The Week

The Week 28 March 2024

Rosie Beacon
Research Manager and Head of Health

This week we saw bleak numbers for public approval of the NHS with the lowest level of satisfaction recorded since the British Social Attitudes (BSA) survey began.

The BSA tracks social and political attitudes. It has been running since 1983, repeating many of the same questions over time, giving one of the more rigorous insights into public attitudes over a long time series.

Overall satisfaction with the NHS fell to 24 per cent, with 52 per cent dissatisfied. Most interesting, however, was respondents’ attitudes toward NHS funding. 84 per cent of respondents to the survey said they thought the NHS had a major or severe funding problem. And when asked about government choices on tax and spend in the NHS, 48 per cent — nearly half — chose ‘increase taxes and spend more on the NHS’.

It is not wholly surprising that public opinion would be comfortable with tax increases given the profound commitment to an NHS that is free at the point of use. But health spending should not be looked at in isolation and policymakers should be conscious of its trajectory of seemingly never-ending growth. Health spending is the highest it’s ever been, yet health outcomes are worsening — more money evidently does not translate as better results.

With this said, public service expenditure can grow sustainably so long as it does so in line with economic growth, but the growth in health spending is currently outstripping the growth of our economy. It is true that healthcare expenditure growth in particular has tended to outstrip GDP growth since the inception of the NHS, but this imbalance is set to widen given growth forecasts for the next decade.

Before the pandemic, health spending — not including social care — accounted for 8 per cent of GDP. In 2020, the OBR predicted that this would exceed 10.5 per cent in 2040, and in 50 years’ time, our health service is set to account for 14.8 per cent of GDP. Even if constantly increasing tax revenue were to be relied on as a source of income for the NHS, in 50 years’ time as more people become pensioners, there will be less people to tax as well as more demand on the health system. As the OBR stated, health spending is the “largest — and most likely — source of long term risk to fiscal sustainability”.

This is not only a matter of finding more money, but of where the money is going. The fact we are providing more GP appointments than ever before yet producing satisfaction levels that are lower than ever implies there is something more profound undermining our current delivery model. The way the NHS is designed does not meet people’s needs as is and it is not particularly clear that ploughing more money into an ineffective model fixes this.

Look out for Reform's new report with ideas for the future of the health system — coming next week!

What we’ve been reading…

The Centre for Cities’ interactive map following the release of the Household Below Average Income statistics (commonly known as poverty statistics) is a brutal insight into the scale of regional inequality for child poverty. The 2022 statistics were already damning, with the largest annual increase in absolute child poverty for 30 years, but the article highlights that a child in Burnley today is almost four times as likely to be in absolute poverty than a child in Cambridge. Across all cities outside of the Greater South East, 43,000 more children are in relative poverty. But in Greater South East cities, it is 25,000 fewer.

Levelling up is a unique point of policy consensus between the major parties, with the debate mostly revolving around the execution rather than the underlying principle. As Labour launch their campaign for the local elections in May today, centred on their commitment to the levelling up programme, it will be interesting to see how Labour’s version of this policy agenda evolves should they win the election.