For the third year running, we have carried out a small, snapshot survey of the NHS amongst the policy makers, senior managers, academics and clinicians who are attending our forthcoming Health Policy Summit, which takes place on 7 and 8 March.
This survey does not pretend to be representative in any way, but nevertheless provides a flavour of opinion amongst the 53 people who responded, in the wake of a year which has brought prolonged gloom about the prospects of improvement in the state of public finances and the passing and implementation of one of the most controversial pieces of reform legislation in the history of the NHS.
The Summit also follows hard on the heels of the Francis Inquiry report into the failures at Mid Staffordshire NHS Trust, which presented some big challenges to all those delivering, managing and regulating the NHS.
The sobering message from the Francis report – that there are some real doubts that care will be safe or compassionate across the NHS and that the system can spot failure and intervene when things go wrong – may have influenced our responses.
For three years in a row, we've asked the same question in an annual survey about whether people feel that care in the NHS has improved, got worse or stayed about the same.
In 2011, 74 per cent of people felt that care had improved, whereas this year, only 30 per cent felt that it had. Nearly twice as many (63 per cent compared to 27 per cent) now think standards of care have stayed the same, although it is still only a small minority who think care has actually got worse (seven per cent this year, compared to six per cent in 2011).
Equally striking is the gradual change in sentiment about whether the NHS needs reforming.
We asked people to state whether the NHS needs only minor change; whether it is good but in need of more fundamental change; or has so many problems that it needs to be rebuilt completely.
The proportion opting for only 'minor' change has declined steadily (36 per cent in 2011, 22 per cent in 2012 and 17 per cent this year) with an increase in those choosing the 'good but fundamental change needed': 63 per cent (2011), 74 per cent (2012) and 80 per cent this year.
Only a minority believes that a complete rebuild is needed (four per cent this year compared to one per cent in 2011).
We asked a few specific questions about aspects of the current reform programme.
There has been little change in the scepticism about whether the NHS is on track to meet the £20 billion efficiency savings target (two thirds think the NHS will not) and continuing uncertainty about whether the NHS reform programme is helping or not (two thirds of respondents, this year and last, do not agree that reform is 'essential' to meeting the efficiency targets).
And there is near unanimity (93 per cent agreeing or strongly agreeing) that austerity and efficiency targets are going to last for another decade.
There have been no radical shifts in opinion about the likely efficacy of clinical commissioners to outperform primary care trusts (the doubters slightly outnumber the enthusiasts) or whether clinical commissioning groups will break down barriers between primary and secondary care (there is a real spread of confidence here).
There has also been a drop in enthusiasm for the potential of competition to drive quality and efficiency in the NHS: this year 41 per cent of respondents agreed with this, compared to 59 per cent in 2011.
Overall, our snapshot survey paints a picture of faltering confidence in the quality of NHS services and the capacity of reform to deliver change.
Follow our live streams and Twitter coverage from 7 March to see whether this mood is reflected in our debates and conversations on the day.
Thorlby R (2013) ‘Snapshot survey on the NHS: is confidence faltering?’. Nuffield Trust comment, 6 March 2013. https://www.nuffieldtrust.org.uk/news-item/snapshot-survey-on-the-nhs-is-confidence-faltering