HEALTH
The Long Road Back for the NHS: A local approach to a national challenge
Despite widespread dissatisfaction with GP and hospital services, local factors significantly influence public perception of the NHS. A dual approach is needed: a national strategy tailored to local needs and a strong national message emphasising tangible improvements, particularly in access to care.
Ipsos MRP Model
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Key findings
Dissatisfaction with local health services transcends demographics, especially low among those of working age, with a long-term health condition, and living in deprived areas.
of UK public adults are dissatisfied with the quality of GP and hospital services in their local area.
of people say they are dissatisfied with health services in Northern Ireland, where discontent is highest.
of the most satisfied 20 local authorities in England are in the North East.
The last time the Labour Party took office after a period in opposition, as many as 90% of Britons were satisfied with their GP and 80% with NHS hospitals. The difference this time round is stark, with 40% satisfied with their GP and 32% with NHS hospitals, and views worsening markedly since the early 2020s. The current rhetoric around the NHS won’t necessarily be supporting more positive perceptions – Mr Streeting, Secretary of State for Health and Social Care, has asserted that the NHS is broken and two-thirds of Britons (65%) agree with him. As the government and the NHS in England prepare the 10 Year Health Plan, the public support its three ‘shifts’ towards a more community-based, digital, preventative health service. However, they have limited confidence that the Plan will lead to improvements and it is not difficult to see why, when looking at current public perceptions of the NHS.
Confidence in local health services is on life support
Our analysis reveals a concerning reality: no area in the UK is immune to public dissatisfaction with GP and hospital services. Across the UK, around half (52%) of the UK public are dissatisfied with the quality of GP and hospital services in their local area, and only a third (31%) are satisfied, leading to a net satisfaction score of -20%.
Furthermore, this dissatisfaction with local health services transcends demographics. It is especially low among those of working age (e.g. -29% among 35-44s), people with a long-term health condition that impacts their abilities a lot (-36%) and people living in the most deprived areas of the UK (-29%).
Our MRP also identifies some geographical variation. Most notably, the public in Northern Ireland are more dissatisfied with GP and hospital services than people in Britain, ranging from -61% net satisfaction in Ards and North Down, to a not much better -44% in Mid Ulster. While healthcare is a devolved issue, this highlights the impact of political paralysis that has meant stubbornly high waiting lists have not been dealt with.
While not as extreme, perceptions are also poor in Wales, with scores as low as -39% in Blaenau Gwent and Merthyr Tydfil. Overall satisfaction is about average in Scotland, but this also hides a range from local authorities with higher levels of satisfaction, notably +13% in Orkney, +12% in the Western Isles, or +10% in the Shetland Islands, to more dissatisfaction across its central belt. With health a devolved issue, this suggests that understanding what drives the views of different local areas needs to be just as much a concern for the governments of the nations as it is for Westminster.
In England nine of the least dissatisfied 20 local authorities are in the North East (e.g. Newcastle upon Tyne -1%, County Durham -4%) and a further nine from London (e.g. Wandsworth -3%, Merton -5%). Other regions see significant variation across their local authorities, notably the West Midlands and the South East, both of which include local authorities recording among both the highest and lowest satisfaction levels (e.g. from -9% in Warwick to -35% in Sandwell, and from -6% in Oxford, to -31% in Thanet).
Our analysis reveals a concerning reality: no area in the UK is immune to public dissatisfaction with GP and hospital services.
The impact of local context on public perceptions
This variation across local authorities demonstrates a need to understand how local factors can shape perceptions of the NHS. For example, analysis of the GP Patient Survey shows that the context in which health services operate influences ratings of GP practices. Practices with older patient populations, mostly from a single ethnicity and living in areas of lower deprivation tend to have more positive ratings. Better funding, more GPs and lower local mortality rates are also associated with better patient experience.
We can see a similar pattern if we look at the MRP survey in NHS Hampshire and Isle of Wight Integrated Care System (ICS), an ICS that spans several local authorities with varying levels of public satisfaction. In Winchester, net satisfaction is -9%, yet in neighbouring Portsmouth net satisfaction falls to -31%. The population in Portsmouth is younger, more ethnically diverse, and has a higher level of deprivation than Winchester. This follows the pattern we would expect: it is harder to achieve higher satisfaction in Portsmouth due to the make-up of the local population.
There’s more than just local context – patient experience and service performance also count
But the make-up of the local population is not the whole story. In NHS North East and North Cumbria ICS, net satisfaction in South Tyneside is -13%, compared with -5% in Sunderland. And yet the populations of both are similar in terms of age profile, ethnicity and deprivation. What might explain this?
Our analysis of the GP Patient Survey demonstrates that it is not just about local context. Patients’ experiences also matter, most prominently their interactions with staff, ease of contact with the practice, and conversations about managing long-term conditions for those who have one. While there is a difference between patients’ ratings of their experiences and public ratings of the NHS (the latter being more influenced by what people hear through the media or word of mouth), the analysis suggests that there is much that can be done to improve perceptions of local NHS services, with implications for the UK government and devolved governments, and the NHS nationally and locally.
The public in Northern Ireland are more dissatisfied with GP and hospital services than people in Britain.
A local focus, a national narrative
These findings underscore the need for a dual approach:
- The NHS’ strategy must take account of local factors. Working with local communities to understand their unique needs and co-designing services is essential. This fits with the UK government/NHS move towards a ‘Neighbourhood Health Service’ in England. If done well, it will mean accounting for local context in service provision. However, careful management of public concerns about potential disparities in service provision is crucial to avoid accusations of a ‘postcode lottery’.
- A strong national narrative is crucial. While the public acknowledges the long road to recovery, with only 35% believing in improvement in the next five years, their patience isn’t limitless. We already see some blame directed towards the government for failure to improve other areas. The current deep pessimism is likely to make it even more difficult to convince the public that improvements are being made, making it even more important to focus on areas where progress can be felt immediately – especially if the aim is to swing public perceptions of the NHS in time for the next election. This means the government must clearly articulate how the 10 Year Health Plan's three ‘shifts’ will directly translate into tangible improvements in access to care – the public's top priority.
Perhaps the NHS is indeed broken, as Wes Streeting has concluded. It will be a long road to recovery, so demonstrating an understanding of people’s local needs, and a compelling national vision that shows on-going tangible improvement will be critical to keeping the public on board.
There is much that can be done to improve perceptions of local NHS services.
Kate Duxbury Research Director, Ipsos
Holly Brown Senior Research Executive, Ipsos
