The general public and the NHS 2015 Views for the new Parliament

Transcription

1 The general public and the NHS 2015 Views for the new Parliament A report launched at the House of Commons Wednesday, 8 July 2015

2 Foreword By Marc Bell, Chief Executive, Benenden It is my pleasure to introduce the latest edition of public policy research produced by Benenden. We are delighted to share it with you at this year s annual Parliamentary reception at the House of Commons. This year, the research, commissioned by Benenden, looks at the public s attitudes following the recent General Election. It focusses on people s views on where the government should prioritise its health spending. During the Queen s speech at the official opening of the new Parliament, Her Majesty reconfirmed the government s priorities: a commitment to the NHS England s Five Year Forward View and an additional 8 billion spending on the NHS, per year, by Prime Minister David Cameron also spoke about the seven-day NHS and better access to GPs, as well as focussing on mental health support and talking therapies. 02 This Benenden report sought to unearth what the public s priorities for the NHS are expected to be over the next five years to see if they match up with the government s own. In addition, we looked at the public s views on the types of organisations that could be involved in the provision of NHS services. This report shows that the public are happy to see a mixed market for the provision of healthcare in the United Kingdom. As a not-for-profit mutual focussing on health and wellbeing, we truly believe that mutuals like ours are able to support the NHS across the United Kingdom to deliver the care that people need. Benenden has been doing so for 110 years and will continue to do so in the future. I hope you will find this report useful and informative. Marc Bell, Chief Executive

3 Executive Summary Once the election result was known, Benenden conducted research * among the general public to assess how they felt about healthcare issues. This is a summary of the key findings of the research, which was conducted several weeks after the election. It aimed at identifying how people felt about healthcare and health issues in the new government environment, the NHS, private medicine, and their own hopes and fears. Full details of the questionnaire and sample are available on request. NHS now and in the future 64% of people believe that the NHS can cope with their health needs at present, but 5 of people believe that the new Government will be worse than the Coalition for the NHS. 60% of respondents think the NHS will get worse over the next five years. 17% say the election outcome has made them more likely to want private healthcare. Healthcare provision in the UK 53% of the general public are happy for the private sector to be involved in the NHS, and a further 29% are happy with the not-for-profit/voluntary sector to be providing healthcare services. Only 1 of those questioned believe that there should be no private involvement in healthcare in the UK. Allocating resources When asked to which particular diseases or treatments funds should be allocated, 4 chose cancer as their highest priority. Mental health, which the Coalition Government sought to give parity of esteem with physical ailments and this government has prioritised, was placed fourth on the list. Surprisingly, and despite the media attention in recent months, obesity was given the lowest priority by the general public (26% allocated it last in the list). There was strong support for the idea of super hospitals to deal with major health issues, such as heart attacks and strokes. The public, in general, believed that other conditions are best treated locally. The public found it very difficult to decide where funds should be allocated across the NHS, particularly in relation to age. The retired and under 80 groups received the highest allocation (29%) but the other categories (children: 25%; adults: 23%; and over 80: 23%) were all very close. Right to mutualise Despite it being a significant policy of the last government, only 10% of the public have a strong level of support for the right to mutualise, and most are ambivalent towards the policy. *Benenden worked with COG Research to develop the survey. A national sample of 1,025 was interviewed online, with the sample representative of the UK in terms of age, sex and region. More details can be found on page 7. 03

4 Findings Views on the NHS We asked respondents a number of questions relating to their views on the NHS now and in the future. Confidence about the ability of the NHS to cope? The general public were asked if, compared with the previous coalition, the new government has better policies for the NHS. 26% of general public said they were very confident about the ability of the NHS to cope. Does the new government have better policies for the NHS? Only 11% strongly agreed the new government has better policies, with another 30% agreeing moderately. Should the private sector be involved in the NHS? We asked panel members whether or not the NHS should work with private and not-forprofit organisations. Just over half supported private company involvement, while a further 29% of the public supported the NHS working with non-profit organisations. Only 1 of the public thought that only the NHS should deliver healthcare. Clearly, the notion of private or third sector medicine is widely supported in the UK. 53% NHS and private healthcare Healthcare in the UK 1 Only NHS and NO private healthcare 29% NHS and non-profit/ voluntary sector In which type of setting are conditions best treated? We showed respondents a range of conditions and asked them where they thought they would be best treated. Super Hospital Local Cottage Hospital GP Surgery Home 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Heart attack Stroke Neurological conditions Hip replacement Childbirth Injury/ Fracture Diagnostic tests Childhood ailments Diabetes Care for elderly Pregnancy checkup A clear pattern emerges where super-hospitals are more likely to be favoured for heart attack, stroke, neurological problems, and hip replacements, while childbirth and injury/fracture are seen as best handled at cottage-style hospitals. Diagnostic tests, childhood ailments, diabetes, and pregnancy checkups are best dealt with by GP surgery. Only care for the elderly scores a significant number, with all saying this is best performed at home. 04

5 What are the priorities for spending extra NHS funds? We asked respondents to allocate priorities to different health conditions. Below is the pattern of responses: 1 2 to 3 4 to 6 7 to 9 10 to 11 Last 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Rare/Genetic diseases Dementia care Conception and infertility Pregnancy and childbirth Orthopaedics Preventative health Mental health Cancer Obesity Diabetes Stroke Heart disease We see that cancer and preventative care are the most frequent first choices: obesity and fertility care are the least supported areas of health among the public. Which demographic groups should resources be allocated to? We also asked respondents to choose how much of the total resources they would allocate to four distinct groups: children, adults, retired and under 80. The results are shown in the adjacent chart. As can be seen, the share attributed to each group is almost identical. We then went on to ask why people allocated resources as they did. Those who favoured the elderly typically explained their answers with comments such as, There should be greater resources than currently [allocated] for the elderly to cater for healthcare for those on limited budgets. 25% Children 23% Adult Resource Allocation 23% Over 80 29% Retired and under 80 Those who favoured more resources going to children commented that they were more deserving, or were our future. On the other hand, those who supported more focus on adults gave more rational and economic reasons such as the need to support the workforce or their tax contributions. However, it was clear that most people found resource allocation between groups a challenging exercise. As one respondent wrote How can I choose between them? They are all equally deserving. 05

6 Support for the right to mutualise The scores for support for mutualisation are shown below: 25% National Sample 20% 15% 10% National Sample 5% 0% Response to the questions 0 = no support 10 = total support Few have a strong level of support for the right to mutualise. While this may have been a priority for the previous government, it has not caught the interest of the public, and this graph may well reflect the fact that many people know little about this policy. Research methodology Sample A UK sample of 1,025 was interviewed online, with the sample representative of the UK in terms of age, sex and region. Fieldwork dates: May Age 100% 90% 80% 70% 60% 50% 21% 14% 17% 65 years and over years years 6% Scotland 40% 30% 20% 10% 0% 17% 17% 14% years years years Northern Ireland 9% North West 5% North East Yorkshire & Humber 49% Male 6% East Midlands Gender 5% Wales West Midlands East England 51% Female South West England 17% 16% South East England 06

7 Background of the issues covered in the research Throughout the lengthy 2015 General Election campaign, the NHS resolutely remained the issue of greatest concern to the electorate. As the dust settles and the priorities of the Conservative Government become clearer, Benenden has sought to understand how these priorities match up to the views of the general public. This section of the report provides an overview of the topics posed to our panel, and further, considers the questions posed. Private sector involvement in the NHS The NHS has always commissioned a proportion of healthcare services from private providers (including dentistry, optical care, pharmacy, and technically, most GP practices, as they are private partnerships). As part of their reform programme during the late 1990s and into the 2000s, the Labour governments under both Blair and Brown opened up the NHS to competition by using private providers to increase patient choice and competition. However, the Health and Social Care Act 2012, brought in by the Coalition Government, did extend a market-based approach to the NHS, emphasising a diverse provider market, competition and patient choice, as ways of improving healthcare. This outsourcing, giving contracts to the private sector to run NHS services, has been very controversial. It is widely acknowledged that around 10% of NHS expenditure on health services is on non-nhs providers, which includes for-profit companies, local authorities, social enterprises, charities, and community interest companies. However, during the 2015 election, there was concern from the Labour Party and the SNP that further reforms would result in much greater involvement of for-profit companies in the NHS. For more information on this subject please visit The King s Fund website. Super hospitals versus cottage hospitals Simon Stevens, the Chief Executive of NHS England, used his first speech in this position to emphasise the need for a rethink of recent policies to close local cottage hospitals as a result of services being stripped out and centralised 1. It is recognised that while super hospitals are very successful in areas such as stroke care and major trauma, where significant benefits have been gained by concentrating upon specialist care, there is a need to revisit the merits of localised care without reverting to the 1950s image of cottage hospitals. His vision, which was laid out in the NHS England Five Year plan 2, will see investment in services to care for the elderly and other members of the community in the areas in which they live. Focus on the ageing population With more than of the UK population expected to be aged over 75 by , there is a recognised need to care for those older people in our society, both in terms of supporting them to live healthier lives for longer and in living with long-term and/or multiple conditions. However, many have called on the government to not lose focus on avoidable illnesses such as diabetes and obesity 4, which are affecting younger members of our society and will also have a profound impact on the NHS in the future. Some have argued that preventive measures in these areas are a major priority for public health services and that funding should have been increased to try and stop these conditions (and their associated costs) from developing at the rate currently seen. Right to mutualise The 2015 Conservative manifesto emphasised a right to mutualise as an extension of their and the Liberal Democrats support in recent years for the opportunity for public sector workers to spin out of the NHS, establish mutuals or community investment companies (CICs), and serve their communities in that way. The rationale for this move was to free up the entrepreneurial spirit of public servants and yield better value for money for taxpayers. An example of a public-sector spinout is Central Surrey Health and Medway Community Health. Their websites can be found here: More information, see The Daily Telegraph, 29 May The NHS Five Year Plan can be found at 3 Office of National Statistics 2010: 4 For example, the prevalence of adult obesity increased from 15% in 1993 to 26% in In 2010, 67. of men and 57. of women were overweight or obese. See for more information. 07

8 Conclusion On the NHS, the overall tone among panel respondents was anxious, with many people worried that the NHS was unlikely to be able to do as good a job in the future combined with a real sense of hope that it can be protected and enhanced. There was greater criticism of the management of the NHS than of the political support for it, suggesting that there is still a belief in the need for change or reform. The results of the Benenden survey show that while the British public have great faith in the NHS and its ability to help and support them in times of need, they are not opposed to the private sector being involved in the process. It may also shed some light on why despite the fact that the pollsters said the NHS was the major issue for voters in the 2015 General Election and the Labour Party used its views as a major campaigning tool in the end, the majority of people are happy with a mix of public and private sector provision of healthcare in the UK. One can conclude that the public at least for the time being are happy for the private sector to maintain its involvement in the NHS, but a cultural shift or government policy intervention will be required to move the public away from its fondness for, and reliance upon, the NHS as it stands. The research also revealed that while those polled appreciate that there are limited resources (and many difficult decisions to be made about how these are allocated), there is little desire to look for alternatives to the NHS. As the government moves forward with its plans to increase NHS funding by 8 billion, Benenden will continue to work in tandem with the NHS to ensure that the healthcare needs of its members and the general public are well served in an efficient and cost-effective manner that, in line with our own principles, focusses on individual needs while catering for all. Benenden Holgate Park Drive York YO26 4GG SP8685/06.15/V1