From principle to performance: how the public is judging the NHS ahead of the elections
As many of us head to the polls tomorrow for local elections, it’s likely that the NHS will be at the forefront of many voters’ minds. When asked what areas they are most concerned about right now, the NHS was the 3rd most selected topic by consumers (15% rating it the issue they were most concerned about) coming behind cost-of-living (22%) and immigration / asylum (18%). When looking at the proportion ranking these areas in their top three concerns, the NHS rises to second place (40%) behind only cost-of-living (51%).
But this is not just another election where the NHS features as a key issue. Increasingly, it is something voters are experiencing directly in their day-to-day lives, which is changing how it is judged.
So, what is driving this concern, and what options are consumers most open to in supporting the improvements they clearly feel are needed?
Consumers feel the NHS is struggling: there is a perception of decline over the last 5 years, despite more positive views of service quality
2 in 5 (39%) say the NHS overall has got worse over the last 5 years, rising slightly to 41% among those who rely on NHS services to manage a long-term illness or condition. These perceptions appear to be driven by a particularly negative view of waiting times, with 45% saying this has got worse. However, it is not all negative, with more positive views of the standard of care provided, where a greater proportion feel it has improved than worsened (35% vs 28%), and of the quality of NHS staff (36% vs 21%).
This points to a clear divide in how the NHS is experienced. When people are treated, the care and staff are still viewed positively. The challenge is accessing that care in the first place.
This distinction is important. It suggests that dissatisfaction is not with the idea of the NHS itself, but with how it is currently functioning in practice.
But despite the struggles, a majority believe the core principle of the NHS being free at the point of use must be maintained
2 in 3 (68%) say it is essential for the NHS to remain free at the point of use. Interestingly, there is no difference in the views of those who feel the NHS overall has got better vs those who feel it has got worse (67% for both), showing the depth of support for one of the defining principles of the NHS.
While there is very limited appetite for any move towards a model of payment for services via insurance contributions (4%), there is some potential to expand elements of payment beyond areas like dentistry and prescriptions if, and it's a big if, this would lead to improvements in waiting times (9%) or more commonly, the quality of service received (19%). This potential funding stream may grow over time, with younger adults less likely to feel the NHS must remain free at the point of use than their older counterparts (62% of those aged 16-24 say this compared with 79% of those aged 65+).
This highlights a tension in public opinion. The principle of a free NHS remains strong, but there is some openness to change if it leads to tangible improvements in how the system works.
Consumers feel more money is needed: a lack of funding is seen as the main challenge for the NHS, but they also feel they could get more bang for their buck
Just under half (46%) cite a lack of funding as the biggest challenge or issue facing the NHS, and this lack of funding is likely linked to issue number two of a lack of staff (40%). But there is a sense that some of the funding that the NHS receives is not always being spent wisely, with inefficiencies in the system the 3rd most mentioned issue (31%). Recent waves of strikes by doctors and other NHS staff are also affecting public perceptions, cited by 21%. As with other areas of life during the cost-of-living crisis, consumers also expect the NHS to spend money as wisely as possible.
Here too, there is a balance in how people think about the problem. More funding is seen as necessary, but it is not seen as sufficient on its own. There is a clear expectation that the system should make better use of the resources it already has.
Despite cost-of-living pressures, many are prepared to contribute more to support the NHS
Just under half (46%) say they would be prepared to pay more tax or higher National Insurance contributions to provide an increase in funding to the NHS. This is well above the 1 in 3 (34%) for whom this was an outright ‘no’, with a further 20% currently ‘unsure’ who likely want to see the detail of how much and on what before picking a side. This does suggest that there is some willingness among consumers to foot the bill to support the NHS, even during a time when cost-of-living pressures are high across the board.
When asked to choose between different ways to increase NHS funding, paying more in tax and NI was the most selected (40%), followed closely by reducing spending on other public sector services to increase funding on the NHS (37%). Only around 1 in 10 selected the option to add charges or increase existing charges for NHS services (14%) or scaling back NHS services to avoid the need for future funding increases (9%).
Taken together, this suggests the public is willing to support the NHS financially, but only where there is confidence that this will lead to meaningful improvements in access and outcomes.
What this means
Overall, the public mood is clear: the NHS remains a core national priority, but many feel it is under strain, driven above all by worsening waiting times. At the same time, trust in frontline care and staff remains comparatively strong, and support for the NHS being ‘free at the point of use’ runs deep.
What has changed is how the NHS is being judged. It is no longer assessed primarily on what it represents, but on how it performs in practice.
For voters, the question is no longer simply whether they support the NHS, but whether it is working for them.
The most viable route to sustaining and improving the service therefore looks like a credible plan to reduce waiting times and strengthen capacity, all continuing to be backed by funding through taxation. This must be matched with convincing evidence that money is being spent efficiently and effectively.
As expectations of the NHS continue to evolve, understanding how people judge performance in real terms will be critical. At The Harris Poll UK, we help organisations get closer to the reality behind public opinion. To find out more, get in touch.