Despite soaking up more than £200 billion of taxpayers’ money per year, the NHS and health policy more widely are two areas which have gone ignored. Since the coalition government’s half-baked reforms, Britain’s approach to health policy can be summarised as: give the NHS money and hope for the best.
This approach is running out of road. Over the last few years, the NHS has faced unprecedented pressure. A combination of bad winters and the shocks of the pandemic have left it in a poor state, with high waiting lists and demoralised staff. Clearly something isn’t working. The current government has continued where the Tories left off, papering over the cracks. Something has to change. But what? The NHS is spoken about like a national religion, and reforming it is believed to be a third rail of British politics.
The public are disillusioned with the NHS, its funding model, the quality of its services and its priorities
In the pandemic, the public were implored to ‘protect the NHS’, rather than expect the health service to protect the public. The establishment of the NHS was treated like one of Britain’s founding myths, akin to Alfred the Great or the Battle of Hastings, in the opening ceremony to the 2012 Olympic Games. This sentiment also manifested itself in public opinion, such as the Clap for Carers initiative in 2020 and 2023 polling which found more than half of British citizens believed the NHS made them proud to be British.
But if both taxes and NHS spending are at record highs, and yet the health service refuses to improve, then something has to give. That is why Prosperity Institute conducted a 5,000-person poll with Merlin Strategy this winter. We wanted to find out whether the public still do treat the NHS like some kind of sacred cow, whether they believe it is working and what should be done.
The findings reveal a country finally in the mood to try something different. The public are disillusioned with the NHS, its funding model, the quality of its services and its priorities. Anyone who wishes to grasp the nettle of NHS reform should take heart in the results, as they suggest the British people are far more willing to roll the dice and try something new.
Naturally, the NHS is one of the public’s highest priority issues. Forty-nine per cent of voters said the NHS was in one of their top three concerns, behind only the economy, chosen by 66 per cent, and immigration, listed by 50 per cent of the population. Though it may seem obvious, these three issues remain the central concerns of the voting public, and they overlap in many ways.
While our polling found that the public believed funding is one of the biggest challenges the NHS faces, 59 per cent of voters believed that NHS reform should be prioritised over increased funding. Private healthcare has become remarkably popular, with 60 per cent of voters reporting that they would use it if they could afford it and, if recent figures are anything to go by, a large and growing proportion of the population is doing just that: more than 8.4 million people had private health insurance as of 2024.
Of course, it is worth examining if people are turning to private healthcare as a last resort, using the market where the NHS has failed, which is what many have claimed regarding the high levels of out-of-pocket expenditure on private healthcare these days. But our polling revealed high levels of trust in private practitioners as well.
Similarly, when asked about the public’s preferred healthcare systems from around the world, Switzerland, the Netherlands, Germany and Australia came out on top. All are countries with a mixed model of provision, where the state, the private sector and charities deliver healthcare in a more competitive system with better results than the NHS.
While it is worth bearing in mind that the public’s awareness of the details of these countries’ health policies may vary – Switzerland is generally assumed to be a well-run, efficient country – thousands of British doctors have moved to practise in Australia recently, and it is highly likely that many British people will have heard about the better state of their health service from friends or family. Unsurprisingly, the public remain hostile to an American-style model, which is still associated with expensive treatments and insurance costs.
These findings are a useful reminder that the public understand that the health policy dichotomy of ‘the NHS or America’ often posed in British politics is false, and there is a whole world of functioning, accessible healthcare out there, much of it on our doorstep.
In a sense, it is hardly surprising that the public are ready for reforming the health service. Taxes and immigration are at record highs, two policies which the government claims were chosen to support the NHS, but without the public seeing a notable improvement in care as a consequence. Indeed, our polling reveals that the public believe that immigration is a burden on the health service rather than a net benefit by a significant margin – 49 per cent versus just 22 per cent respectively.
This is a view shared by Reform, Conservative, Liberal Democrat, SNP and Plaid Cymru voters. Whether this reflects public dissatisfaction with immigration because it increases demand on the health service or because of poor-quality care deserves further research; however, our survey revealed a strong public preference for training more British doctors and nurses, and around 42 per cent of voters believe that the quality of care provided by foreign staff in the NHS is worse than that offered by British doctors.
The public have a far greater appetite for reforming the delivery and funding of the health service than ever before. Britain’s politicians should have the courage to re-establish a new social contract with the public when it comes to public services, one which respects British taxpayers and strives to create the finest public services for British people in the world, taking inspiration from best practice in other countries. The public, evidently, are running out of patience, and won’t forgive the political class if it passes the buck to the next generation once more.
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