How did COVID-19 affect the public mood, will the pandemic change people’s expectations of health and social care services, and what are the implications for government policy?  

These questions were central to the webinar we co-hosted with Ipsos MORI this month. Informed by new polling on how the public views the NHS, our panel discussed how perceptions and expectations of health and social care have evolved during the COVID-19 crisis. Here I summarise some of the key points from our discussion.  

Pride in the NHS remains high 

While COVID-19 tested the health service to its limits, its standing with the public is (so far) intact. Pride in the NHS remains high – 75% agree it is one of the best health care systems in the world and only 10% disagree. Confidence in the health service’s ability to cope with the pandemic hit a low during the worst weeks of January, but 60% still believed it would be there for everyone unwell with COVID-19.  

Gratitude for the work of the NHS has been palpable throughout the pandemic. From mass participation in the clap for carers, to the surprisingly strong emotions stirred – even among hardened politicians – by the rollout of mass vaccination against the virus that has taken so much from so many.

More of us now dare to hope the end of the pandemic is in sight – even if there’s still a way to go. Public concern about COVID-19 has fallen, albeit from a very high base, but may soon be overtaken by worries about the state of the NHS itself. 

Public concern about NHS waiting times 

The pandemic has created a substantial backlog of unmet need, with consequences for millions of people. Given the context, the amount of non-urgent treatment delivered in 2020 was remarkable. Even so, the number of patients on the waiting list is growing and more are experiencing longer waits

That’s reflected in the polling. Improving waiting times is the public’s top priority for the NHS (picked by 50% of people surveyed). 85% agreed waits for routine hospital services were longer than before the pandemic, while only 12% thought current waiting times were acceptable – very low, even if people do tend to think the health service is performing less well than it actually is.  

Our panellists discussed these findings during the webinar. Vin Diwakar (Regional Medical Director, London Region, NHS England and NHS Improvement) gave examples of how NHS staff are innovating to diagnose and treat patients in the most timely and equitable way. And he reiterated how the public can support plans to address the backlog by following official advice to stop the spread of COVID-19.  

Isabel Hardman (Assistant Editor, The Spectator) explained how dynamics within government, particularly inside the Treasury, will shape the size and speed of extra funding to tackle the backlog, and may also affect the approach – who to prioritise, the more politically-salient year-long waits or the most clinically-urgent?  

And Ben Page (Chief Executive Officer, Ipsos MORI) noted that concerns about waiting times haven’t undermined support for the government so far – but cautioned that public opinion on the NHS, when roused, can become a major problem for politicians.  

Awareness of other priorities 

The polling suggests people want action on a range of other issues too. At least a third of the people who participated in the survey prioritised increasing NHS staff numbers (43%), vaccinating people against COVID-19 (41%), supporting the wellbeing of NHS staff (38%) and improving mental health services (36%). For the latter to be only five percentage points below vaccination during a global pandemic may be a reflection of the widespread negative impact COVID-19 is having on our mental health, but it also echoes the increasing concern seen in recent years.   

In many respects, the public’s priorities for the NHS – as expressed through this polling – align with those in the government’s 2021/22 mandate. But setting policy priorities is a walk in the park compared to the challenges of implementing policy action that results in an increase in public satisfaction. So much so that, as Dr Jennifer Dixon highlighted during the webinar, the Prime Minister has felt the need to revive the Delivery Unit and seek advice from New Labour-era delivery guru Sir Michael Barber.  

An early test for the new delivery arrangements will be whether they reinforce the planned NHS reforms (and vice versa). Previous reorganisations delivered few measurable benefits and it’s not entirely clear how these reforms will drive improvements in the areas prioritised by the public.  

Public understanding of health inequalities  

Towards the end of the webinar, discussion turned to prevention and health inequalities, which rank lower down the public’s list of priorities. That may be more a reflection of a question that asked about the context of the NHS, rather than public indifference. Responsibility for GP appointments and hip operations fit neatly into the box marked ‘health service’ – and, as Vin highlighted, the public care deeply about inequalities in access to NHS services. In contrast, what makes us healthy is a far broader concept and views on who is responsible for making sure people generally stay healthy and addressing health inequalities are more complicated.  

Early in the pandemic, there were big increases in the percentage of the public who thought national government, local government and the NHS had at least some responsibility for our health compared to 2018 – but the individual was still seen as having the most responsibility. People mostly recognise the importance of the wider determinants of health, but think the government has a lot of responsibility for some and far less responsibility for others.   

In a democracy, it’s clearly important that government policy is guided by public priorities. But it’s equally important for policymakers to improve public understanding – a longstanding barrier to social care reform – and to address misperceptions where they arise. Public perception isn’t always accurate, but it’s always important.

Tim Gardner (@TimGardnerTHF) is Senior Policy Fellow at the Health Foundation.

This content originally featured in our email newsletter, which explores perspectives and expert opinion on a different health or health care topic each month.

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