Party politics and attitudes towards the NHS

The Nuffield Trust and The King's Fund's analysis of the latest NatCen British Social Attitudes survey found that overall public satisfaction with the NHS had plummeted to just 36 per cent. Health is a highly politicised issue in the UK, so how does that picture look when broken down by party-political allegiance? John Appleby and Laura Schlepper examine the associations between Conservative and Labour voters and their views on the health service.

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Published: 05/05/2022

It seems a very long time since many of us stood outside at eight o’clock on Thursday evenings to clap and bang pans for NHS staff and other key workers. As the first lockdown came to an end in the summer of 2020 and cases and deaths from Covid-19 declined, so too did that audible and visible appreciation of health staff.

But support for the NHS and particularly its staff as they dedicated themselves to caring for patients in extremely difficult circumstances seemed to transcend politics and political allegiances. Or did they?

Alongside The King’s Fund, we recently published analysis of the British Social Attitudes (BSA) survey, which is carried out by the National Centre for Social Research. In this blog, we look at what it revealed about the party allegiances of the public and how these might affect their views and attitudes towards the NHS.

What we found

Across everyone surveyed (3,112), those saying they were very or quite satisfied with the NHS fell from a historic peak of 70% in 2010 to a low of 36% in 2021 – similar to the two lowest levels (1996 and 1997) since the survey began in 1983.

As Figure 1 shows, satisfaction fell regardless of party allegiances. 39% of those identifying as Conservatives were very or quite satisfied, which was true for just 36% of Labour supporters. Satisfaction across both parties plummeted between 2020 and 2021 by between 17 and 18 percentage points for Labour and Conservative supporters respectively.

Figure 1: “All in all, how satisfied would you say you are with the way in which the National Health Service runs nowadays?” 04/05/2022

Chart

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This sort of convergence of attitudes has happened in the past, although more commonly it would seem that the public are more satisfied when the party they support is in power. This is typified by the surge in satisfaction among Labour supporters in 1998 and 1999 of over 20 percentage points (even though it fell back somewhat in the next two years).  

Overall, there is a definite pattern of Labour supporters being less satisfied than Conservative supporters during periods of Conservative rule and more satisfied during periods of Labour rule (and vice-versa, of course). Before 1997 this tendency was particularly strong, but perhaps less so over the last decade as perhaps a more consensual view about the NHS (rather than the party in power) has started to emerge.  

What is behind the satisfaction levels?

There are of course many reasons for being satisfied or dissatisfied with the NHS over and above whether the party you support is in power or not.

As the chart below suggests, funding issues is a reason for supporters of both parties to be dissatisfied, but for different reasons. Seven out of 10 of Conservative supporters say they are dissatisfied because the NHS wastes money – a reason given by only two out of 10 Labour supporters.

On the other hand, and also perhaps not surprising, 54% of Labour supporters cite the government not spending enough money on the NHS as a main reason for dissatisfaction, which is only the case for 18% of Conservative supporters. However, there is more consensus on the top reason for dissatisfaction: waiting for GP or hospital appointments.

What should be priorities for the NHS?

Mirroring a key reason given for dissatisfaction, it is waiting times for hospital operations and GP appointments that both supporters of Conservative and Labour rank highly as priorities for the NHS – although reducing waiting times seems to be a bigger priority for Conservative supporters, with Labour supporters spreading their priorities more evenly.

While low on their list of priorities for both Conservative and Labour supporters, there is a significant difference between both groups in support for improving the health of the most disadvantaged, as shown in this chart.

Support for the fundamentals of the NHS

While there are differences between the attitudes of Conservative and Labour supporters towards the NHS, there is also some consensus (currently at least) on the relatively low level of satisfaction and, on the other hand, on reasons to be satisfied. But how do attitudes compare on the fundamental principles of the NHS – that it is free when needed, available to all and paid for collectively through taxes? A new question this year sought to explore the public’s views on these matters.

Well, this does divide the public down party lines, but perhaps not as much as some might think. As Figure 4 shows, on perhaps the defining characteristic of the NHS – breaking the link between payment and consumption, with care being free at the point of use – close to 100% of Labour and nearly 90% of Conservative supporters agree that this principle should definitely or probably apply.

As to whether care should be available to everyone, there is still some consensus, although with weaker agreement among Conservative supporters. Notable is that over 20% of Conservative supporters (and 10% of Labour supporters) do not think the NHS should be a universal service. (Quite who should not have access to the NHS remained unexplored in the BSA survey.)

On how the NHS should be paid for, again there is broad consensus, but with weaker support from Conservatives for tax funding.

With nearly three-quarters of Conservatives and nine out of 10 Labour supporters saying the NHS has a severe or major funding problem (Figure 5), there is a question of where any extra money for the NHS should come from.   

On extra funding, there are two clear differences between Labour and Conservative supporters. Around two-thirds of Labour supporters would generally prefer extra funding to come from a tax of some sort – either current taxes they pay or a hypothecated tax. But for Conservatives, only around a third favour taxes, with a further third expressing a sterner view that the NHS should live within its budget (Figure 6).

It may be impossible to satisfy all of the people all of the time. The latest BSA survey results suggests it is very possible to dissatisfy some people some of the time. For both Conservative and Labour supporters, satisfaction with the NHS is at its lowest for 20 years. And there is consensus on the top reason for this, which is that waiting lists and times are too long.

Fixing this will take time, money, staff and – given lessons from reducing waiting times earlier this century – a relentless management focus on the task.

Suggested citation

Appleby J and Schlepper L (2022) "Party politics and attitudes towards the NHS". Nuffield Trust blog, 5 May.

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