction of our health system – but who wants ministers to be directly involved in operational decisions about our health care? Greater use of independent experts and evidence may help to improve trust.
Ultimately, the next government has a choice about the direction it takes on the NHS. They can try to squeeze out more short-term performance by flogging the system harder and hope for some positive headlines with a few gimmicks, or they can focus on the longer-term stuff – staffing, capital investment, evidence of what works – in order to bring about lasting improvements to the quality of care. They should do the latter.
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