Will the NHS be there for me?

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1 Will the NHS be there for me? A report by Benenden Healthcare Society Launched at the Palace of Westminster London 11 th July 2012

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3 Foreword By Ken Hesketh Chief Executive Benenden Healthcare Society It is my pleasure to introduce this research that Benenden Healthcare Society has commissioned into public attitudes to the NHS and the wider healthcare system. This is the third piece of important research that Benenden has produced, looking at public attitudes to our healthcare system and which we are delighted to launch at our annual Summer Parliamentary reception in the Palace of Westminster. No one, of course, can predict the future. And it is very encouraging that the public still overwhelmingly feels, after all these years, after everything that the NHS has been through, that the NHS was created for people like them and that it will still be there for them in the future. However, it is apparent that the public is worried about what the future of healthcare will look like in the UK in ten or twenty years time. And some believe that the public is often ahead of policy makers and commentators on health issues. Notwithstanding the different views and positions taken on the recent Health and Social Care Act, the fact is the health service faces a period of unprecedented and unchartered territory. The 20 billion efficiency savings currently being sought from health spending, while demand is increasing, will mean even greater need in the future, and this will have a profound effect on attitudes. I believe we will see a trend emerge in future years of a public more willing to consider how a properly funded, publicly paid for health service should be paid for. The country s public finances are unable to sustain a level of spend that the public have come to expect in the past decade and this of course, is not peculiar to the UK. Most people want a publicly funded and accountable healthcare system. The challenge for the future is meeting demand and expectations in a way that is both fair and efficient. Benenden Healthcare Society intends to be at the heart of that debate. Ken Hesketh Chief Executive, Benenden Healthcare Society July 2012

4 Executive Summary The British people still overwhelmingly believe that the NHS was created to help people like them and they remain confident that today s NHS will be there for them. However, the public feels less certain and confident about the NHS of the future with fewer than half the public being confident that the NHS will be there for them in ten years time. It is also the case that younger people feel less confidence about the NHS than older people; this could be a reflection of the fact they have less reason to think about healthcare but it could be part of a broader and longer-term trend. It is not just younger people who feel less confident about the future: across all age groups the public are concerned that as they grow older the NHS will not be as able to provide the right support and healthcare. The least optimistic group about the ability of the NHS to support them as they grow old are people in early to late middle age (45-54 year olds): more than a third say they are not optimistic about the NHS of the future. This is significant politically as this group is more likely to vote both now and in the future than younger people, and their concerns could become a wider political issue for all the political parties. The vast majority of people believe that the NHS will be there for them in an emergency, but for chronic conditions, including those associated with an ageing society, public confidence is lower. The public also seem to have concerns about the amount of health spending that is ultimately invested in private healthcare providers; the public would rather see more balance between the use of the not-for-profit sector and the private sector in the provision of health services within the NHS. The government s recent reforms to the NHS commands very little support from the public at the moment with just one in ten people believing that current policies will strengthen the NHS. Against a backdrop of unprecedented efficiency savings being sought within the NHS and wider primary care system, alongside a perception that the government s current policy direction will weaken the NHS, it is likely that the public s perception of the NHS being there for them in the future could worsen over time.

5 Introduction This polling based research, commissioned by Benenden Healthcare Society, managed by Woodnewton Associates and conducted by ICM over the weekend of 22 nd 24 th June among a representative sample of 2,034 British adults seeks to contribute to the debate on healthcare in the UK. There is lots of current research and policymaker and media commentary on the current state of the NHS. What makes this research different and original is that it seeks to gain an understanding of whether the public believe the NHS will be there for them in the future, as well as understanding their views on the present. A number of things are apparent from this research. The overwhelming majority of the public believe that the NHS was created for them, and people like them. The public also believe that the NHS is still able to provide them with good quality healthcare. However, people are concerned about the future and this is very possibly an instinctive reaction to the current debate surrounding the future of the NHS (which has been largely negative) and a wider pessimism about the future given the broader economic context. A key area of concern for many people is whether the health service will be able to care for them if they get longer-term, chronic conditions. Given the uncertainty over how, and in what ways, to fund a social care model in the UK, particularly in England, this is not surprising. Notwithstanding concern about the future, the public seem to be firmly wedded to founding principles of the NHS, in particular how it is funded. Again, though, there seems to be an emerging picture of people being willing to countenance the concept of paying top ups for certain types of service. But the vast majority of people still want and expect the NHS to be free at the point of use. There is more concern around where current health spending is allocated and what proportion is and should go to private providers operating within the NHS, as well as the role of not-for-profit providers within the system. People s attitudes toward the future cannot be divorced from the situation as it is today. The research clearly shows that however well intentioned the government s recent reforms to the NHS might have been (and many would disagree even with that statement) the public does not believe that current policies will strengthen the NHS. That current reality, against a backdrop of the NHS needing to make efficiency savings of a level that it has never sought to do in its 64-year history, means that confidence in the NHS could sadly fall in the years to come as perception becomes reality.

6 Survey Findings Overall confidence in the NHS being there for me The overwhelming majority of the British public, (91%), believe that the NHS was created to provide good quality healthcare for people like them. This is a deeply held view, with more than three in five (62%) strongly agreeing with this statement. Just one in fifty people (2%) disagree. Broadly speaking, people remain confident that today s NHS would be there to provide them with good quality healthcare. Three-quarters (74%) of the public believes the NHS will be there and only one in twelve (8%) disagree that it will. However, this confidence is less heartfelt: just one in four strongly agree that the NHS will provide them with good quality healthcare today, which is 40 percentage points down from the proportion who strongly feel the original intention of the NHS was to do this. The picture that emerges when the public is asked to think about the future of the NHS is much less clear-cut. More people agree than disagree that the NHS will provide them with good quality care in 10 years time (42% vs. 19%), but this means that fewer than half the public are confident about this and only one in nine (11%) are sure (i.e. strongly agree ) that this will be the case. A similar pattern emerges when we ask the public about the NHS in 20 years time. Across nearly all sub groups of the public around nine in ten believe the NHS was originally designed for people like them. However, this falls among younger adults with 80% of years who agree with this statement. Another way of looking at this is that twice as many over 65 year olds than year olds strongly agree that the NHS was originally designed to provide good quality healthcare for people like me (80% vs. 40%). Younger adults, year olds, are also the least likely to think the NHS today will provide them with good quality healthcare if they need it: two-thirds (65%) agree that it will. Londoners are also less likely than the average to believe the NHS today will be there for them (68%).

7 We also asked the public about whether they think the NHS will be there for them as they grow old. On this issue the public is more divided. Just over a third (36%) is confident the NHS will provide me with the right support and healthcare as I grow old but 28% disagree and 35% say they don t know or neither agree or disagree. On this measure, the least optimistic about the NHS s ability to support them as they grow old are year olds: 31% say they are confident in the NHS, but 37% say they are not. In contrast, those in the North-East of England are most optimistic: 48% are confident and just 16% not. Providing good quality healthcare in different events To help us better understand people s confidence in the NHS we also asked the public the extent to which they agree or disagree that the NHS will provide good quality healthcare as a result of a range of health-related scenarios. Almost nine in ten (88%) people think that the NHS would be there for them if they have an emergency, such as a road accident or a heart attack and more than half the public (52%) strongly agree the NHS would provide good quality healthcare in such an event. More than half the public also thinks the NHS would provide good quality healthcare in the event they are diagnosed with serious long-term or life-threatening illness, but fewer people are certain about this. For example, only a quarter (24%) of adults strongly agree that the NHS would be there for them if they are diagnosed with a long-term illness such as Parkinson s Disease. Chronic, but not life threatening, illness are where there is no majority confidence in the NHS s ability to provide good quality healthcare: slightly fewer than half (48%) of the public agrees that the NHS will be there for them, but as many as 22% disagree.

8 Commentary: It is not surprising, and, indeed, it is satisfying, to see that support for the NHS remains so strong. Regardless of the day-to-day debates and arguments surrounding the NHS, the British people remain firmly wedded to its founding principles. But concerns over the future of the NHS and it being there for people in the future deserves further comment. Younger people are less certain if the NHS will be there for them. This could be a reflection of young people not having to use or think about healthcare in the same way that older people do. However, it could also tap into a wider dispossession that young people feel towards the system at the moment: they have seen trust being eroded in other institutions of authority in recent years, and assume that the same might hold true for the NHS. A kind of will anything still be there? attitude toward the future. Policymakers should take note of the fact that middle age and older people have concerns about the NHS being there for them in the future if they have chronic but not life threatening conditions. The issue of social care is one of the greatest political issues facing the country; politicians can see this and they are grasping their way towards a solution. Can there ever be a genuine consensus on this issue and how would any solution be paid for? These are questions that policymakers are grappling with at the same time as the public are demanding urgent answers. Healthcare spending Most people think more money should be spent on the NHS and less on private healthcare companies. On average, the public thinks 63% of healthcare spending (including by government and individuals) is currently spent on the NHS, but they think this should be as high as 74% of spending. In contrast, the public thinks 24% of healthcare spending goes to private healthcare companies, but they think just 13% should. A) Overall, what proportion of healthcare spending (including by government and individuals) in Britain do you think is spent on B) And what proportion of healthcare spending in Britain do you think should be spent on C) In 10 years time, what proportion of healthcare spending in Britain do you think will be spent on Currently Should 10 Years % % % The NHS Private healthcare companies Not-for-profit healthcare providers

9 As the table above illustrates, the amount of healthcare spending people think is currently devoted to not-for-profit healthcare providers is the same as that which they think should be spent and expect will be the case in 10 years time. As such, people see that in 10 years the private sector will receive twice as much healthcare spending than they think it should have; and that this will come at the expense of the NHS. Paying extra for additional healthcare benefits Most people say they would not be willing to pay extra each month for additional healthcare benefits, though a significant minority say they would pay a little extra. Our research shows that three-quarters (75%) would not want to pay any more each month in order to see their GP more quickly. Just one in eleven (9%) would be willing to pay 5 per month for this. More people would be willing to pay 5 per month in order to access free physiotherapy (13%) or to receive inpatient care more quickly (14%). This equates to about six million adults. A higher proportion (17% of people or c7.5 million adults) say they would be willing to pay 5 per month to see a hospital consultant more quickly. Commentary: The public has concerns about the amount of health spending that is invested in private healthcare providers and they would like to see a better balance between the use of the not-for-profit sector and the private sector. It is likely that the public, on the back of a fall in confidence in key parts of the private sector (financial services), has concerns over the motives of some private providers. The public ethos of the NHS is, as we have seen above, deeply engrained in the British psyche. This, coupled with an ever-shrinking budget for healthcare, leads to a key question: why should some providers profit out of the healthcare system? Should not every penny of available cash be re-invested in health services? Funding has always been the key issue for healthcare, and controversy has always existed around the role of profit-making providers. The public does understand the role and purpose of other providers as a way of helping to ease pressure on directly provided NHS services but they tend to feel more comfortable about this if they know that those services are being provided by a non-profit provider and where money is not leaving the system in order to make a return for a private business or for shareholders. The country s public finances are unable to sustain a level of health spend that the public have come to expect in the past decade and the role of top-up payments and copayment plans will be crucial for the continuation of good quality healthcare. Given public concern about the role of the private sector in the provision of public services the role of the not-for-profit sector will arguably become more important in the future.

10 Confidence in the Government s policies on the NHS Reflecting the public s lower levels of confidence that the NHS will be there for them in the future, many more people think that the current Government s policies will weaken (50%) rather than strengthen (11%) the NHS over the next few years. Those aged between 45 and 54 years old are most likely to think the Government s policies will weaken the NHS (60%) and so do a relatively high proportion of people living in North England (55%). People who have used the NHS in the last 12 months are more likely to think the Government s policies will weaken the NHS than are those who have not used it (51% vs. 42%). Commentary: Leaving aside the well-covered debate about the rights and wrongs of the Lansley reforms of the NHS, the political problems that the Health and Social Care Act has created are unarguable. The Coalition Government inherited a very difficult spending situation; the Conservatives had promised to protect frontline health spending and all sides recognised that, however that was defined, some very difficult decisions needed to be made on how efficiencies within the NHS were to be achieved. The unprecedented spending situation of 20 billion savings is occurring alongside the growing demands of an ageing population. These two issues will lead to an impact on service levels within the NHS. The probability is this will create a perception that the reforms enacted are in some way, at least partly, responsible for this.

11 Conclusion The debate about the future of the NHS is almost as old as the NHS itself. But the terms of the debate have changed in recent years. The public overwhelmingly support the NHS. They believe it is for them and will, on the whole, be there for them when they need it. However, confidence for the future is less certain. As the demands on the health service grow and investment falls how will the public feel in the future? And for certain issues, such as chronic conditions, concern is growing about the ability of the NHS to be there for people when they need it most. The NHS is in unchartered territory. The time for an open and honest debate on how we fund our health service in the future has come.

12 The Benenden Healthcare Society Limited is an incorporated friendly society, registered under the Friendly Societies Act 1992, registered under 480F. The Society s contractual business (the provision of tuberculosis benefit) is authorised by the FSA. The remainder of the Society s business is undertaken on a discretionary basis. The Society is subject to FSA requirement for prudential management. Benenden Healthcare Society Holgate Park Drive York YO26 4GG Tel: Fax:

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