With campaign messages and manifesto commitments being shaped ahead of the next general election, no political party can afford to overlook health and social care. Following a difficult winter and continued industrial action, the state of the NHS is a top issue for the public. Rishi Sunak promised to cut waiting lists in his five key pledges for 2023, while Keir Starmer has made the health service central to Labour’s five missions for the next parliament. Beyond the NHS, both of the main parties at Westminster acknowledge the importance of social care and preventing ill-health, but neither has so far set out detailed plans for ending the decades-long neglect of social care or improving public health. 

So what are the public’s priorities for policy on the NHS, social care and public health? What lies behind the growing concerns about the health service? After delays to promised reforms, are people similarly worried about the state of social care? And does the public think government should be as concerned with preventing ill-health as curing an ailing health service? 

This long read presents our analysis of findings from the fourth wave of our programme of public perceptions research with Ipsos that tracks the public’s views on health and social care in the UK every 6 months. This survey was conducted via Ipsos’ UK KnowledgePanel between 5 and 10 May 2023, with 2,450 people aged 16 and older across the UK (see Box 1: Methods).

Full survey results and further details about the methodology and the UK KnowledgePanel can be found in the downloadable slide deck.

In the run up to this survey, the NHS continued to face severe pressures. Cold weather and seasonal flu contributed to an extremely difficult winter, with ambulance and A&E delays hitting the worst levels on record. An unprecedented series of strikes by NHS unions began in November, with regular walk-outs in the months before our survey. While a short-term funding boost was announced in the Autumn Statement, a combination of inflation, higher demand, ongoing costs from the COVID-19 pandemic, staff shortages and challenging efficiency requirements has left the health service facing difficult trade-offs. The government’s spending plans do not provide the necessary investment, while Labour’s current plans emphasise reform over funding increases. On the policy front, the Prime Minister's pledge to cut waiting lists was followed by recovery plans for urgent and emergency care and primary care. While the service marked its 75th anniversary with the long-promised NHS Long Term Workforce Plan, this was published after our survey closed.

The public remains pessimistic about how the NHS is performing

Only a third (33%) of the public agree the NHS is providing a good service nationally – the same as in November 2022, but well below May 2022 and November 2021 (43% and 44%, respectively). Just under half disagree (43%), which is less than 6 months ago in November 2022, yet still negative overall. People are slightly more positive about the performance of local health services. 39% think their local NHS is providing a good service, similar to previous surveys, while 33% think local services are not performing well – down from 37% in November 2022.

Two-thirds of the public think the general standard of NHS care got worse over the past 12 months (66%), similar to November 2022 (Figure 1). A little over half think standards will get worse over the next 12 months (54%) (Figure 2), which means people are less pessimistic than 6 months ago (62%) but remain negative overall. The pressure and workload on NHS staff remains the aspect of the health service people are most likely to think got worse (80%) since May 2022 and will get worse in the year ahead (68%). 
 

Perceptions of national government policies on the health service remain very low overall. People in Scotland (32%) and Wales (22%) are still more likely than those in England (9%) to agree that their national government has the right policies for the NHS. Aside from a small increase in negative views in November 2022 (70%), the proportion of the public who disagree that the government has the right policies for the NHS has generally remained stable compared to May 2022 and November 2021 (65% compared to 63% and 62% respectively). 

Supporting and expanding the NHS workforce remain the top priorities

The public’s priorities for the health service have remained stable, with addressing the pressure on or workload of NHS staff (40%) and increasing the number of staff in the NHS (39%) being seen as the top issues. Improving waiting times for routine hospital services (34%) and making it easier to get face-to-face GP appointments (27%) also continue to be seen as important. Compared to 6 months ago, fewer people see improving waiting times in A&E as a priority (26% compared to 31%). This coincides with a modest improvement in A&E performance, albeit only by comparison to the record numbers of delays over winter, and the consequent reduction in the media coverage of urgent and emergency care. 

Most people continue to think the NHS needs increased funding 

8 in 10 people (80%) think that the NHS needs an increase in funding, similar to our previous survey. Just 17% think the NHS does not need further funding and should operate within its current budget – essentially unchanged from 6 months ago. While a majority of people, regardless of voting intention, support a funding increase, people intending to vote Conservative or ‘Other’ are far more likely to think the NHS should operate within its current budget – 38% and 32% respectively. This compares to just 7% of Labour voters and 8% of Liberal Democrat voters, most of whom (93% and 90% respectively) think funding needs to increase. 

While there is no clear consensus about how any increase in the health service budget should be funded, the most popular single mechanism remains an additional tax that is earmarked specifically for the NHS (31%). This option enjoys similar levels of support regardless of voting intention. However, in the context of concerns about the growing cost of living, support for an earmarked tax is down from 36% since November 2022. Support for increases in National Insurance (22% down from 25%) and income tax (21% down from 25%) have also declined since our last survey. Those intending to vote Conservative are more likely to favour increasing National Insurance (27%), while Labour voters are more likely to favour income tax (25%) – with both options more likely to be supported by Liberal Democrat voters (33% and 31% respectively). 

While NHS waiting lists continued to grow before this survey, only 23% of people say they are likely to pay for private health care or private health insurance if they need it – similar to our surveys since November 2021 onwards. 15% of the public say they already pay to go private – slightly more than in our last survey, but this is not directly comparable as the question was revised to clarify that employer-funded private health care is included. 

While the situation in the NHS makes the headlines, the crisis in social care is largely silent – yet many older people and disabled people still go without vital services, support for families providing unpaid care is insufficient, and pay and conditions for care workers are dismal. The Sunak government is the latest in a long line of administrations to break promises to ‘fix’ social care, with a further two-year delay to the flagship funding reforms to protect people from high care costs announced shortly after our previous survey. Other plans for social care, including action on improving workforce training, were watered down shortly before this survey. Labour’s ambitions to shift care from hospitals to the community would rely on improving access to social care. Although Keir Starmer has pledged action on care worker pay, the party is yet to come forward with detailed plans for social care.

People remain negative about social care

The public's views about the performance of their local social care services are more negative than positive, similar to our previous surveys. Around 1 in 10 (12%) think social care services in their local area are good, while a third (33%) disagree. However, 31% of people neither agree nor disagree and 25% say they don't know, highlighting the relative lack of public awareness of social care compared to the health service (on whether local NHS services are good, 26% neither agree nor disagree and 2% don't know). Labour voters tend to be more negative, with 39% disagreeing that local services are good, compared to 22% of Conservative voters.

Compared to 6 months ago, the public is slightly less negative about the standard of social care but remains negative overall (Figure 3). 3 in 5 people (59%) think the general standard of social care got worse over the past 12 months, down from 63% in November 2022 and 69% in November 2021. Only 3% think standards improved, the same as in November 2022. Looking to the future, the public remains pessimistic overall. Just over half (52%) think the general standard of social care services will get worse over the next 12 months (Figure 4), down from 57% in November 2022. However, just 5% expect standards to get better, similar to 6 months ago (6%) but worse than May 2022 (13%) and November 2021 (12%). Labour voters are more likely than the public as a whole to be pessimistic – 66% think standards have got worse and 60% think they will do so in the next 12 months. People who personally use social care are more likely to think services have got better (11%) and will improve in the year ahead (10%), although this remains very low. 

Perceptions of government policy on social care remain very low overall. Only around 1 in 20 (6%) agree that the government has the right policies for social care and nearly two-thirds (63%) disagree, similar to November 2022. Conservative voters are more likely to think that the government has the right policies (12%), but 40% still disagree.

Staffing, integration and supporting unpaid carers are top priorities for social care

The public's priorities for social care are improving pay and conditions for social care staff (42%), making it easier for health and social care services to work together to provide care and support (37%), increasing support for people who provide care for friends or family members who need support who are not paid (32%) and increasing the number of staff in social care (32%) (Figure 5).

As well as being the top priority for the public overall, support for improving pay and working conditions is higher among people who intend to vote Labour (51%), Liberal Democrat (51%) and the Green Party (52%). Better pay and conditions is less important to Conservative voters (30%), who prioritise supporting people to be independent by providing more care services in people's own homes (41%). 

In the context of the government’s recent decision to backtrack on planned reforms to social care, increasing state protection against care costs is a relatively low priority for the public. Only around 1 in 5 (22%) prioritise action to protect people against high care costs and just 1 in 7 (14%) prioritise making more people eligible for free social care.

Despite this, the public tends to think that means testing social care is unfair when the NHS is primarily free at the point of use. When reminded that social care is largely means tested in England, Wales and Northern Ireland and partly means tested in Scotland, around half (51%) think this is unfair while one third (34%) think it is fair. Compared to the public overall, Labour voters are more likely to think means-testing is unfair (56%) but are as likely to think it fair. Conservative voters are more likely to think the current system is fair (39%), but are as likely as the wider public to think it unfair.

Improving healthy life expectancy requires action across the whole of government to tackle the ‘building blocks’ of good health, including the leading risk factors for preventable ill health and early death – smoking, alcohol and unhealthy food. Since 2010, national policy on public health since 2010 has generally focused on supporting individuals to change their behaviour, with less emphasis on population-level approaches – despite these being among the most effective and equitable ways of improving public health. The government’s recently published framework for tackling long-term conditions acknowledges the need for strong action on prevention and inequalities, but a lack of ambition on policy is a major barrier to the administration achieving its own target. While Labour’s commitment to focus on the wider determinants of health is welcome, more detailed plans and investment will be needed to make it happen.

The public thinks that health and wellbeing in the UK are getting worse

People are slightly less pessimistic about the health of the nation than 6 months ago, but expectations are still negative overall. Nearly two-thirds (64%) of the public think the overall level of health and wellbeing in the UK got worse over the past 12 months, while just 8% think it got better (Figure 4). People are less gloomy than in our previous survey, when 69% thought the nation’s health had got worse and 8% thought it had improved, but still negative overall.

Looking to the year ahead, half (50%) think overall health and wellbeing of the population will get worse over the next 12 months and only 1 in 10 (10%) think it will get better (Figure 7). Expectations have improved compared to 6 months ago, when 61% thought things would get worse while 8% were optimistic, but are still negative overall. While people intending to vote Conservative are less pessimistic, more still expect that the nation’s health will get worse (35%) than expect it to improve (14%). Labour voters are more negative, with 60% expecting overall health and wellbeing to get worse over the next 12 months.

The public is largely unconvinced that the government is taking credible action to improve the population’s health. Just 16% of the public think the government has the right policies to improve public health, while half (49%) disagree. In line with the public’s expectations for the year ahead, perceptions of the government’s approach remain negative overall but have improved slightly from 6 months ago when 13% thought the government had the right policies and 54% disagreed. 

There is an appetite for more action to improve public health

A majority of the public see the state as having an important role in addressing the main risks for ill health. 80% think that the government has a great deal or fair amount of responsibility for reducing harm from smoking, although this has fallen from 85% 6 months ago. Most also see the government as having responsibility for reducing harms from alcohol (67%), down from 72% 6 months ago. For the first time, we also asked about gambling – a major contributor to mental ill health with wider impacts on families and society. Similar to alcohol, 70% of the public think that the government has a great deal or a fair amount of responsibility for reducing harm from gambling. While people planning to vote Labour are more likely to think the government has responsibility for addressing harm related to alcohol (75%) and gambling (79%), a majority of Conservative voters also agree – 60% on alcohol and 61% on gambling.

In line with our previous surveys, the public thinks the government has been most effective at reducing the harm from smoking. 58% think the government has been effective at reducing smoking related harm, while 37% disagree. However, people are far less positive about the government’s record on alcohol and gambling. Just 25% think the government has been effective at reducing harm from alcohol and 67% disagree. On gambling, 21% think the government has been effective and 69% disagree.

The public would support local government having a bigger role on smoking, alcohol, and unhealthy food 

Local government has a major role in shaping the building blocks of health and preventing disease. More than half (55%) of the public support local authorities having greater responsibility to implement policies to reduce harm from tobacco, alcohol and unhealthy food, with only 21% opposed. Support is higher among Labour voters (63%), but nearly half of Conservative voters (48%) would also support a bigger role for local government (29% oppose). 
 

There have been slight improvements in public perceptions of the NHS, social care and the nation's health since November 2022. The Prime Minister might view this as a tentative endorsement of his administration's approach to health and social care. However, people remain negative overall and still feel more pessimistic than in May 2022 – shortly before Boris Johnson's resignation as Prime Minister. Few believe the UK government has the right policies for improving public health (16% agree), the NHS in England (9%) or social care (6%). 

Rishi Sunak began 2023 with a speech about giving people hope for a better future, but this survey suggests optimism on health and social care is in short supply. While the government has promised a range of improvements, the public at large appears unconvinced that it has answers to the problems facing the NHS, social care or public health. As the Conservatives bid for a historic fifth term in office, the NHS waiting list is still growing and making meaningful progress before the election will be difficult. Plans for improving the nation’s health are still limited, despite the public thinking the government should play a bigger role. Yet there are still opportunities for the government to lay the foundations that will enable faster improvement in the years after an election that is not a forgone conclusion. Publication of the NHS Long Term Workforce Plan aligns with the public’s top priorities for the health service, although putting it into practice will require wider action and investment over the long term. 

The challenge for Keir Starmer is different. Labour has started sketching out its programme for health and social care, majoring on reform and ruling out tax hikes for working people, but the public and particularly Labour voters think the NHS needs more funding. Compared to the public overall, people planning to vote Labour are more likely to want to see government taking decisive action to improve the nation’s health, but the party has only provided limited details about what it would do in power. Should Labour form the next government, it will need to be ready to meet expectations of what it will do.

This survey reveals important political differences in several areas – notably on priorities for social care and the extent of the government’s responsibilities for improving public health. But it also highlights many others where the public are far more united. Such as prioritising improved staffing and access in the health service, the need for extra NHS funding and expectations of government taking responsibility for addressing leading risk factors for preventable illness and premature death. With the clock counting down to the next election, no party that aspires to government can afford to be out of step with public opinion.